MedWorm: Arterial Line

Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

Advances in Pharmacological Sciences — Mon, 23 Jan 2012 18:36:31 +0100

In this report, we present a case of acute compartment syndrome of the right forearm in a 78 years old male patient following repeated attempts to secure an arterial line for initiating the thrombolytic therapy for the management of massive pulmonary embolism. The patient underwent urgent surgical decompression of the forearm compartments and thus managed to save his limb. (Source: Advances in Pharmacological Sciences)

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Ability of the Masimo pulse CO-Oximeter to detect changes in hemoglobin

Journal of Clinical Monitoring and Computing — Tue, 17 Jan 2012 07:10:44 +0100

Abstract The decision to administer blood products is complex and multifactorial. Accurate assessment of the concentration of hemoglobin [Hgb] is a key component of this evaluation. Recently a noninvasive method of continuously measuring hemoglobin (SpHb) has become available with multi-wavelength Pulse CO-Oximetry. The accuracy of this device is well documented, but the trending ability of this monitor has not been previously described. Twenty patients undergoing major thoracic and lumbar spine surgery were recruited. All patients received radial arterial lines. On the contralateral index finger, a R1 25 sensor (Rev E) was applied and connected to a Radical-7 Pulse CO-Oximeter (both Masimo Corp, Irvine, CA). Blood samples were drawn intermittently at the anesthesia provid...

Establishing goals of volume management in critically ill patients with renal failure.

Journal of Nephrology — Wed, 11 Jan 2012 05:00:00 +0100

Conclusion: Physiologic variables assessing cardiac performance (SVI) and preload responsiveness (SVV) provide simple yet meaningful targets when one is determining the best approach for volume management in critically ill patients undergoing dialysis. PMID: 22241635 [PubMed - as supplied by publisher] (Source: Journal of Nephrology)

Multidisciplinary management of an obstetric patient with glycogen storage disease type 3

International Journal of Obstetric Anesthesia — Mon, 05 Dec 2011 05:00:00 +0100

Abstract: A 22-year-old primiparous woman with known glycogen storage disease type 3a presented to our hospital during her 12th week of pregnancy. Glycogen storage disease type 3 is a rare inherited disorder resulting from a deficiency of the glycogen debranching enzyme, causing the accumulation of abnormal short-chain glycogen in liver, blood cells, myocardium and striated muscle. Symptoms improve after puberty but the increased metabolism of pregnancy predisposes to hypoglycaemia, ketosis and lactic acidosis. Cardiomyopathy, distal weakness and peripheral neuropathy may present after the third decade. The patient was managed antenatally with regular cornflour feeds and was scheduled for elective caesarean delivery. She presented in early labour at 38weeks and delivered a healthy neonate ...

Off-pump coronary artery bypass grafting in a low-volume center.

The Heart Surgery Forum — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: The OPCAB technique is still evolving. Low-volume centers have higher rates of conversion to CPB. Hypotension due to an impaired left ventricular function can be successfully treated by using an IABP. Although blood loss can be managed with BTs, use of a cell saver helps to reduce the number of BTs. We conclude that our technique of total arterial OPCAB using a cell saver can be safely performed in a low-volume center. PMID: 22167759 [PubMed - in process] (Source: The Heart Surgery Forum)

Changing clinical practice of central line culture investigation in a Regional Intensive Care Unit: Category: Clinical lesson

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Neonates admitted to NICU often require insertion of a central venous or arterial line. Central venous lines (umbilical venous lines, PICC lines and broviac lines) allow for administration of high osmolarity fluids, in addition to various drug infusions, parental nutrition and emergency drug administration in neonates. All removed central line tips were sent for culture as part of routine practice to the Royal Victoria Hospital Microbiology Department. We conducted an audit in 2009, looking at whether central line tip cultures influenced the treatment and management of the neonates concerned. We repeated this audit in 2010 following recommendations from the 2009 audit, that central line tips should not be sent for routine culture in well neonates. However the line tip should be cultured in...

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Anesthetic management of vaginal delivery in a parturient with hemochromatosis induced end-organ failure

International Journal of Obstetric Anesthesia — Mon, 21 Nov 2011 05:00:00 +0100

Abstract: The vast majority of females affected by hemochromatosis are asymptomatic during childbearing years. We were able to provide effective obstetric anesthesia care to a 35-year-old woman with severe hemochromatosis. She had systolic heart failure with a left ventricular ejection fraction of 15%, severe pulmonary hypertension, mitral insufficiency, a history of ventricular tachycardia, cirrhosis, obstructive sleep apnea, gestational diabetes, and severe scoliosis. A multidisciplinary approach was used to stabilize her heart failure and prepare her for childbirth. An arterial line and epidural analgesic were placed before induction of labor. Vaginal delivery was accomplished with passive decent of the fetus and forceps assistance. We discuss hemochromatosis and its implications for th...

Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool?

Journal of Cardiothoracic Surgery — Sun, 20 Nov 2011 05:00:00 +0100

Antegrade selective cerebral perfusion in conjunction with hypothermia attenuate postoperative neurological injury, which in turn still remains the main cause of mortality and morbidity following aortic arch surgery. Hypothermic circulatory arrest however could be a useful tool during arch surgery, surgery for chronic thromboembolic disease, air on the arterial line during CPB, during cavotomy for extraction of renal cell carcinoma with level IV extension, or when dealing with difficult trauma to the SVC or IVC. Cerebral protective effects with hypothermic procedures including inhibition of neuron excitation, and discharge of excitable amino acids, and thereby, prevention of an increase in intercellular calcium ions, hyperoxidation of lipids in cell membranes, and free radical production.T...

A simple method of vascular access to perform emergency coronary angiography in patients with veno-arterial extracorporeal membrane oxygenation

Intensive Care Medicine — Wed, 12 Oct 2011 16:33:25 +0100

Conclusion Cardiac catheterization using a Y-shaped adapter introduced into the arterial ECMO cannula is feasible. In a resuscitation setting, a new puncture of the femoral artery always carries the risk of complications, wherefore this new technology can be regarded as fast alternative. Content Type Journal ArticleCategory Physiological and Technical NotesPages 1-4DOI 10.1007/s00134-011-2383-1Authors Dierk H. Endemann, Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyAlois Philipp, Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, GermanyChristian Hengstenberg, Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyAndreas Luchner, Department of Interna...

Ecthyma gangrenosum of a single limb

Indian Journal of Critical Care Medicine — Wed, 14 Sep 2011 04:00:00 +0100

We report a case of a previously healthy lady with no apparent immune deficiency or neutropenia who had ecthyma gangrenosum of left lower limb in which the arterial line was placed. (Source: Indian Journal of Critical Care Medicine)

Potassium values in cardiac arrest patients measured with a point-of-care blood gas analyzer

Resuscitation — Fri, 26 Aug 2011 04:00:00 +0100

Potassium has an important role in stabilizing cell membranes. Hyperkalaemia and hypokalaemia can cause life-threatening ventricular arrhythmias and even cardiac arrest. Accurate and rapid bedside identification of potassium disorders is therefore crucial. Measurement of arterial blood gases (ABGs) with electrolytes with point-of-care-testing (POCT) enables rapid potassium measurement. A small number of studies exist regarding the usefulness and reliability of electrolytes from POCT blood gas analyzers in the critical care setting. These studies show small differences between mean electrolyte values measured by POCT and central laboratory (CL) testing, but the limits of agreement are variable. In a study of patients receiving cardiopulmonary resuscitation (CPR), the limits of agreements be...

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[Relationship between PAO(2)/FIO(2) and SATO(2)/FIO(2) with mortality and duration of admission in critically ill children.]

Anales de Pediatria — Tue, 23 Aug 2011 23:00:00 +0100

CONCLUSIONS: PaO(2)/FiO(2) and SatO(2)/FiO(2) index are markers of severity in critically ill patients. In patients who do not have an arterial line, SatO(2)/FiO(2) index can be used for assessment of oxygenation as an indicator of severity in children in critical condition. PMID: 21871849 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Hemodynamic Evaluation of the Avalon Elite Bi‐Caval Dual Lumen Cannulae

Artificial Organs — Mon, 01 Aug 2011 04:00:00 +0100

AbstractIn previous studies, we have evaluated the hemodynamic properties of selected oxygenators, pumps (centrifugal and roller), and single lumen cannulae. Because the dual lumen cannulae are widely used in veno‐venous extracorporeal life support (ECLS) and are receiving popularity due to their advantages over the single lumen cannulae, we evaluated the flow ranges and pressure drops of three different sizes of Avalon Elite dual lumen cannulae (13Fr, 16Fr, and 19Fr) in a simulated neonatal ECLS circuit primed with human blood. The experimental ECLS circuit was composed of a RotaFlow centrifugal pump, a Capiox BabyRX05 oxygenator, 3 ft of 1/4‐in venous and arterial line tubing, an Avalon Elite dual lumen cannula, and a soft reservoir as a pseudo‐right atrium. All experiments were ...

Discrepancies between Arterial Oxygen Saturation and Functional Oxygen Saturation Measured with Pulse Oximetry in Very Preterm Infants.

Neonatology — Mon, 25 Jul 2011 23:00:00 +0100

Conclusion: SaO(2) was lower on average than SpO(2) with an increased bias at lower saturation. The -2.4 ± 9.2 95% limits of agreement for SaO(2) - SpO(2) in the 85-89% SpO(2) category suggest that SpO(2) and SaO(2) are not interchangeable and intermittent SaO(2) assessments are warranted when the targeted SpO(2) is within this range. PMID: 21791935 [PubMed - as supplied by publisher] (Source: Neonatology)

The Impact of Variation in Donation After Cardiac Death Policies Among Donor Hospitals: A Regional Analysis

American Journal of Transplantation — Mon, 11 Jul 2011 23:00:00 +0100

The Joint Commission requires all hospitals have a policy regarding donation after cardiac death. To this date however, a quantitative analysis of adult hospital donation after cardiac death (DCD) policies and its impact on transplantation outcomes has not been reported. Specific characteristics for DCD polices were identified from 90 of the 164 (54.9%) hospitals within the New England Organ Bank's donor service area. Forty‐five policies (50.0%) allow family members to be present during withdrawal of life‐sustaining therapy (WLST) whereas eight (8.9%) prohibit this. Seventeen policies (18.9%) require WLST to occur in the operating room (OR); 20 (22.2%) specify a location outside of the OR. Fifty‐six (62.2%) policies fail to state the method of determining death; however, some require...

Plasma pentraxin-3 as a marker of bioincompatibility in hemodialysis patients.

Journal of Nephrology — Tue, 21 Jun 2011 23:00:00 +0100

Conclusions: Our findings suggest that PTX3, which is rapidly produced by several cell types and released by neutrophils upon stimulation, could be a biomarker of HD-induced inflammation and of blood-membrane bioincompatibility. PMID: 21725917 [PubMed - as supplied by publisher] (Source: Journal of Nephrology)

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The Ability of Pulse Pressure Variations Obtained with CNAPTM Device to Predict Fluid Responsiveness in the Operating Room.

