Correlation Between Blood Pressure Measurement by Non-invasive and Invasive Methods in Critically-ill Children

Objective: To determine the correlation of non-invasive blood pressure obtained byauscultatory and oscillometric methods, with invasive blood pressure in critically ill children.Methods: We compared invasive with auscultatory and oscillometric blood pressures usingpaired t-test, Pearson’s correlation coefficient and Bland-Altman plot in 50 children (age 1-12y) admitted in Pediatric intensive care unit. Results: Systolic, diastolic, and mean arterialpressures of invasive methods significantly correlated with auscultatory and oscillometricmethods (P<0.001). Auscultatory and oscillometric measurements under-estimated systolicarterial pressures [mean (SD) difference 5.4 (12.2) mmHg and 6.3 (14.0) mmHg,respectively; P<0.001] and overestimated diastolic arterial pressures [-4.1 (5.8) mmHg and-3.6 (7.2) mmHg; P<0.001] compared to invasive blood pressure. Conclusion: Mean arterialpressure obtained by NIBP measurement is more closer than systolic or diastolic pressures,when compared with invasive blood pressure measurement.

Clinical Observation of Paclitaxel Combined with Cisplatin and Fluorouracil for Gastric Cancer with Liver Metastases via Indwelling Hepatic Arterial Catheter / 中国药房

OBJECTIVE:To observe the efficacy and safety of paclitaxel combined with cisplatin and fluorouracil for gastric cancer with liver metastases via indwelling hepatic arterial catheter. METHODS:56 gastric cancer patients with liver metastases were randomly divided into control group(28 cases)and observation group(28 cases). Control group received Paclitaxel injection 135 mg/m2,d1+Cisplatin injection 75 mg/m2,d1+Fluorouracil injection 750 mg/m2,d1-5,pumping administrated via central venous. Ob-servation group received Paclitaxel injection 135 mg/m2,d1+Cisplatin injection 75 mg/m2,d1+Fluorouracil injection 750 mg/m2,d1-5, administrated via indwelling hepatic arterial catheter. 3-4 weeks were a course,it lasted 8 courses at most. Magnesium isoglycyrrhiz-inate injection 200 mg/d was intravenously infused for liver protection in 2 groups during treatment. Clinical efficacy,serum car-cinoembryonic antigen (CEA),alanine aminotransferase (ALT),aspartate aminotransferase (AST) levels before and after treat-ment,and the incidence of adverse reactions in 2 groups observed. RESULTS:Short-term clinical efficacy in observation group was significantly higher than control group,with statistical significance(P0.05). After treatment,CEA,ALT and AST levels in 2 groups were significantly high-er than before,ALT and AST levels in observation group were significantly higher than control group,while CEA level in observa-tion group was lower than control group,with statistical significances(P<0.05). The incidences of bone marrow suppression,nau-sea,vomiting and fever in observation group were significantly lower than control group,with statistical significances (P<0.05). CONCLUSIONS:Paclitaxel combined with cisplatin and fluorouracil has good efficacy for gastric cancer with liver metastases via indwelling hepatic arterial catheter,while it exists liver dysfunction.

The current understanding of arterial-catheter related bloodstream infection / 中华危重病急救医学

Catheter-related bloodstream infection (CRBSI) is one of the common severe infections in intensive care unit (ICU),which tends to increase the mortality of patients,the length of hospital stay and the cost of hospitalization.Arterial catheter-related bloodstream infection (AC-BSI) is often overlooked or underestimated.Some studies pointed out that the incidence of AC-BSI is close to or even higher than central venous catheter related bloodstream infection (CVC-BSI),which plays an important role in catheter-related infections.Once AC-BSI is suspected,arterial catheter should be removed immediately after bacterial culture and antibiotics should be prescribed according to severities of patients.Prevention is the key to reduce AC-BSI.The research progress of epidemiology,etiology,pathogenesis,risk factors,diagnosis,treatment and prevention of AC-BSI was reviewed to facilitate the clinical decision.

