Correlación del gasto cardiaco por fórmula de continuidad a través de ecocardiografía transtorácica vs termodilución por Swan-Ganz en la Unidad de Cuidados Intensivos / Correlation of cardiac output by continuity formula through transthoracic echocardiography vs thermodilution by Swan-Ganz in the Intensive Care Unit / Correlação do débito cardíaco pela fórmula de continuidade através da ecocardiografia transtorácica vs termodiluição por Swan-Ganz na unidade de terapia intensiva

Resumen: Introducción: la termodilución se considera el estándar de referencia para la medición del gasto cardiaco. Durante las últimas décadas la aparición de otros métodos menos invasivos ha resultado útil para determinar el gasto cardiaco. El objetivo del estudio es analizar la correlación entre el gasto cardiaco obtenido por ecocardiografía transtorácica mediante el método de continuidad y termodilución pulmonar por catéter de Swan-Ganz. Material y métodos: estudio prospectivo, descriptivo, transversal realizado en la Unidad de Cuidados Intensivos del Hospital General Las Américas. A los pacientes se les colocó catéter Swan-Ganz; se realizó medición de gasto cardiaco por ecocardiografía; posteriormente cuantificación de gasto cardiaco por termodilución pulmonar durante marzo de 2021 a agosto de 2022. Resultados: se compararon 58 mediciones de gasto cardiaco (GC) por Swan-Ganz con una mediana de 4.95 (rango 3.1-7.2), y GC por ecocardiografía con una mediana 4.93 (rango 3.2-7.0). La diferencia de medias para la medición de gasto cardiaco por Swan-Ganz fue de 5.20 (95% IC 4.56-5.84, p < 0.0001), comparado con gasto cardiaco por termodilución 5.19 (95% IC 4.56-5.81, p < 0.0001). Conclusiones: existe correlación significativa entre el gasto cardiaco medido por termodilución y ecocardiografía; se le considera una alternativa confiable para la determinación del gasto cardiaco.

Abstract: Introduction: thermodilution considered the reference standard for measuring cardiac output. During the last decades, the appearance of other less invasive methods has been useful to determine cardiac output. The aim of the study is to analyze the correlation between cardiac output obtained by transthoracic echocardiography by continuity method and pulmonary thermodilution by Swan-Ganz catheter. Material and methods: prospective, descriptive, cross-sectional study carried out in the Intensive Care Unit of the Hospital General Las Américas, the patients underwent a Swan-Ganz catheter; cardiac output was measured by echocardiography; subsequently, quantification of cardiac output by pulmonary thermodilution during March 2021 to August 2022. Results: fifty-eight measurements of cardiac output by Swan-Ganz with a median of 4.95 (range 3.1-7.2) and CO by echocardiography with a median of 4.93 (range 3.2-7.0) were compared. The difference in means for the measurement of cardiac output by Swan-Ganz was 5.20 (95% CI 4.56-5.84 p < 0.0001), compared to cardiac output by thermodilution 5.19 (95% CI 4.56-5.81 p < 0.0001). Conclusions: there is a significant correlation between cardiac output measured by thermodilution and echocardiography; being considered a reliable alternative for the determination of cardiac output.

Resumo: Introdução: a termodiluição é considerada o padrão de referência para a medida do débito cardíaco. Nas últimas décadas, o surgimento de outros métodos menos invasivos mostrou-se útil para a determinação do débito cardíaco. O objetivo do estudo é analisar a correlação entre o débito cardíaco obtido pela ecocardiografia transtorácica pelo método da continuidade e a termodiluição pulmonar pelo cateter de Swan-Ganz. Material e métodos: estudo prospectivo, descritivo, transversal, realizado na Unidade de Terapia Intensiva do Hospital Geral Las Américas, onde foi colocado cateter de Swan-Ganz; o débito cardíaco foi medido por ecocardiografia; posteriormente, quantificação do débito cardíaco por termodiluição pulmonar no período de março de 2021 a agosto de 2022. Resultados: foram comparadas 58 medidas do débito cardíaco por Swan-Ganz com uma mediana de 4.95 (intervalo 3.1-7.2), e GC por ecocardiografia com uma mediana de 4.93 (intervalo 3.2-7.0). A diferença média para medição do débito cardíaco por Swan-Ganz foi de 5.20 (IC 95% 4.56-5.84 p < 0.0001), em comparação com o débito cardíaco por termodiluição 5.19 (95% CI 4.56-5.81 p < 0.0001). Conclusões: existe uma correlação significativa entre o débito cardíaco medido por termodiluição e ecocardiografia; considerando-o uma alternativa confiável para a determinação do débito cardíaco.