Anesthesia and Analgesia — Thu, 02 Jun 2011 23:00:00 +0100

Conclusions: A value of ΔPP(CNAP) >11% has a sensitivity of at least 62% in predicting preload-dependent responders to VE in mechanically ventilated patients during general anesthesia. PMID: 21642606 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Arterial line in prehospital emergency settings – A feasibility study in four physician-staffed emergency medical systems

Resuscitation — Sun, 29 May 2011 23:00:00 +0100

Conclusion: The insertion of arterial lines is feasible under prehospital conditions, without delaying or complicating patient care. Indications originating from intrahospital use are also valid in the field. In particular when combined with arterial blood gas measurement, the use of arterial lines often leads to important therapeutic consequences. (Source: Resuscitation)

Removal of uraemic retention solutes in standard bicarbonate haemodialysis and long-hour slow-flow bicarbonate haemodialysis

Nephrology Dialysis Transplantation — Thu, 31 Mar 2011 23:00:00 +0100

Conclusions. The present controlled study using a crossover design indicates that small and middle molecules are removed more adequately from the deeper compartments when performing a prolonged HD, even if blood and dialysate volumes are kept constant. Hence, factor time t is very important for these retention solutes. The kinetic behaviour of protein-bound solutes is completely different from that of small and middle molecules, mainly because of the strength of their protein binding. (Source: Nephrology Dialysis Transplantation)

Clinical evaluation of the air removal characteristics of an oxygenator with integrated arterial filter in a minimized extracorporeal circuit.

The International Journal of Artificial Organs — Thu, 31 Mar 2011 23:00:00 +0100

Authors: Stehouwer MC, Boers C, de Vroege R, C Kelder J, Yilmaz A, Bruins P The use of minimized extracorporeal circuits (MECC) in cardiac surgery is an important measure to increase the biocompatibility of cardiopulmonary bypass during coronary artery bypass grafting (CABG). These circuits eliminate volume storage reservoirs and bubble traps to minimize the circuit. However, the reduction in volume may increase the risk of gaseous microemboli (GME). The MECC system as used by our group consists of a venous bubble trap, centrifugal pump, and an oxygenator. To further reduce the risk of introducing GME, an oxygenator with an integrated arterial filter was developed based on the concept of minimal volume and foreign surface. We studied the air removal characteristics of this oxygenator w...

Non-invasive monitoring of central blood pressure by electrical impedance tomography: first experimental evidence

Medical and Biological Engineering and Computing — Tue, 15 Mar 2011 05:47:14 +0100

Abstract There is a strong clinical demand for devices allowing continuous non-invasive monitoring of central blood pressure (BP). In the state of the art a new family of techniques providing BP surrogates based on the measurement of the so-called pulse wave velocity (PWV) has been proposed, eliminating the need for inflation cuffs. PWV is defined as the velocity at which pressure pulses propagate along the arterial wall. However, no technique to assess PWV within central arteries in a fully unsupervised manner has been proposed so far. In this pilot study, we provide first experimental evidence that electrical impedance tomography (EIT) is capable of measuring pressure pulses directly within the descending aorta. To obtain a wide range of BP values, we administrated norad...

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New prototype of femoral arterial SmartCannula with anterograd and retrograde flow.

Perfusion — Mon, 21 Feb 2011 00:00:00 +0100

CONCLUSION: The modified self-expanding cannula exhibited superior distal arterial flow compared to the routinely used rectilinear shunt system. This has a potential to reduce ischemic events of the inferior extremity in prolonged perfusion. PMID: 21339246 [PubMed - as supplied by publisher] (Source: Perfusion)

Comparison of non-calibrated pulse-contour analysis with continuous thermodilution for cardiac output assessment in patients with induced hypothermia after cardiac arrest

Resuscitation — Thu, 03 Feb 2011 00:00:00 +0100

Conclusion: Induced hypothermia was not associated with increased bias or limits of agreement for the comparison of Vigileo and continuous thermodilution, but percentage error was high during normothermia and increased further during hypothermia. Less than 50% of clinically relevant CO changes during hypothermia were concordant. (Source: Resuscitation)

A nurse initiated arterial line insertion service: The implementation of a pilot program is supported by nursing and medical staff

Australian Critical Care — Tue, 01 Feb 2011 00:00:00 +0100

Introduction: Radial arterial lines are one of the most commonly performed procedures in our busy Intensive Care Unit. Due to demands on the registrar's time and their level of skill, successful insertion is not always achieved. A comprehensive education program to insert arterial lines was developed to provide an advanced practice for highly experienced registered nurses. It was envisioned that this skill would provide additional support to the medical team and increased satisfaction to nurses. (Source: Australian Critical Care)

Evaluation of shunting flow differences in varied conditions in a simulated adult CPB model during normothermia.

Perfusion — Mon, 31 Jan 2011 00:00:00 +0100

CONCLUSION: During different states of shunt opening, varying degrees of blood flow were diverted away from the arterial line. Shunting of blood flow may, therefore, result in hypoperfusion in the patient. PMID: 21282298 [PubMed - as supplied by publisher] (Source: Perfusion)

FDA: CombiSet Hemodialysis Blood Tubing Set Recalled

Modern Medicine — Mon, 24 Jan 2011 00:00:00 +0100

The U.S. Food and Drug Administration and Fresenius Medical Care North America have notified health care providers of a class 1 recall of CombiSet True Flow Series hemodialysis blood tubing sets with priming set and transducer protectors for use with a blood volume monitor, as the hemodialysis blood tubing set can develop kinking of the arterial line that may result in serious injury and/or death. (Source: Modern Medicine)

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Fresenius Medical Care North America, CombiSet True Flow Series Hemodialysis Blood Tubing Set with Priming Set and Transducer Protectors for Use with the Blood Volume Monitor: Class I Recall - Potential for Kinking of Arterial Line

FDA MedWatch — Fri, 21 Jan 2011 15:50:00 +0100

Kinking can cause the destruction of red blood cells which may result in serious injury and/or death. (Source: FDA MedWatch)

Class I Medical Device Recall: Fresenius Medical Care North America, CombiSet True Flow Series Hemodialysis Blood Tubing Set with Priming Set and Transducer Protectors for Use with the Blood Volume Monitor

Food and Drug Adminstration (FDA): CDRHNew — Thu, 20 Jan 2011 05:00:00 +0100

Reason for Recall: The hemodialysis blood tubing sets may develop kinking of the arterial line. Kinking can cause the destruction of red blood cells which may result in serious injury and/or death. (Source: Food and Drug Adminstration (FDA): CDRHNew)

The Acute Coagulopathy Of Trauma Is Due To Impaired Initial Thrombin Generation But Not Clot Formation Or Clot Strength

Journal of Surgical Research — Wed, 19 Jan 2011 20:26:56 +0100

Introduction: The Acute Coagulopathy of Trauma (ACOT) has been described as a very early hypocoagulable state, but the mechanism remains controversial. One proposed mechanism is tissue hypoperfusion leading to protein C activation, and subsequent inhibition of Factors V and VIII. Variability in acute trauma has impeded the use of clinical data towards the elucidation of the mechanisms of ACOT, but thromboelastography (TEG) may provide insight by assessing haemostatic function from initial thrombin activation to fibrinolysis. We hypothesized that, in a controlled animal model of trauma/hemorrhagic shock, clotting factor dysfunction is the predominant mechanism in early ACOT. Methods: Rats anesthetized by inhaled isoflurane (N=6) underwent laparotomy, and hemorrhage was induced to maintain a...

Accuracy of arterial pressure waveform analysis for cardiac output measurement in comparison with thermodilution methods in patients undergoing living donor liver transplantation

Journal of Anesthesia — Wed, 19 Jan 2011 09:30:28 +0100

Conclusion These data suggest that the accuracy of APCOv.3.0 has improved compared to APCOv.1.0 due to the updated algorithm, but additional improvements should be evaluated, especially in patients undergoing living donor liver transplantation with low systemic vascular resistance. Content Type Journal ArticlePages 1-6DOI 10.1007/s00540-010-1087-yAuthors Kozaburo Akiyoshi, Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanTadashi Kandabashi, Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanJunko Kaji, Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidas...

Evaluation of two pediatric polymethyl pentene membrane oxygenators with pulsatile and nonpulsatile perfusion.

Perfusion — Wed, 19 Jan 2011 00:00:00 +0100

CONCLUSIONS: Both the Quadrox-iD Pediatric and HILITE 2400LT PMP membrane oxygenators are suitable for pediatric ECLS therapy under both non-pulsatile and pulsatile perfusion. An optimized combination of flow rate and MAP should be achieved in order to deliver the maximal pulsatile energy in the extracorporeal circuit. PMID: 21247985 [PubMed - as supplied by publisher] (Source: Perfusion)

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Extracorporeal life support systems: alternate vs. conventional circuits.

Perfusion — Wed, 12 Jan 2011 00:00:00 +0100

Authors: Khan S, Vasavada R, Qiu F, Kunselman A, Undar A Emerging technologies and practices for pediatric and neonatal extracorporeal life support (ECLS) are promising. This experiment sought to compare the Medtronic 0800 silicon rubber membrane oxygenator to the Quadrox-iD Pediatric oxygenator in the conventional roller pump circuit, as well as comparing the conventional circuit to an alternative circuit. Three circuits were set up in the experiment. Two conventional roller pump circuits were used to compare the two oxygenators and an alternative circuit consisting of the Quadrox-iD Pediatric oxygenator and Maquet Rotaflow centrifugal pump system was used to identify differences between circuits. All three circuits were primed with Lactated Ringers' solution and human blood, with an ...

Evaluation of a radial artery cannulation training program for intensive care nurses: A descriptive, explorative study

Australian Critical Care — Fri, 07 Jan 2011 00:00:00 +0100

Conclusion: The findings showed that ICU nurses can safely insert radial arterial lines with improvements recommended. (Source: Australian Critical Care)

Neutropenia immediately after inducing general anesthesia

Journal of Critical Care — Wed, 01 Dec 2010 00:00:00 +0100

We report a case of isolated profound neutropenia following induction of general anesthesia. Management strategies are discussed. A 72-year-old, 97-kg woman with an incarcerated ventral hernia was scheduled for herniorrhaphy. She was on Coumadin as an outpatient secondary to previous pulmonary emboli. Admission laboratory results were as follows: white blood cell (WBC), 5500; hematocrit, 34%; platelets, 274 000, international normalized ratio, 2.2; and normal electrolyte and liver panels. A total of 6 units of fresh frozen plasma were given in the 24 hours prior surgery, and the international normalized ratio decreased to 1.7. Two more units were given while en route to the operating room, and the patient also received vitamin K (10 mg) and recombinant activated factor VIIa (Novo7, 1.5 m...

Pacemaker and internal cardioverter defibrillator lead extraction: a safe and effective surgical approach.