Surgical Treatment of Advanced Rectal Carcinoma in Aged People / 中国医师杂志

Objective To explore the surgical treatment of advanced rectal carcinoma in aged people. Methods The clinical data of 65 aged patients with advanced rectal carcinoma from 2000 to 2004 were analyzed retrospectively. Results All cases were Dukes D stage or accompanied with hepatic metastasis. Hartmann's operation was performed in 26 cases, single lumen sigmoidostomy in 11 cases, double lumen sigmoidostomy in 11 cases and resection of hepatic metastatic cancer in 12 cases. Rectal upper arterial catheter chemotherapy was performed in 19 cases and hepatic arterial catheter chemotherapy in 15 cases. The 3-year survival rate of Hartmann's operation was 34%(9/26), and the average survival time was 20?3.17 months in the patients underwent rectal upper and hepatic arterial catheter chemotherapy, and 10?1.77 months in the patients who could not be treated surgically(P

Effects of Umbilical Arterial Catheterization on Intestinal Hemodynamics

PURPOSE: An umbilical arterial catheter (UAC) in the high position reduces the lumen of the aorta and may thereby impair blood supply to the intestine. Effects of UAC on intestinal blood flow were investigated. METHODS: With the measurement of the aortic diameter, pulsed Doppler ultrasonography was performed in 23 fasting newborns to measure blood flow velocities (peak systolic velocity, end-diastolic velocity, mean velocity, time velocity integral and resistive index) in the celiac trunk (CT) and the superior mesenteric artery (SMA) before and after removal of the UAC in the high position. RESULTS: UAC reduced the cross-sectional area of the aorta by 3.5-15.0% (mean 7.5%), with the percentage of reduction being inversely related to birth weight (r=-0.86, P<0.0001). Blood flow velocities in the CT and the SMA did not change significantly after removal of the UACl left in place for 7 days. There were also no differences in blood flow velocities pre- and postremoval of the UAC which stayed in place for 17.3 days and caused a mean aortic obstruction of 11.7%. However, a longer indwelling time of the UAC may lead to a higher velocity in the CT with UAC in place, as reflected by a correlation by multiple regression analysis (r=0.42, P=0.045). CONCLUSION: Although UAC remaining in place for up to 2 weeks in fasting newborns does not lead to direct alterations in blood supply to the intestine, the possibility of blood flow impairment to abdominal organs by prolonged use cannot be excluded.

Study of a Comparison of Ultrasonography with Radiography to Localize the Umbilical Arterial Catheter

PURPOSE: This study was performed to observe the utilization of ultrasonography in locating the position of UAC and to compare the position with anatomical landmarks seen on radiography. METHODS: Optimal position is when the catheter tip is located between T6-T10 or L3-L5 by anteroposterior radiography (AP-R) and above the diaphragm by cross-table lateral radiography (CTL-R). Ultrasonographic studies used a Hewlett Packard Sonos 1000 with 5 MHz scanner, the distance from the catheter tip to the origin of the celiac artery in high position and the distance from the catheter tip to the origin of the renal arteries and to the aortic bifurcation in low position were measured. RESULTS: In 23 of 36 newborns, high type UAC was properly positioned by AP-R, but ultrasonographic examination showed that 3 UAC were malpositioned under 5mm above the origin of the celiac artery. Detection of properly positioned UAC by AP-R had a sensitivity of 80% and specificity of 72.7%. In 19 of 28 newborns, high type UAC was properly positioned by CTL-R, but ultrasonographic examination showed that 2 UAC were malpositioned under 5mm above the origin of the celiac artery. Detection of properly positioned UAC by CTL-R had a sensitivity of 81% and specificity of 71.4%. In 15 of 20 newborns, low type UAC was properly positioned by AP-R, and ultrasonographic examination showed that 1 UAC was malpositioned below the aortic bifurcation. Detection of properly localized UAC by AP-R had a sensitivity of 77.8% and specificity of 50%. CONCLUSION: Ultrasonographic catheter localization is a noninvasive technique that uses no ionizing radiation and has no known deterimental side effects, and allows direct visualization of the pertinent vascular anatomy, providing more information than traditional radiography.

Cardiac Injury Diagnosed with Echocardiogram in the Patient of Blunt Chest Trauma: A case report / 대한마취과학회지

Blunt trauma of the chest and abdomen frequently result in cardiac injury. We experienced a 47 year-old male patient of myocardial contusion with aortic insufficiency after blunt chest trauma. On the secondd day after admission, the patient developed sudden hypoxemia and wide pulse pressure. A pulmonary arterial catheter was inserted and initial cardiac output and pulmonary capillary wedge pressure was 3.56 L/min/m(2) and 32 mmHg, respectively. There was akinesia of the anterior septum, anterior wall, inferior wall and inferior septum with aortic regurgitation(I/IV), and the ejection fraction was 25% on echocardiogram. Myocardial contusion with valvular injury was suspected. Dobutamine infusion was started and after five days the pulmonary capillary wedge pressure was decreased to 14 mmHg. The ejection fraction was increased to 69% in spite of decreasing dobutamine but aortic regurgitation(II/VI) remained. Therefore echocardiogram and pulmonary artery catheterization will be helpful to diagnose suspected cardiac contusion and for better outcome.