Monitoreo hemodinámico en el paciente crítico

RESUMEN La atención al paciente crítico requiere del manejo del sistema cardiovascular y del equilibrio del medio interno, por lo cual es necesario el monitoreo hemodinámico. Con el objetivo de describir el sustento fisiológico del monitoreo hemodinámico y los medios para su determinación se realizó una búsqueda de información en las bases de dato Scopus, SciELO, PubMed, LILACS, AmeliCA y Redib. El monitoreo hemodinámico permite determinar la necesidad de administrar fluidos y su respuesta terapéutica; al analizar la curva de Frank-Starling. Además, necesita la determinación de parámetros estáticos y dinámicos, que analizan el gasto cardíaco, la presión de pulso, medidos mediante métodos invasivos, mínimamente invasivos y no invasivos. La variabilidad de la presión de pulso y del volumen sistólico constituyen nuevas variables útiles en el proceso. El estudio mediante ecocardiografía de la vena cava inferior juega un importante papel en el monitoreo hemodinámico.

ABSTRACT Caring for the critically ill patient requires management of the cardiovascular system and balance of the internal environment. Hemodynamic monitoring is therefore necessary. With the objective of describing the physiological basis of hemodynamic follow-up and means for its determination, a search for information was carried out in the -Scopus, SciELO, PubMed, LILACS, AmeliCA, and Redib- databases. Hemodynamic monitoring allows determining when fluid administration is required and its therapeutic response by analyzing the Frank Starling curve. It requires the determination of static and dynamic parameters that analyze cardiac output and pulse pressure. These parameters are measured by invasive, minimally invasive and noninvasive methods. Pulse pressure and stroke volume variability are useful new variables in the process. Echocardiographic study of the inferior vena cava plays an important role in the hemodynamic follow-up.

Changes in Haemodynamic Parameters during off Pump Coronary Artery Bypass Grafting (CABG) in Patients with Ejection Fraction ≥40%

Introduction: Airway management is a crucial skill for theclinical anaesthesiologist. It is an integral part of generalanesthesia, allowing ventilation and oxygenation as wellas a mode for anesthetic gas delivery. The laryngeal maskairways(LMA) have become popular in airway managementas a missing link between facemask and tracheal tube interms of both anatomical position and degree of invasiveness.Haemodynamic stability is an important aspect to theanaesthesiologist for the benefit of the patients especiallyduring intubations, laryngeal mask insertion. Laryngoscopyand endotracheal intubation can cause striking changes inHaemodynamics as result of intense stimulation of sympatheticnervous system. The aim of this study was to evaluate thehemodynamic changes between endotracheal intubation andlaryngeal mask airway insertion.Material and Methods: This was a prospective observationalstudy on 46 patients of ASA I-II status divided into 2 groups of23 each. In the ETT (Endotracheal tube) group endotrachealintubation was done using Macintosh laryngoscope by usingportex cuffed endotracheal while in LMA (Laryngeal maskairway) group laryngeal mask airway was inserted accordingto the standard recommendation. Heart rate, Systolic, Diastolicand Mean arterial pressure and dysrhythmias were monitored.Results: The two groups were comparable in terms ofdemographic data as there were no significant differencesbetween the 2 groups in terms of age, sex, duration of surgery,ASA grades and MPC classification. Heart rate (HR), Systolicblood pressure (SBP), Diastolic blood pressure(DBP), Meanarterial pressure (MAP) remains on higher side in ETT groupthan LMA group which was statistically significant. P<0.05.Dysrhythmias were noted in 2 patients of ETT group whileLMA group did not notice any dysrhythmias.Conclusion: This study demonstrated that there is ahaemodynamic response consisting of an increase in Heartrate, SBP, DBP and MAP that comes with ETT insertion aswell as with LMA insertion. However, the response causedby ETT insertion is significantly greater than that caused byLMA insertion.