The Annals of Thoracic Surgery — Mon, 01 Nov 2010 00:00:00 +0100

CONCLUSIONS: A lead extraction protocol that included procedures done in an operating room environment allowing rapid, open intervention for bleeding, a varied choice of extraction tools, arterial line monitoring, transesophageal echocardiography, general anesthesia, and an experienced team yielded complete extraction in more than 90% of patients, with a low complication rate and no procedurally related deaths. PMID: 20971231 [PubMed - indexed for MEDLINE] (Source: The Annals of Thoracic Surgery)

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Dangers of rapid oxytocin administration in Eisenmenger’s Syndrome

International Journal of Obstetric Anesthesia — Mon, 01 Nov 2010 00:00:00 +0100

Rapid administration of oxytocin has been reported to cause decreased systemic vascular resistance (SVR), tachycardia and maternal death. A 29-year-old woman at 36weeks of gestation presented with increasing dyspnea. She reported a recent chest infection and a history of a patent ductus arteriosus (PDA) with Eisenmenger’s Syndrome (ES) diagnosed 2years previously. An echocardiogram demonstrated a large PDA with severe pulmonary hypertension, which was treated with inotropic support and diuretics. Hemoptysis accompanied by fetal distress four days after admission prompted emergency cesarean delivery. In the operating room, the patient was placed in a seated position due to her orthopnea; her baseline SpO2 recorded from a pulse oximeter on her right hand was 75% on facemask oxygen. An arte...

Respiratory Variation in Pulse Pressure and Plethysmographic Waveforms: Intraoperative Applicability in a North American Academic Center.

Anesthesia and Analgesia — Mon, 25 Oct 2010 23:00:00 +0100

Authors: Maguire S, Rinehart J, Vakharia S, Cannesson M Dynamic variables are the best predictors of fluid responsiveness in patients under general anesthesia and mechanical ventilation; namely, respiratory variations in pulse pressure and in the plethysmographic waveform. However, these variables have potential limitations. Our aim was to evaluate their intraoperative applicability. We extracted clinical data from all anesthesia procedures performed at our institution in 2009 and identified the number of cases that presented predetermined conditions of application. Among the 12,308 procedures, 39% met the criteria for the noninvasive monitoring of variations in the plethysmographic waveform of which 23% had arterial lines and met the criteria for the invasive monitoring of variations ...

Pacemaker and Internal Cardioverter Defibrillator Lead Extraction: A Safe and Effective Surgical Approach [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Thu, 21 Oct 2010 23:00:00 +0100

Conclusions A lead extraction protocol that included procedures done in an operating room environment allowing rapid, open intervention for bleeding, a varied choice of extraction tools, arterial line monitoring, transesophageal echocardiography, general anesthesia, and an experienced team yielded complete extraction in more than 90% of patients, with a low complication rate and no procedurally related deaths. (Source: The Annals of Thoracic Surgery)

Antireflux Action of Nissen Fundoplication and Stretch-Sensitive Mechanism of Lower Esophageal Sphincter Relaxation

Gastroenterology — Mon, 18 Oct 2010 00:00:00 +0100

Conclusions: Fundoplication reduces LES relaxation by interfering with axial stretch on the LES. Based on this mechanism of the antireflux actions of fundoplication, it might be possible to design new surgical strategies to treat reflux disease and reduce complications of fundoplication surgery. (Source: Gastroenterology)

In reply

International Journal of Obstetric Anesthesia — Mon, 13 Sep 2010 23:00:00 +0100

I thank the authors for providing information that was not provided in the original publication. The purpose of the editorial was to highlight how the current developments in interventional radiology can influence the future management of women with placenta accreta. It is understandable that obstetricians prefer performing cesarean hysterectomy in conventional operating rooms. Likewise, interventional radiologists prefer performing placement of intra-arterial catheters and subsequent embolization in interventional radiology suites due to better quality of imaging. However, in the future, all specialists must muster skills and training to perform their part in novel surroundings. There is a learning curve for any new intervention and with time, the novel care becomes a routine. We have see...

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Utilization and reliability of base deficit as a surrogate for serum lactate in the peri-operative setting

BMC Anesthesiology — Wed, 08 Sep 2010 23:00:00 +0100

Conclusion: BD can often mislead the clinician as to the actual Lac. Lac can now be measured in the OR in real time. Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly. (Source: BMC Anesthesiology)

Persistence of muscle sympathetic nerve activity during vasovagal syncope

European Heart Journal — Sat, 14 Aug 2010 07:08:36 +0100

Conclusion Our data challenge the established view that the final trigger for human orthostatic vasovagal reactions is sympathetic nervous system inhibition. Efferent sympathetic nerve traffic to the skeletal muscle vasculature was nearly always maintained through the faint. This finding supports an alternative viewpoint, that vasodilator mechanisms underlie the blood pressure fall in VVS. (Source: European Heart Journal)

Double ECMO in severe ARDS: Report of an unique case and literature review.

Perfusion — Sun, 08 Aug 2010 23:00:00 +0100

We report on a 49-year-old male patient who suffered from severe herpes simplex (HSV) pneumonia after a fall-from-height injury, causing a circumscript type B aortic dissection. The subsequent occurrence of ARDS required a veno-venous ECMO circuit that was upgraded to a veno-arterial system due to further oxygenation deficits. Following continued respiratory deterioration, the ECMO system already in place had to be complemented by a second veno-arterial line. After the onset of recovery and because of a developing of a disseminated intravasal coagulation, the double ECMO circuit was replaced by a pumpless extracorporeal lung assist system (PECLA). The patient recovered completely under systemic virostatic therapy. PMID: 20696738 [PubMed - as supplied by publisher] (Source: Perfusion)

Use of a Carotid Artery for Arterial Cannulation: Side-Related Differences*

The Thoracic and Cardiovascular Surgeon — Tue, 03 Aug 2010 09:06:23 +0100

Thorac cardiovasc Surg 2010; 58: 276-279DOI: 10.1055/s-0029-1240979Abstract Cannulation of arch arteries (innominate, axillary or carotid) for arterial return during cardiopulmonary bypass is increasingly being used; however, the flow and pressure profile in the cannulated arteries remains unclear. The aim of this study was to evaluate the flow and pressure characteristics of arterial inflow through a carotid artery, especially with regard to operative and technical aspects, clinical outcomes, and side-related differences. Between January 2005 and April 2008, 200 consecutive patients underwent elective aortic arch surgery at our facility. One hundred patients were assigned to undergo cannulation of the left and another 100 to undergo cannulation of the right carotid artery. Both groups wer...

Noninvasive Arterial Blood Pressure Monitor and Possible Nerve Injury

Journal of Oral and Maxillofacial Surgery — Wed, 21 Jul 2010 05:43:34 +0100

I was interested in the recent article by Madsen et al regarding noninvasive hypotensive anesthesia monitoring. I saw this device used for the first time in our hospital a few months ago during an orthognathic procedure. Our practice performs a significant number of orthognathic cases every year at our local hospital, but on this day I was paired with an anesthesiologist with little experience with this surgery. After discussing the requirement of hypotensive anesthesia, the anesthesiologist preferred to place an arterial line. We discussed the case further and he elected to place a noninvasive continuous blood pressure monitor similar to what was presented in the article. The surgery consisted of a 3-piece Le Fort osteotomy and bilateral sagittal split osteotomy advancement. The noninvasi...

Arterial line for monitoring SpO2 in patients with ischemic peripheries

Journal of Clinical Monitoring and Computing — Fri, 16 Jul 2010 07:22:46 +0100

Abstract Monitoring the oxygenation status of patients with poor peripheral perfusion or ischemic peripheries is challenging in view of unreliable or unrecordable pulse oximeter data. In this article we describe a very simple and innovative technique of using the arterial line for reliable recording of arterial oxygen saturation (SpO2) in such patients. We conclude that the arterial line can be used as an extension of the artery and SpO2 may be reliably measured using the arterial line in such patients as long as the blood in the arterial tubing is pulsatile and a good contact is ensured between the arterial tubing and the sensor of the pulse oximeter. Content Type Journal ArticleDOI 10.1007/s10877-010-9245-1Authors Goneppanavar Umesh, Kasturba Medical College Departme...

An In Vitro comparison of the ability of three commonly used pediatric cardiopulmonary bypass circuits to filter gaseous microemboli.

Perfusion — Sun, 20 Jun 2010 23:00:00 +0100

Conclusions: The combination of the Baby RX-05 oxygenator and Capiox AF02 arterial line filter provides the highest level of protection from air emboli in an in vitro investigation. PMID: 20566585 [PubMed - as supplied by publisher] (Source: Perfusion)

Continuous non-invasive arterial pressure measurement: Evaluation of CNAP device during vascular surgery.

Annales Francaises d'Anesthesie et de Reanimation — Thu, 10 Jun 2010 23:00:00 +0100

CONCLUSION: Despite low accuracy for SAP and DAP measurements, CNAP system seems more accurate for MAP measurement in patients undergoing vascular surgery. PMID: 20542405 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

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Unilateral cerebral perfusion: right versus left [Original articles]

European Journal of Cardio-Thoracic Surgery — Tue, 01 Jun 2010 15:22:06 +0100

Conclusion: Unilateral cerebral perfusion under mild hypothermia is an efficient method of cerebral protection. The advantage of the right-sided perfusion in which two brain-supplying arteries are perfused could not be verified. (Source: European Journal of Cardio-Thoracic Surgery)

Extracorporeal bubbles: a word of caution [Negative results - Cardiopulmonary bypass]

Interactive CardioVascular and Thoracic Surgery — Mon, 17 May 2010 15:40:07 +0100

Conclusions: Both the EDAC and Gampt can be used in a clinical setting for monitoring basal GME production. However, both devices have some major limitations when used for studying ‘worst case’ scenarios. One should take great caution when correlating measured data with neurocognitive outcome. Finally, results obtained by one device in a first study cannot be compared nor exchanged with results from the other device in a second study. (Source: Interactive CardioVascular and Thoracic Surgery)

Cardiopulmonary bypass simulation at the Boot Camp

The Journal of Thoracic and Cardiovascular Surgery — Mon, 10 May 2010 00:00:00 +0100

Conclusions: This Boot Camp session introduced residents early in their training to aortic cannulation, principles and management of cardiopulmonary bypass, and crisis management. Based on a modular approach, technical skills and knowledge of cardiopulmonary bypass can be acquired and assessed by using simulations, but further work with more comprehensive educational modules and practice will accelerate the path to mastery of these critical skills. (Source: The Journal of Thoracic and Cardiovascular Surgery)

From arteritis to mycotic aneurysm: visualization of the progression of mycotic aneurysm development following femoral arterial line insertion in an infant

Pediatric Radiology — Sat, 01 May 2010 06:53:22 +0100

We describe the sonographic detection of an early stage mycotic aneurysm in a 4-month-old following femoral artery catheterization complicated by methicillin-resistant Staphylococcus aureus (MRSA) septicemia. We also describe the sonographic and radiographic progression of this mycotic aneurysm before surgery. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00247-010-1649-zAuthors Nira Beck-Razi, Israel Institute of Technology Department of Medical Imaging, The Rappaport Faculty of Medicine, Technion Haifa IsraelGad Bar-Joseph, Israel Institute of Technology Pediatric Critical Care Unit, The Rappaport Faculty of Medicine, Technion Haifa IsraelAmos Ofer, Israel Institute of Technology Department of Medical Imaging, The Rappaport Faculty of Medicine, Technion Haifa Israe...

Toward a new approach for the detection of pain in adult patients undergoing cardiac surgery: Near-infrared spectroscopy—A pilot study

Heart and Lung — Mon, 26 Apr 2010 00:00:00 +0100

Conclusions: Although further research is needed in critically ill adult patients undergoing more painful procedures, the NIRS may become a promising technique for assessing pain. (Source: Heart and Lung)

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Anesthesia 2.0: Web 2.0 in anesthesia education

Clinical Cases and Images — Wed, 31 Mar 2010 13:30:00 +0100

Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education.Web 2.0 technologies include:- microblogging- blogs- really simple syndication (RSS) feeds- podcasts- wikis- social bookmarking and networkingAlthough direct practice and observation in the operating room are essential, Web 2.0 technologies hold promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed.Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.References:Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in ane...

Tight control of effectiveness of cardiac massage with invasive blood pressure monitoring during cardiopulmonary resuscitation

The American Journal of Emergency Medicine — Fri, 26 Mar 2010 00:00:00 +0100

The continuity of chest compression is the main challenge in prehospital cardiopulmonary resuscitation in the field as well as during transport. Invasive blood pressure monitoring with visible pulse waves by means of an arterial line set prehospitally allows for tight control of the effectiveness of chest compressions as well as of the impact of the administered epinephrine and also captures beginning fatigue of the rescuers. In this case, maintaining uninterrupted circulation through manual as well as mechanical chest compressions continued until the successful percutaneous coronary intervention saved the patients life without neurologic damage. (Source: The American Journal of Emergency Medicine)

New technique: Norwood operation with regional cerebral and coronary perfusion

Revista Brasileira de Cirurgia Cardiovascular — Fri, 19 Mar 2010 17:46:08 +0100

CONCLUSIONS: The modified Norwood procedure can be accomplished with ARCeP and RRCoP in children with HLHS with HA with satisfactory immediate surgical result and without neurological complications. (Source: Revista Brasileira de Cirurgia Cardiovascular)

Sildenafil exposure in neonates with pulmonary hypertension after administration via a nasogastric tube

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 15 Mar 2010 11:33:26 +0100

Conclusions SIL pharmacokinetics are highly variable in post-ECMO neonates and infants. In a median patient, the current dose regimen of 0.5–2.0 mg/kg four times a day leads to an exposure comparable to the recommended adult dose of 20 mg four times a day. Careful dose titration, based on efficacy and the occurrence of hypotension, remains necessary. Follow-up research should include appropriate pharmacodynamic endpoints, with a population pharmacokinetic/pharmacodynamic analysis to assign a suitable exposure window or target concentration. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Reducing the risk of fatal and disabling hypoglycaemia: a comparison of arterial blood sampling systems

British Journal of Anaesthesia — Fri, 12 Mar 2010 16:46:21 +0100

Conclusions Recommended minimal discard volumes are inadequate in the presence of glucose as the flush solution and can lead to high blood glucose readings, inappropriate insulin use, and iatrogenic neuroglycopaenia. Our study demonstrates that the closed-loop arterial sampling system could be the universal solution sought by the NPSA. (Source: British Journal of Anaesthesia)

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Hypotensive Anesthesia Monitoring Using a Noninvasive Arterial Line During Orthognathic Surgery

Journal of Oral and Maxillofacial Surgery — Tue, 23 Feb 2010 14:21:45 +0100

Hypotensive anesthesia has a 3-fold benefit during orthognathic surgery. First, it has been well-documented that there is decreased blood loss. Second, less blood improves the quality of the surgical field; and third, improved visualization decreases the duration of procedure. To achieve a hypotensive state, the anesthesiologist must ensure an appropriate patient preoperative evaluation, proper positioning, and monitoring during the surgery, and adequate fluid therapy in patients undergoing induced hypotension during orthognathic surgery. (Source: Journal of Oral and Maxillofacial Surgery)

A Phase III, Randomized, Double-Blind, Placebo-Controlled Study of Tenecteplase for Improvement of Hemodialysis Catheter Function: TROPICS 3.

Clinical Journal of the American Society of Nephrology : CJASN — Thu, 04 Feb 2010 00:00:00 +0100

CONCLUSIONS: Tenecteplase improved HD catheter function and had a favorable safety profile compared with placebo. PMID: 20133491 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)

Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: a 10-year retrospective review.

Hong Kong Med J — Mon, 01 Feb 2010 00:00:00 +0100

CONCLUSION. Postpartum haemorrhage and pregnancy-associated hypertension were the most common causes of admission to our Intensive Care Unit. Overall mortality was low. Long-term health-related quality of life in discharged patients was lower than the norm of the Hong Kong population. Appropriate antenatal care is important in preventing obstetric complications. Continued psychosocial follow-up of discharged patients has to be implemented. PMID: 20124569 [PubMed - in process] (Source: Hong Kong Med J)

Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding.

Chinese Journal of Traumatology — Sat, 30 Jan 2010 20:20:24 +0100

Conclusions: Low Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH (larger than 100 pg/ml) are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality. PMID: 20109364 [PubMed - in process] (Source: Chinese Journal of Traumatology)

Ultrasound-guided arterial line catheterization in the critically ill: Technique and review.

The Journal of Vascular Access — Tue, 29 Dec 2009 00:00:00 +0100

Authors: Hofmann LJ, Reha JL, Hetz SP Arterial line catheterization in the critically ill patient is often an arduous task. Here we identify risk factors in the critical care patient that may predict a more difficult arterial catheter insertion. We also describe our ultrasound technique and review of the literature with regard to location of access, complications, and the use of ultrasound guidance. PMID: 20119907 [PubMed - as supplied by publisher] (Source: The Journal of Vascular Access)

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Agreement between Central Venous and Arterial Blood Gas Measurements in the Intensive Care Unit.

Clinical Journal of the American Society of Nephrology : CJASN — Thu, 17 Dec 2009 00:00:00 +0100

CONCLUSIONS: Peripheral or central venous pH, Pco(2), and bicarbonate can replace their arterial equivalents in many clinical contexts encountered in the ICU. PMID: 20019117 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)

Variations in arterial blood pressure are associated with parallel changes in FlowTrac/Vigileo(R) - derived cardiac output measurements: a prospective comparison study

BioMed Central — Mon, 09 Nov 2009 00:00:00 +0100

Conclusions: Acute variations in arterial blood pressure alter the reliability of the Flowtrac/Vigileo(R) device with the second-generation software. This finding may help to explain the variable results of studies comparing the FTV system with other cardiac output monitoring techniques, questions the usefulness of this device for hemodynamic monitoring of patients undergoing rapid changes in arterial blood pressure, and should be kept in mind when using vasopressors during FTV-guided hemodynamic optimization. (Source: BioMed Central)

Comparison of continuous arterial pressure waveform analysis with the lithium dilution technique to monitor cardiac output in conscious dogs with systemic inflammatory response syndrome.

American Journal of Veterinary Research — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions and Clinical Relevance-Agreement between the PulseCO and LiDCO methods for measurement of CO was not acceptable at 4- and 8-hour intervals after calibration in conscious dogs with naturally occurring SIRS. PMID: 19878019 [PubMed - in process] (Source: American Journal of Veterinary Research)

Hemodynamics after intraosseous administration of hydroxocobalamin or normal saline in a goat model

The American Journal of Emergency Medicine — Sun, 01 Nov 2009 00:00:00 +0100

Conclusion: Hemodynamic effects of OHCo given by the IO route in non–CN-poisoned goats are mild and well tolerated. Increases in mean blood pressure at peak after baseline were greater in the NS group, but the mean values over time were not significantly different from those observed in the OHCo group. Hemodynamic effects would likely differ somewhat in a CN-poisoned goat. Intraosseous OHCo administration warrants additional investigation. (Source: The American Journal of Emergency Medicine)

An unusual arterial line complication.

The American Surgeon — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Nebel C, Kulwicki A, Muck P PMID: 19927527 [PubMed - in process] (Source: The American Surgeon)

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Does CO2 flushing of the empty CPB circuit decrease the number of gaseous emboli in the prime?

Perfusion — Wed, 28 Oct 2009 00:00:00 +0100

In conclusion, CO2 flushing of the empty circuit decreases the number of gaseous emboli in the prime compared with a conventional circuit that contains air before being primed with fluid. Knocking of the oxygenator releases gaseous emboli and the duration of re-circulating the circuit with prime influences the number of microemboli. PMID: 19864467 [PubMed - as supplied by publisher] (Source: Perfusion)

Acute Limb Ischemia Caused by Femoral Arterial Line Induces Remote Liver Injury in a Rabbit Model of Liver Ischemia/Reperfusion Injury

Angiology — Thu, 22 Oct 2009 08:29:10 +0100

In conclusion, femoral artery cannulation induces remote liver injury. The use of femoral arterial lines should be avoided in experimental studies concerning liver function. (Source: Angiology)

Acute Lung Injury May Be Missed in Kids on Ventilation

Medscape Critical Care Headlines — Mon, 21 Sep 2009 15:56:55 +0100

Given that arterial lines are used less frequently in pediatric ICUs these days, the criteria for diagnosis of acute lung injury are less often available, making it difficult to conduct randomized controlled trials of therapies in children with this condition. Reuters Health Information (Source: Medscape Critical Care Headlines)

Improving Straight Needle Safety: An Alternate Method

The Journal of Emergency Medicine — Thu, 17 Sep 2009 23:00:00 +0100

Many pre-packaged, commercially available central venous catheter and arterial line sets come with a straight needle for suturing the line in place. The straight needle requires using the free hand to stabilize the skin, placing the user at risk for a percutaneous injury (). This was recently addressed in the Journal of Emergency Medicine by Nelson, who recommended using the cap from an 18G needle as a “thimble” (). We have attempted this on several occasions and have found that the needle can still come perilously close to the free-hand fingers. We successfully used a syringe with the plunger removed as a thimble (). The 5-mL syringe included in a central venous catheter kit or a tuberculine syringe with a removable needle may be used as a thimble. These longer syringes keep the finge...

Peripartum anesthetic management of patients with aortic valve stenosis: a retrospective study and literature review

International Journal of Obstetric Anesthesia — Thu, 03 Sep 2009 23:00:00 +0100

Conclusions: Carefully titrated regional analgesia is usually well tolerated in patients undergoing vaginal or cesarean delivery even in the presence of severe aortic stenosis. Standard monitoring is usually adequate for vaginal delivery, but invasive monitoring may facilitate management in some patients. An arterial line allows close monitoring of systemic blood pressure. Facilities for close 24-48-h post-partum observation should be available. A multidisciplinary approach is needed. (Source: International Journal of Obstetric Anesthesia)

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Catecholamine Interference in Enzymatic Creatinine Assays [Brief Communications]

Clinical Chemistry — Thu, 27 Aug 2009 23:00:00 +0100

Conclusions: Negative interferences were pronounced for Roche enzymatic results in blood samples obtained from indwelling catheters, a phenomenon not observed in peripheral draws. Physicians and laboratorians should be alert to the possibility of a falsely low creatinine result and reevaluate questionable samples using a method unaffected by catecholamines. (Source: Clinical Chemistry)

A False Alarm

The American Journal of Medicine — Fri, 21 Aug 2009 10:35:54 +0100

A 61-year-old man's surgery was suddenly preempted by an apparent myocardial infarction. He had been admitted for elective surgical resection of esophageal adenocarcinoma. In the operating room, he complained of sudden chest tightness, sweating, and difficulty breathing. This occurred after the placement of central venous and arterial lines but before the administration of preanesthetic or anesthetic medications. His past medical history was remarkable only for anxiety disorder and hypertension, and he reported no prior angina or other cardiac symptoms. He did not smoke or use recreational drugs, and his family history was unremarkable. The preoperative workup, which included an electrocardiogram (ECG), pulmonary function test, and dobutamine stress echocardiogram, was normal. (Source: The...

Dynamic filling index: a novel parameter to monitor circulatory filling during minimized extracorporeal bypass [Original articles]

European Journal of Cardio-Thoracic Surgery — Wed, 29 Jul 2009 23:00:00 +0100

Conclusion: The dynamic filling index can detect small changes in venous return and drainable volume which remain unrevealed by routinely recorded parameters. This index could be a valuable tool to monitor and control circulatory filling in individual patients supported by minimized extracorporeal bypass. (Source: European Journal of Cardio-Thoracic Surgery)

Transvenous Removal of an Entangled Central Venous Line Following Complex Cardiac Surgery

Pacing and Clinical Electrophysiology : PACE — Thu, 16 Jul 2009 23:00:00 +0100

The objective of this brief communication is to describe of a simple and safe removal method using a transvenous rotational cutting device to divide the hemostasis suture. In order to avoid complicating bleeding, a time delay between initial placement and removal is highly recommended. For extraction, a fully equipped cardiovascular operating room with central venous and arterial lines, attached defibrillator pads, transesophageal echo monitoring, fluoroscopy, and a surgical team, including a heart and lung machine and a perfusionist standby, is mandatory. (PACE 2009; 32:1099[ndash]1100) (Source: Pacing and Clinical Electrophysiology : PACE)

Reply to Letter from Inglis and Price

The Journal of Emergency Medicine — Mon, 13 Jul 2009 00:00:00 +0100

We agree with the sentiments expressed by Drs. Inglis and Price; that acutely injured patients who are elderly warrant stabilization before inter-hospital transfer. Of course, what constitutes appropriate stabilization depends on the circumstances and the care setting. Especially if resources are limited at the referring facility, we interpret “stabilization” to mean diagnosis and initial management of life- or limb-threatening but treatable conditions. We therefore favor focusing on the high-yield maneuvers—establishing an airway, decompressing any hemo- or pneumothorax, applying pressure to compressible sites of external hemorrhage, and administering intravenous fluids—that comprise the primary and secondary surveys and adjunctive tests and imaging. To us, it does not make sense,...

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Haemodynamic effects of repeated doses of oxytocin during Caesarean delivery in healthy parturients

British Journal of Anaesthesia — Sun, 12 Jul 2009 23:00:00 +0100

Conclusions An initial bolus of oxytocin 5 u produced prominent haemodynamic changes, whereas a second bolus produced smaller changes. This could be due to desensitization of endothelial oxytocin receptors. (Source: British Journal of Anaesthesia)

Inhibition of HA Synthase 3 mRNA Expression, with a Phosphodiesterase 3 Inhibitor, Blocks Lung Injury in a Septic Ventilated Rat Model

Lung — Mon, 06 Jul 2009 17:06:12 +0100

Abstract Low-molecular-weight hyaluronan produced by hyaluronan synthase 3 (HAS3) has been shown to play a role in acute lung injury secondary to high-tidal-volume ventilation. Phosphodiesterase 3 inhibitors have been shown to decrease HAS3 expression. We hypothesized that low-molecular-weight hyaluronan (LMW HA) produced by HAS3 mediates LPS-induced lung injury in the mechanically ventilated rat and that milrinone (MIL), by blocking HAS3 mRNA expression, would prevent the injury. Rats were randomized to four groups: controls with mechanical ventilation at 7 cc/kg MV, MV+LPS, MV+MIL, and MV+LPS+MIL. Rats were intubated and ventilated without PEEP for 4 h. Lipopolysaccharide (LPS) (1 mg/kg) was infused into the arterial line 1 h prior to MV. MIL 10 ...

Axillary artery cannulation pitfalls

The Journal of Thoracic and Cardiovascular Surgery — Tue, 30 Jun 2009 23:00:00 +0100

We present another possible drawback of axillary artery cannulation. A 69-year-old woman was admitted to the Department of Cardiac Surgery for a type A acute aortic dissection involving the innominate artery. After the usual cannulation of the right axillary artery, with a prosthetic side graft, and the right atrium, cardiopulmonary bypass (CPB) was established with no perfusion problems. At 26°C core temperature, CPB was arrested and the aorta was opened longitudinally. The entry tear was located in the ascending aorta. The innominate artery was clamped, and brain perfusion was begun through the axillary artery cannulation. The dissected aorta was excised, and a 30-mm prosthetic vascular graft was sutured to the distal aortic stump, just proximal to the innominate artery. The vascular gr...

[Interstitial lung disease] Exercise peripheral oxygen saturation (Spo2) accurately reflects arterial oxygen saturation (Sao2) and predicts mortality in systemic sclerosis

Thorax — Thu, 25 Jun 2009 23:00:00 +0100

Conclusion: In patients with SSc-ILD, Spo2 is an adequate reflection of Sao2 and radial arterial lines need not be inserted during cardiopulmonary exercise tests in these patients. Given the ease of measurement and its prognostic value, Spo2 should be considered as a meaningful clinical and research outcome in patients with SSc-ILD. (Source: Thorax)

Continuous cardiac index monitoring: A prospective observational study of agreement between a pulmonary artery catheter and a calibrated minimally invasive technique

Resuscitation — Wed, 10 Jun 2009 23:00:00 +0100

Conclusions: This calibrated minimally invasive (i.e. radial arterial line and peripheral IV) technique demonstrated low bias compared with CCI measured by PAC. However, the relatively wide confidence limits indicate that differences in the two measurements could still be clinically significant. (Source: Resuscitation)

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An Evidence Based Study on the Minimum Volume of Blood Wastage from Arterial Lines

Journal of PeriAnesthesia Nursing — Mon, 01 Jun 2009 04:00:00 +0100

Frequent laboratory testing, convenience of arterial catheters and inconsistent practices contribute to blood loss in postoperative patients. EBP Question: What is the minimum discard volume required when drawing blood from arterial lines? (Source: Journal of PeriAnesthesia Nursing)

[Institutional report - Cardiopulmonary bypass] Circulating particles during cardiac surgery

Interactive CardioVascular and Thoracic Surgery — Mon, 20 Apr 2009 04:00:00 +0100

Shed blood is known to be a source of lipid micro-emboli in cardiac surgery. The aim of this study was to characterize the occurrence of these particles at different stages of the operation, and to study their occurrence in the circulation at multiple time-points after the retransfusion of shed blood. Forty-four patients undergoing routine surgery with cardiopulmonary bypass were included. Blood was sampled from the surgical field at different sampling locations during the operation. Shed blood was collected in a transfusion bag and retransfused. After which, blood was sampled from the arterial line of the heart-lung machine. A Coulter counter was used for particle determinion. The mean volume of shed blood collected was 340±215 ml. Particles in the size range 10–60 ...

Circulating particles during cardiac surgery [Institutional report - Cardiopulmonary bypass]

Interactive CardioVascular and Thoracic Surgery — Sun, 19 Apr 2009 23:00:00 +0100

Preoperative oral pentoxifylline for management of cytokine reactions in cardiac surgery.

The Heart Surgery Forum — Tue, 31 Mar 2009 23:00:00 +0100

CONCLUSIONS: We conclude that pretreatment with oral pentoxifylline before cardiac surgery inhibits proinflammatory cytokine release caused by cardiopulmonary bypass and has some beneficial effects in protecting the myocardium during the cardioplegic arrest period in open-heart surgery, without affecting postoperative hemodynamics. PMID: 19383582 [PubMed - in process] (Source: The Heart Surgery Forum)

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Emergency Department Control of Blood Pressure in Intracerebral Hemorrhage

The Journal of Emergency Medicine — Mon, 16 Mar 2009 04:00:00 +0100

Conclusions: Adopting a protocol to reduce and maintain the MAP to a target of 100–110 mm Hg within 120 min of ED arrival was safe and well tolerated in patients presenting with spontaneous ICH. If future trials demonstrate a clinical benefit of early BP control in spontaneous ICH, EDs should implement similar protocols. (Source: The Journal of Emergency Medicine)

Predictors of hemodynamic compromise with propofol during defibrillator implantation: a single center experience

Journal of Interventional Cardiac Electrophysiology — Thu, 05 Mar 2009 12:19:11 +0100

Conclusions Hypotension is a common occurrence during defibrillator implantation under conscious sedation. Risk factors for significant hypotension include: higher NYHA class, lower left ventricular ejection fraction, lower creatinine clearance, higher doses of propofol and longer procedure times. Content Type Journal ArticleDOI 10.1007/s10840-008-9355-6Authors Khyati Pandya, Michigan State University Thoracic and Cardiovascular Institute, Sparrow Health System 405 West Greenlawn, Suite 400 Lansing MI 48910 USAMehul B. Patel, Michigan State University Thoracic and Cardiovascular Institute, Sparrow Health System 405 West Greenlawn, Suite 400 Lansing MI 48910 USAJaya Natla, Michigan State University Thoracic and Cardiovascular Institute, Sparrow Health System 405 West G...

[Original articles] Association of IL6 and IL10 with renal dysfunction and the use of haemofiltration during cardiopulmonary bypass

European Journal of Cardio-Thoracic Surgery — Wed, 04 Mar 2009 05:00:00 +0100

Conclusions: Haemofilter use during cardiopulmonary bypass does not have a protective effect on postoperative kidney function. Haemofilter has no effect on the level of IL6 and IL10. (Source: European Journal of Cardio-Thoracic Surgery)

Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation.

Acta Cirurgica Brasileira — Sun, 01 Mar 2009 00:00:00 +0100

CONCLUSION: The deleterious hemodynamic alterations observed are probably related with the association of severe acidosis, hyperlactemia, hypoglycemia, and reduction of total circulating blood volume. Close hemodynamic and metabolic monitoring should be provided during experimental MVTx in order to promote an increase in successful rates of this complex and challenging procedure. PMID: 19377786 [PubMed - in process] (Source: Acta Cirurgica Brasileira)

Evaluation of air handling in a new generation neonatal oxygenator with integral arterial filter.

Perfusion — Sun, 01 Mar 2009 00:00:00 +0100

We report on the first use of the Terumo((R)) CAPIOX((R)) FX05 (Baby-FX) oxygenator with integral arterial filter, prime volume 43 ml, evaluating performance and air-handling of six Baby-FX versus thirteen Baby-RX oxygenators. The Terumo Baby-FX primes and performs as easily as the Baby-RX series. A significant prime component in the neonatal CPB circuit can be the arterial line filter (ALF). Removal of the ALF may lead to significant reduction in prime volume, decreased exposure to foreign surfaces with subsequent reduction in inflammation, and potential elimination or reduction in blood product exposures. PMID: 19654153 [PubMed - in process] (Source: Perfusion)

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Arterial blood gas analysis: mplications for nursing.

Paediatric Nursing — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Lynch F Nurses caring for children need to be able to understand the investigations that contribute to holistic assessment of the child. Blood gas analysis is a common investigation in critical care settings but is also used during stabilisation or preparation for transfer to critical care of children who are acutely ill. In this article the indications for arterial blood gas analysis are discussed and patient groups that may benefit from this investigation identified. The basic science behind acid-base balance and its impact on homeostasis are described. A simple guide to interpreting arterial blood gas results and the principles surrounding care of a child's arterial line are also addressed. PMID: 19266784 [PubMed - in process] (Source: Paediatric Nursing)

Haemodialysis through a cellulose membrane induces dephosphorylation of CD11b and promotes leukocyte adhesion to endothelial cells.

Clinical and Investigative Medicine — Sat, 31 Jan 2009 15:28:06 +0100

Conclusion: Leukocyte activation during HD through a cellulose membrane occurs with decreases in CD11b phosphorylation. Activation also induces increases in CD11b expression associated with enhanced leukocyte adhesion to uremic endothelial cells. PMID: 19178879 [PubMed - in process] (Source: Clinical and Investigative Medicine)

Anesthesiologists Get Their Own iPhone App

Medgadget Anesthesiology — Tue, 20 Jan 2009 18:48:04 +0100

Last summer two anesthesiologists teamed up to create practical software applications that they themselves would find useful in the operating room. They recently released iAnesthesia:Case Logs, an iPhone app that does easy case log tracking for busy anesthesiologists. Features from the product page: Record a new anesthesia case log on the fly, even if you don't have a wireless connection (your iPhone will sync data to the CaseLogs server once it regains connectivity). Browse your Case Log History to quickly find a patient record and open the entry for easy editing (your anesthesia records are organized chronologically). Review totals on your iPhone to identify how many Arterial Lines, Fiberoptic Intubations, Trauma case, etc. you have performed. Work with a wide range of predefined data e...

Time series analysis of use patterns for common invasive technologies in critically ill patients

Journal of Critical Care — Mon, 19 Jan 2009 00:00:00 +0100

Conclusions: The use of invasive technologies in critically ill patients is changing and may have important implications for resource use, clinician education, and patient care. Initiatives should be considered for ensuring clinician competency during technology transitions. (Source: Journal of Critical Care)

A hybrid hierarchical decision support system for cardiac surgical intensive care patients. Part II. Clinical implementation and evaluation.

Artificial Intelligence in Medicine — Fri, 26 Dec 2008 05:00:00 +0100

Authors: Ross JJ, Denaï MA, Mahfouf M OBJECTIVE: Patients emerging from cardiac surgery can display varying degrees of cardiovascular instability arising from potentially complex, multi-factorial and interlinked causes. Stabilization and control of the cardiovascular system are currently managed by healthcare experts using experiential knowledge, and, in some centers, manually inputted decision pathway algorithms. This paper describes a clinical trial undertaken to determine the basic functioning of a clinical decision support system (CDSS) designed and constructed by the authors to facilitate the control of the major cardiovascular components in the early post-operative phase. Part II follows Part I's description of the software and simulation testing of the CDSS, and describes t...

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Leukocyte depletion during cardiac surgery with extracorporeal circulation in high risk patients

Inflammation Research — Thu, 25 Dec 2008 06:55:46 +0100

Conclusions: Interestingly, the activation of neutrophils was more pronounced in the LF group. The use of a leucocyte depleting filter was not advantageous for this patient cohort for clinical or biomedical endpoints. Content Type Journal ArticleDOI 10.1007/s00011-008-8031-8Authors F. Bakhtiary, Johann Wolfgang Goethe University Hospital Department of Thoracic & Cardiovascular Surgery 60596 Frankfurt/Main GermanyA. Moritz, Johann Wolfgang Goethe University Hospital Department of Thoracic & Cardiovascular Surgery 60596 Frankfurt/Main GermanyP. Kleine, Johann Wolfgang Goethe University Hospital Department of Thoracic & Cardiovascular Surgery 60596 Frankfurt/Main GermanyO. Dzemali, Johann Wolfgang Goethe University Hospital Department of Thoracic & Cardiovascular Surgery ...

Traumatic fracture of a central venous catheter resulting in potential migration of distal fragment: a case report

BioMed Central — Sun, 14 Dec 2008 05:00:00 +0100

We report a surgical retrieval of an indwelling portion of a traumatic rupture of the Central venous catheter following hair cutting by a confused patient secondary to Postoperative cognitive dysfunction. He had a dynamic compression screw for fixation of fractured neck of femur after previously failed surgical procedure. The second procedure was complicated with major blood loss, which required central venous and arterial line insertion for intra-operative and post-operative management. The patient was discharged to the ward following an uneventful stay on intensive care. While on the ward, he decided to trim his hair and in the process he inadvertently cut through the right internal jugular catheter. Complications and management resulting from embolisation of central line are reviewed. ...

Arterial Line Pressure control enhanced Extracorporeal Blood Flow prescription in Hemodialysis Patients

BMC Nephrology — Mon, 24 Nov 2008 05:00:00 +0100

Background: In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300-500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP). Methods: This prospective study included 72 patients with catheter Group 1 (G1), 1877 treatments and 35 arterio-venous (AV) fistulae Group 2 (G2), 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250mmHg. We measured ionic clearance (IK: mL/min), access recirculation, DALP (mmHg) and Qb (mL/min). Six prescription zones were identified: from an optimal A zone (Qb>400, DALP -200 to-250) to zones with lower Qb E (Qb (Source: BMC Nephrology)

World apheresis registry data from 2003 to 2007, the pediatric and adolescent side of the registry.

Transfusion and Apheresis Science — Thu, 13 Nov 2008 05:00:00 +0100

CONCLUSION: The paediatric data compared to the whole registry data set are showing that aphereses are performed as safe in paediatrics as in adults. Centres are mostly handling only a few cases younger than 21. Therefore more exchange of information and experience in paediatric apheresis is warranted. PMID: 19010084 [PubMed - as supplied by publisher] (Source: Transfusion and Apheresis Science)

New guidance issued following problems with infusions and sampling from arterial lines

Nursing in Critical Care — Sun, 19 Oct 2008 04:00:00 +0100

(Source: Nursing in Critical Care)

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Using consensus methods to develop clinical practice guidelines for intensive care: The Intensive Care Collaborative project.

Australian Critical Care — Mon, 13 Oct 2008 04:00:00 +0100

CONCLUSION: This project has demonstrated a method for guideline development that is robust, incorporating evidence from research and clinical expertise utilising an objective egalitarian framework. PMID: 18922699 [PubMed - as supplied by publisher] (Source: Australian Critical Care)

Coming to ICU Near You: Monitoring of In Vivo Drug Concentrations

Medgadget Anesthesiology — Thu, 18 Sep 2008 08:09:36 +0100

Cranfield University and Sphere Medical out of Cambridge, England are announcing a collaboration to build a real time drug monitoring system for point-of-care applications. From Sphere Medical: The medical profession is increasingly discovering that in critically ill patients more frequent monitoring of the patient condition results ultimately in improved patient care. The ability to monitor trends and quickly pick up changes in the condition of the patient is a powerful aid for the clinician. Moreover, being able to monitor important parameters, such as the blood concentration of certain therapeutic drugs, frequently and in real time, without increasing the workload and cost of therapy, is expected to result in new treatment regimes in intensive care medicine and may ultimately lead to ...

Central venous catheter-associated infections.

Best Practice and Research. Clinical Anaesthesiology — Mon, 01 Sep 2008 04:00:00 +0100

Authors: Zingg W, Cartier-Fässler V, Walder B Most patients in the hospital need vascular access: a peripheral venous line, a short-term non-cuffed central venous catheter (CVC), a long-term cuffed CVC, an implantable port or an arterial line. Such devices, although often indispensable and of benefit, may have the disadvantage of mechanical complications, local exit-site infections or catheter-associated bloodstream infections (CRBSI). Apart from peripheral venous lines, non-cuffed CVCs are the most frequent catheter type in hospitals. The risk for CRBSI of such catheters is high with an incidence density of 2 to 7 episodes per 1000 catheter-days depending on ward-type, institution and geographical region. This review describes the epidemiology, the frequency and the risk of CRBSI...

Arterial to endtidal carbon dioxide gradient during pediatric laparoscopic fundoplication.

Paediatric Anaesthesia — Tue, 19 Aug 2008 04:00:00 +0100

Conclusions: ETCO(2) may not accurately represent arterial values during laparoscopic fundoplication, especially in the infant when carbon dioxide insufflation is used. Consideration should be given to placing an arterial line for blood gas measurement in some patients. PMID: 18717807 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)

Problems with infusions and sampling from arterial lines

NHS Networks — Wed, 13 Aug 2008 09:54:49 +0100

The National Patient Safety Agency (NPSA) has issued a Rapid Response Report to healthcare professionals in the UK to offer guidance for arterial line use following reports of problems with infusions and sampling. From January 2005 to June 2008, the NPSA had reports of two deaths and 82 other incidents where the wrong infusion fluid was attached to the arterial line. A further 76 incidents, including one case of serious harm, related to faulty sampling technique. All of these incidents were reported to the National Reporting and Learning System (NRLS). Arterial lines are routinely used in critical care areas to obtain samples of arterial blood, to test for blood gases, glucose and electrolytes. Slow infusions of sodium chloride or heparinised saline are currently used to keep the a...

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[Special features of laparoscopic operations from an anesthesiologic viewpoint : A review.]

Der Anaesthesist — Wed, 30 Jul 2008 04:00:00 +0100

Authors: Meininger D, Byhahn C The value of laparoscopic procedures has increased over the last decade. Many patients undergoing laparoscopic surgery also have coexisting diseases. The hemodynamic effects of intraperitoneal carbon dioxide insufflation depend on the extent of intraperitoneal pressure, severity of preexisting cardiopulmonary diseases, volume state of the patient and alterations of acid-base balance due to a capnoperitoneum. In addition to endocrinologic reactions, patient positioning also affects hemodynamic parameters. In high risk patients extended cardiopulmonary monitoring with an arterial line and repeated blood gas analysis is recommended intraoperatively, in addition to assessment of end-expiratory CO(2). In this patient group the intra-abdominal pressure should b...

A regional citrate anticoagulation protocol for pre-dilutional CVVHDf: The 'Modified Alabama Protocol'

Australian Critical Care — Tue, 15 Jul 2008 04:00:00 +0100

CONCLUSION: This paper describes a practical protocol for the delivery of regional citrate anticoagulation for pre-dilutional CVVHDf. The protocol maintains the flexibility in dialysis/haemofiltration dose prescription and advises on the requirement for monitoring and necessary adjustments to prevent the development of metabolic disturbances. This may assist regional citrate to achieve wider acceptance as an alternative anticoagulation strategy for critically ill patients. PMID: 18635373 [PubMed - as supplied by publisher] (Source: Australian Critical Care)

A Comparison of Noninvasive Blood Pressure Measurement on the Wrist with Invasive Arterial Blood Pressure Monitoring in Patients Undergoing Bariatric Surgery

Obesity Surgery — Fri, 11 Jul 2008 07:22:05 +0100

Conclusion The Vasotrac was more comfortable than an oscillometric device. Although the average accuracy was good, individual mean Vasotrac and noninvasive blood pressure pressures often differed considerably from arterial values. These results suggest that the Vasotrac monitor should not be substituted for an arterial catheter in super-obese patients. Content Type Journal ArticleCategory Research ArticleDOI 10.1007/s11695-008-9607-7Authors Helmut Hager, Medical University of Vienna Department of Anesthesiology and General Intensive Care, Vienna General Hospital Waehringer Guertel 18-20 1180 Vienna AustriaGoutham Mandadi, Washington University Department of Anesthesiology St. Louis MO USADebra Pulley, Washington University Department of Anesthesiology St. Louis MO USA...

Imaging Alzheimer Pathology in Late-Life Depression With PET and Pittsburgh Compound-B

Alzheimer Disease and Associated Disorders — Tue, 01 Jul 2008 00:00:00 +0100

In this study, we used PiB-PET to evaluate whether amyloid is present in elders with treated major depression, many of whom have persistent cognitive impairment. We evaluated 9 subjects with remitted major depression [3M: 6F, mean (SD) age=71.8(5.7) y]. Seven of the 9 depressed subjects also met criteria for the diagnosis of MCI. PiB-PET data from healthy elders [n=8; mean (SD) age=71.5(3.0) y] were used for comparison. PET was acquired with arterial sampling and PiB retention was quantified using magnetic resonance imaging-guided cortical regions and graphical analysis of time-activity data; arterial line failure led to exclusion of 1 depressed subject. The data demonstrated variably elevated PiB retention. PiB retention in the 2 depressed subjects with normal cognitive ability was in the...

Class 4 Drug Alert (Caution in use): Enoxaparin Sodium (Clexane) pre-filled syringes - supply update and advice to prescribers on shortage of 150mg syringes and use in pregnancy

NeLM Headline News — Fri, 06 Jun 2008 00:00:00 +0100

Further to the drug alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA) on 24 April and 9 May concerning enoxaparin (Clexane®) pre-filled syringes contaminated with over-sulphated-chondroitin sulphate (OSCS), this class 4 drug alert provides an update on the supply situation and clinical advice. The following advice is given to prescribers (direct from source): • There is no evidence of any specific risks to pregnant women or the developing foetus from exposure to the levels of OSCS found in some enoxaparin batches. However, on a purely precautionary basis, the MHRA are recommending that, wherever possible, use of affected batches should be avoided in pregnant women (see letter from Sanofi Aventis for details of unaffected batches). • Prescribers sho...

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DRUG ALERT CLASS 4 (CAUTION IN USE) - ENOXAPARIN SODIUM (CLEXANE) PRE-FILLED SYRINGES - SUPPLY UPDATE & ADVICE TO PRESCRIBERS [NON URGENT (cascade within 48 hours)] - EL(08)A/05

NeLM/MHRA Drug Alerts — Fri, 06 Jun 2008 00:00:00 +0100

Supply update and advice to prescribers on shortage of 150mg syringes and use in pregnancy Further to the drug alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA) on 24 April and 9 May concerning enoxaparin (Clexane) pre-filled syringes contaminated with over-sulphated-chondroitin sulphate (OSCS), this provides an update on the supply situation and clinical advice. Advice to prescribers • There is no evidence of any specific risks to pregnant women or the developing foetus from exposure to the levels of OSCS found in some enoxaparin batches. However, on a purely precautionary basis, we are recommending that, wherever possible, use of affected batches should be avoided in pregnant women (see attached letter from Sanofi Aventis for details of unaffected batch...

Pharmacokinetics of levofloxacin after single and multiple oral doses in patients undergoing intermittent haemodialysis.

International Journal of Antimicrobial Agents — Tue, 03 Jun 2008 04:00:00 +0100

Authors: Tsaganos T, Kouki P, Digenis P, Giamarellou H, Giamarellos-Bourboulis EJ, Kanellakopoulou K The impact of intermittent haemodialysis (IHD) on the pharmacokinetics of levofloxacin after single and multiple oral doses of 500mg was assessed in 10 patients with end-stage renal failure on IHD. In the first phase of the study where a single dose was administered, IHD was initiated 90min after drug intake. In the second phase of the study where drug was administered daily for three consecutive days, IHD was started exactly after the first dose. Venous blood samples were collected at standard time intervals. Additional samples from the arterial and venous line of the fistula and from the dialysate were drawn at the first, second and fourth hour of the first IHD session. Levofloxacin c...

Neonatal Arterial Thrombosis at Birth: Case Report and Literature Review

American Journal of Perinatology — Thu, 29 May 2008 16:42:11 +0100

We present the case of a full-term infant noted to have marked left arm swelling at birth. Doppler ultrasound of the arm demonstrated a large thrombus in the left subclavian, axillary, and brachial arteries. He underwent left arm fasciotomy and anticoagulant therapy with good recovery. We present this case with a brief review of the literature.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

MHRA Drug Safety Bulletin features advice on contaminated enoxaparin (Clexane)

NeLM news - Cardiology — Tue, 06 May 2008 00:00:00 +0100

The MHRA Drug Safety Bulletin has featured reinforced advice for healthcare professionals with respect to the contamination of enoxaparin (Clexane®) with over-sulphated chondroitin sulphate (OSCS). The Bulletin makes the following recommendations (taken directly from source): • There is no evidence that the level of contamination with OSCS is associated with any increased risks to patients, and the Commission on Human Medicines has advised that product on the UK market can continue to be used to avoid severe supply shortages and subsequent risks to patients. • Purely as a precaution, healthcare professionals are advised not to administer Clexane via the intravenous and arterial line routes, and to be vigilant for any signs of severe allergic or hypotensive adverse reactions. •...

Reduced transfusion requirements with a closed cardiopulmonary bypass system.

The Journal of Cardiovascular Surgery — Thu, 01 May 2008 21:53:08 +0100

CONCLUSION: In patients with preoperative conditions predictive for the need of transfusions, the use of a closed cardiopulmonary bypass circuit can diminish the amount of transfused blood products. PMID: 18446123 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

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Regional citrate anticoagulation for hemodialysis: calcium-free vs. calcium containing dialysate - a randomized trial.

The International Journal of Artificial Organs — Thu, 01 May 2008 04:00:00 +0100

CONCLUSION: Citrate anticoagulation with Ca-1.25 dialysate resulted in significantly worse anticoagulation of dialyzer and venous bubble trap compared with Ca-free dialysate, despite higher citrate dose. PMID: 18609515 [PubMed - in process] (Source: The International Journal of Artificial Organs)

Cardiomegaly in a premature neonate after venous umbilical catheterization

European Journal of Pediatrics — Tue, 01 Apr 2008 07:01:32 +0100

We present a case of a newborn with pericardial effusion following umbilical venous catheterization. An extremely low birth weight infant was intubated for respiratory distress syndrome and had umbilical venous and arterial lines in place. Massive cardiomegaly was noted on the subsequent chest X-ray. Echocardiography revealed a large pericardial effusion without signs of tamponade. After removing the catheter, the effusion gradually resolved. While pericardial effusion is a well-known complication of percutaneous long central lines, only a few case reports have documented sudden cardiovascular compromise associated with umbilical venous catheters. Pericardial effusion may be asymptomatic and should be suspected in infants with central catheters and progressive cardiomegaly. The prom...

Management of a parturient with an acute exacerbation of idiopathic pulmonary haemosiderosis and posterior spinal instrumentation

British Journal of Anaesthesia — Tue, 22 Jan 2008 05:00:00 +0100

We describe the anaesthetic management of a parturient with a history of posterior spinal fusion presenting with an acute exacerbation of IPH necessitating vaginal delivery at 34 weeks gestation. We used a spinal catheter for labour analgesia and bilevel positive airway pressure (BIPAP) ventilation to improve oxygenation during labour. An arterial line sited to allow frequent arterial blood gas sampling also facilitated continuous cardiac output monitoring. The use of a carefully titrated neuraxial block for analgesia, in conjunction with BIPAP, was associated with minimal haemodynamic and respiratory compromise during labour in this patient. (Source: British Journal of Anaesthesia)

The effect of hypovolemic shock on pancreatic secretion

International Journal of Gastrointestinal Cancer — Thu, 03 Jan 2008 16:31:39 +0100

This report studies canine pancreatic secretion in a preparation of hypovolemic shock produced by controlled hemorrhage maintained for varying durations. Pancreatic secretion was collected by cannulation of the main pancreatic duct in anesthetized dogs. Secretin was administered by continuous intravenous (i.v.) infusion of 4 U/kg/h. Four 15-min samples of pancreatic juice were collected. Then the dogs were bled by arterial line withdrawing 25–30% of total blood volume or until the mean blood pressure dropped to about 60 mmHg. Blood was collected in heparinized containers for reinfusion. Blood samples for amylase and 15-min samples of pancreatic juice for volume, bicarbonate, and enzymes were obtained during hypovolemia as well as during and following restoration of the blood vol...

Use of a papaverine solution in peripheral arterial lines.

Neonatal Network — Tue, 01 Jan 2008 05:00:00 +0100

Authors: Bell SG PMID: 18232591 [PubMed - in process] (Source: Neonatal Network)

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Citrate anticoagulation protocol for slow extended hemodialysis with the Genius dialysis system in acute renal failure.

The International Journal of Artificial Organs — Tue, 01 Jan 2008 05:00:00 +0100

CONCLUSIONS: Slow extended Genius hemodialysis with citrate is well tolerated and offers a safe and effective alternative to systemic anticoagulation. PMID: 18286453 [PubMed - indexed for MEDLINE] (Source: The International Journal of Artificial Organs)

Lower Erythrocyte Glutathione Peroxidase Activity in Bronchopulmonary Dysplasia in the First Week of Neonatal Life.

Neonatology — Fri, 07 Dec 2007 05:00:00 +0100

Conclusions: Erythrocyte c-GPx may play an important role in the development of BPD. Lower c-GPx activity in early post-natal life might be a risk factor of BPD. Copyright (c) 2007 S. Karger AG, Basel. PMID: 18063869 [PubMed - as supplied by publisher] (Source: Neonatology)

A new mask designed for patients implanted with a nasogastric tube.

Medical Engineering and Physics — Mon, 12 Nov 2007 05:00:00 +0100

Authors: So EC, Chen YH, Wong KL, Poon PW, Huang BM Pulmonary ventilation of patients implanted with a nasogastric tube is often difficult for medical personnel, since air leakage through the facemask and nasogastric tube interface is inevitable. Here we designed and tested a special facemask to improve ventilation in these patients. Forty patients with ASA class I-II were randomly assigned to two groups (study and control, n=20 each patients/group). All patients received abdominal surgery with a nasogastric tube inserted before operation. Before induction arterial lines were set up under local anesthesia. Blood gas samples were taken before, during and 1min after endotracheal intubation. Haemodynamic data were obtained from the artery lines. Inspiratory and expiratory tidal volumes we...

Similarity between the suprasystolic wideband external pulse wave and the first derivative of the intra-arterial pulse wave

British Journal of Anaesthesia — Fri, 12 Oct 2007 04:00:00 +0100

Conclusions The suprasystolic WEP signals can be used to derive arterial pressure waves which, although not identical, track changes in the intra-arterial pulse wave induced by vasoactive drugs. (Source: British Journal of Anaesthesia)

Family-Member Presence During Interventions in the Intensive Care Unit: Perceptions of Pediatric Cardiac Intensive Care Providers

PEDIATRICS — Mon, 01 Oct 2007 04:00:00 +0100

CONCLUSIONS. Most respondents, nonphysicians more than physicians, believe that family members have a right to be present during all ICU interventions. The majority of respondents encounter families that frequently request to be present for team rounds. However, the majority of respondents encounter families that rarely request to be present during invasive procedures and cardiopulmonary resuscitation. Most respondents believe family-member presence during cardiopulmonary resuscitation would not increase medicolegal concerns. (Source: PEDIATRICS)

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[Surgery for Congenital Heart Disease] Utility of intravenous catheters for femoral arterial cannulation in infants having complicated sternal re-entry

The Journal of Thoracic and Cardiovascular Surgery — Wed, 12 Sep 2007 04:00:00 +0100

Conclusions Peripheral arterial cannulation may be lifesaving in cases of complicated sternal re-entry in children. Intravenous catheters can be used when vessels are too small for standard cannulas. Flow rates that provide adequate support while maintaining acceptable arterial line pressures are achievable with peripheral intravenous catheters until central cannulation can be accomplished safely. (Source: The Journal of Thoracic and Cardiovascular Surgery)

The wrong arterial line flush solution

Anaesthesia — Thu, 06 Sep 2007 14:47:47 +0100

Anaesthesia Volume 62, Issue 10, Page 1077-1078, Oct 2007. (Source: Anaesthesia)

180 ml and less: cardiopulmonary bypass techniques to minimize hemodilution for neonates and small infants.

Perfusion — Sat, 01 Sep 2007 04:00:00 +0100

CONCLUSION: Decreasing the neonatal and small infant extracorporeal circuit prime volume by as little as 46 ml resulted in significantly fewer multiple exposures to exogenous PRBC units. PMID: 18416218 [PubMed - indexed for MEDLINE] (Source: Perfusion)

Prevention of primary bacteraemia.

International Journal of Antimicrobial Agents — Wed, 22 Aug 2007 04:00:00 +0100

Authors: Juan-Torres A, Harbarth S This overview provides information on recent advances in the prevention of primary bacteraemia, commonly defined as bloodstream infection without a documented source of infection, but including those resulting from an intravenous or arterial line infection. The potential to prevent community-acquired, primary bacteraemia is still limited and may be targeted mainly at vaccines for high-risk groups. In contrast, the prevention of catheter-related bacteraemia has seen substantial progress within the last 10 years. Consequently, intravascular device-related bacteraemia has become largely preventable under routine working conditions. Independent of the use of antibiotic-coated catheters, the implementation of clinical pathways and multimodal preventive str...

The potential of accurate SvO2 monitoring during venovenous extracorporeal membrane oxygenation: an in vitro model using ultrasound dilution.

Perfusion — Sun, 01 Jul 2007 04:00:00 +0100

DISCUSSION: There was a strong correlation between actual and calculated mixed venous saturations; however, significant differences between actual and calculated values where observed at the Med and High groups. While this data suggests that using quantified recirculation data to calculate SvO2 is promising, it appears that a straightforward derivative of the oxygen saturation-based equation may not be sufficient to produce clinically accurate calculations of actual mixed venous saturations. PMID: 18181511 [PubMed - indexed for MEDLINE] (Source: Perfusion)

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[ORIGINAL ARTICLES: CARDIOVASCULAR] Recombinant Factor Seven Therapy for Postoperative Bleeding in Neonatal and Pediatric Cardiac Surgery

The Annals of Thoracic Surgery — Wed, 27 Jun 2007 04:00:00 +0100

Conclusions The rFVIIa therapy seems to be an effective treatment for severe bleeding in postoperative pediatric cardiac surgery patients in the absence of surgical bleeding. It must be judiciously used in patients bleeding from multiple sites or having preexistent clots in the ECMO circuit to prevent major thrombotic complications. (Source: The Annals of Thoracic Surgery)

Recombinant factor seven therapy for postoperative bleeding in neonatal and pediatric cardiac surgery.

The Annals of Thoracic Surgery — Tue, 26 Jun 2007 18:10:51 +0100

CONCLUSIONS: The rFVIIa therapy seems to be an effective treatment for severe bleeding in postoperative pediatric cardiac surgery patients in the absence of surgical bleeding. It must be judiciously used in patients bleeding from multiple sites or having preexistent clots in the ECMO circuit to prevent major thrombotic complications. PMID: 17588404 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome

Intensive Care Medicine — Tue, 15 May 2007 21:22:36 +0100

Conclusions Prompt removal of lines and initiation of antifungal treatment are the milestones of management. Conventional amphotericin B remains a commonly used antifungal agent, but its lipid formulations and fluconazole are also used frequently. Novel antifungal agents such as second-generation triazoles and echinocandins exhibit potential as alternative agents in critically ill children with ICI. Although response rates are still far from satisfactory, improved understanding of risk factors, preventive strategies and new treatment options promise a better future outcome. Content TypeJournal Article JournalIntensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Body perfusion in surgery of the aortic arch.

Texas Heart Institute Journal — Mon, 16 Apr 2007 20:20:08 +0100

Authors: Nappi G, Maresca L, Torella M, Cotrufo M We propose a new cannulation and perfusion technique for aortic arch surgery, in order to achieve continuous antegrade total-body perfusion under moderate hypothermia.The heart and the aortic arch are exposed through a median sternotomy. Cardiopulmonary bypass is established from the right atrium to the right axillary artery. At 26 degrees C of body temperature, the supra-aortic vessels are clamped, the ascending aorta and the aortic arch are incised, and a cuffed endotracheal cannula, connected to an arterial line geared by a separate roller pump, is inserted into the descending thoracic aorta. Perfusion is started in the distal body, while the brain is perfused through the right axillary artery. Once the aortic arch has been replaced ...

Dual-lumen catheters for CVVH - limits for blood delivery via femoral vein access and a potential alternative in an experimental setting in anesthetized pigs

Critical Care — Thu, 15 Feb 2007 07:00:00 +0100

Conclusions: With respect to femoral vein approach, none of the commonly assumed reasons for limited Qa via the arterial line of an axial dual-lumen catheter could be confirmed. The 8.5 Fr-sheath, though not engineered for that issue, performed quite well used as alternative catheter. Thus, in patients lacking right jugular vein access with tip positioning of large Fr dual-lumen catheters in the right atrium, it would be interesting to obtain clinical data re-evaluating the dual-vein approach with separate blood delivery via a tip-hole catheter in order to provide high volume hemofiltration. (Source: Critical Care)

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Arteriovenous malformation management

CardioVascular and Interventional Radiology — Sat, 10 Feb 2007 11:29:57 +0100

Abstract??Arteriovenous malformations (AVM) are rare vascular lesions that can present with a myriad of clinical presentations. In our institutions, initial workup consists of a clinical exam, color Doppler imaging, and magnetic resonance imaging. After the initial nonivasive workup, arteriography, at times closed system venography, and ethanol endovascular repair of the AVM is performed under general anesthesia. Depending on the size of the lesion, additional Swan-Ganz line and arterial line monitoring are performed. Patients are usuallay observed overnight and uneventfully discharged the following day if no complication occurs. Patients are followed at periodic intervals despite cure of their lesion. Long-term follow-up is essential in AVM management. Content TypeJournal Article Jo...

Use of a wire-guided cannula for radial arterial cannulation

Journal of Anesthesia — Wed, 07 Feb 2007 07:55:20 +0100

In conclusion, we have confirmed that the success rates of radial arterial cannulation for patients whose physical status is relatively good were similar with the use of the WGC and the non-WGC. Content TypeJournal Article JournalJournal of AnesthesiaOnline ISSN 1438-8359Print ISSN 0913-8668 Journal VolumeVolume 21 Journal IssueVolume 21, Number 1 / February, 2007 (Source: Journal of Anesthesia)

[Reliability and survival of arterial catheter: optimal dynamic response.]

Annales Francaises d'Anesthesie et de Reanimation — Thu, 01 Feb 2007 07:00:00 +0100

CONCLUSION: The measure of the arterial blood pressure invasively can still be reliable for a long period of time (10 days), as long as the catheter is inserted, especially when the mean arterial pressure is considered. Each time the distance of the catheter insertion site moves away 1 cm from the radiocarpal joint or the groin, the risk of troubleshooting is doubled; on each blood sample from the catheter, this risk is reduced by 20%. PMID: 17166690 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Risk Factors Affecting In-hospital Mortality in Patients with Nosocomial Infections.

J Formos Med Assoc — Thu, 01 Feb 2007 05:00:00 +0100

Conclusion: Measures that prevent the occurrence of NI, such as improving the immunity status of the host, removal of catheters as soon as possible, and implementing an infection control program, could reduce the risk of in-hospital deaths attributable to NI. PMID: 17339154 [PubMed - in process] (Source: J Formos Med Assoc)

Correlation of mixed venous and central venous oxygen saturation and its relation to cardiac index

Indian Journal of Critical Care Medicine — Thu, 11 Jan 2007 03:15:02 +0100

Conclusion: Scvo 2 and Svo 2 are closely related and are interchangeable. Even though individual values differ trends in Scvo 2 may be substituted for trend in Svo 2 (Source: Indian Journal of Critical Care Medicine)

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Erythrocyte anti-oxyenzyme activity in preterm infants with retinopathy of prematurity.

Neonatology — Mon, 01 Jan 2007 05:00:00 +0100

CONCLUSIONS: Gestational age and birth weight, 1-min Apgar score, and glutathione peroxidase activity are risk factors for ROP. Defective glutathione peroxidase activity may contribute to the initial phase of ROP. PMID: 17596737 [PubMed - indexed for MEDLINE] (Source: Neonatology)

[Surgery for Acquired Cardiovascular Disease] Carotid artery cannulation in aortic surgery

The Journal of Thoracic and Cardiovascular Surgery — Thu, 07 Dec 2006 07:00:00 +0100

Conclusions Carotid artery cannulation is a fast, safe, and efficient method of arterial cannulation even in very obese patients. In addition, it simplifies the procedure of unilateral cerebral perfusion through the arterial line during circulatory arrest, making it completely unnecessary to interrupt cerebral perfusion. (Source: The Journal of Thoracic and Cardiovascular Surgery)

A Prospective Comparison of Ultrasound-guided and Blindly Placed Radial Arterial Catheters.

Accident and Emergency Nursing — Sun, 05 Nov 2006 00:11:02 +0100

Conclusions In this study, US guidance for arterial cannulation was successful more frequently and it took less time to establish the arterial line as compared with the palpation method. PMID: 17079789 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)

Venous line filtration: a novel technique for cases involving inferior vena caval and right atrial tumor and associated thrombus: a two-case series.

Perfusion — Wed, 01 Nov 2006 05:00:00 +0100

Authors: Smigla GR, Lawson DS, Kaemmer DD, Shearer IR Two patients are presented with right atrial tumors, who were considered to be at risk for tumor thrombus migration down the venous line into the cardiopulmonary bypass (CPB) circuit during surgical excision, which may lead to compromised or interrupted venous drainage. An arterial line filter was placed in the venous line to capture any material that might become dislodged and embolize into the circuit. Vacuum-assisted venous drainage, at approximately -50 mmHg, was used to overcome any resistance caused by the filter in the venous line. In one case, tumor thrombus obstructed the filter, requiring the use of the bypass line around the filter, so venous return could be maintained. In both cases, thrombus was found in the filter. The...