Catéter de Swan Ganz con marcapasos en la cirugía mini-invasiva mitral / Pacing Swan-Ganz Catheter in Minimally Invasive Mitral Valve Surgery

RESUMEN Introducción: La cirugía mediante mini-toracotomía lateral presenta ventajas comparativas sobre el acceso convencional como menor trauma quirúrgico, reducida morbimortalidad y un resultado estético superior, pero plantea dificultades en caso de necesitar estimulación eléctrica temporal. Objetivo: Valorar el empleo terapéutico del catéter de Swan-Ganz con marcapasos incorporado como solución a dicho problema y analizar sus complicaciones. Material y métodos: Se incluyeron pacientes programados para cirugía mini-invasiva mitral mediante mini-toracotomía lateral. Se definió empleo terapéutico del catéter al uso debido a bradiarritmias o trastornos de conducción o necesidad de incrementar la frecuencia cardíaca con fines hemodinámicos. Pacientes intervenidos de urgencia o emergencia, fueron excluidos del estudio. Resultados: Fueron incluidos 517 pacientes (289 de sexo masculino, con edad promedio de 68,3 ± 10,4 años); se efectuaron 115 (22,2%) reemplazos y 402 (77,7%) plásticas mitrales. Simultáneamente, se realizaron 294 (56,9%) procedimientos de Maze, 182 (35,2%) cierres de orejuela izquierda, 9 (1,7%) cierres de defectos septales y 14 (2,7%) plásticas tricuspídeas. Ciento sesenta y dos (313%) pacientes necesitaron ser marcapaseados; debido a bradiarritmias, 85 (52,47%) pacientes; por trastornos de conducción, 50 (30,86%) pacientes; mientras que otros 27 (16,66%) requirieron incrementar su frecuencia debido a bajo volumen minuto. La mortalidad resultó de 12 (2,32%) casos. Catorce (2,7%) pacientes presentaron pérdida de captura y se resolvieron con el reposicionamiento del catéter, mientras que 2 (0,6%) pacientes presentaron atrapamiento y requirieron reintervención. Conclusiones: Casi un tercio de los pacientes intervenidos mediante mini-toracotomía lateral requirieron del empleo terapéutico del catéter de Swan-Ganz con marcapasos. Dos pacientes presentaron atrapamiento y requirieron resolución quirúrgica.

ABSTRACT Background: The use of a lateral mini-thoracotomy presents several advantages over the standard access, such as less surgical trauma, reduced morbidity and mortality, shorter recovery time and better cosmetic results, but presents difficulties if temporary pacing is required. Objective: The aim of this study was to evaluate the therapeutic use of a Swan-Ganz catheter with pacing capabilities and analyze its complications. Methods: Patients undergoing scheduled minimally invasive mitral valve surgery through lateral mini-thoracotomy were included in the study. Therapeutic use of the pacing catheter was defined as the need for pacing due to bradyarrhythmias or conduction disorders or need of increasing heart rate in case of hemodynamic instability. Patients undergoing urgent or emergency surgery were excluded from the study. Results: A total of 517 patients were included in the study; mean age was 68.3 ± 10.4 years and 289 (55.9%) were men; 115 patients (22.2%) underwent mitral valve replacement and 402 (77.7%) mitral valve repair. The following concomitant procedures were carried out: 294 (56.9%) Maze procedures, 182 (35.2%) left atrial appendage closures, 9 (1.7%) atrial septal defect closures and 14 (2.7%) tricuspid valve repair surgeries. In the postoperative period 162 (31.3%) patients required pacing due to bradyarrhythmias in 85 cases (52.47%), conduction disorders in 50 (30.86%), and need to increase heart rate in 27 (16.66%) patients with low cardiac output syndrome. Postoperative mortality was 2.32% (n=12). Fourteen (2.7%) patients presented loss of capture that was resolved with catheter repositioning, while 2 (0.6%) patients presented catheter entrapment requiring reintervention. Conclusion: Almost one-third of the patients undergoing lateral mini-thoracotomy required therapeutic use of the pacing Swan-Ganz catheter. Two patients presented catheter entrapment and required surgical reintervention.

Correlación de gasto cardiaco obtenido por termodilución y por monitor ultrasónico (USCOM) en pacientes con choque séptico / Correlation of cardiac output obtained by termodulution and by ultrasonic monitor in patients with septic shock (USCOM) / Correlação do débito cardíaco obtido pela termodulação e pelo monitor ultrasônico (USCOM) em pacientes com choque septico

Resumen: El catéter en la arteria pulmonar (CAP) es un dispositivo utilizado en unidades de cuidados intensivos (UCI) para medir las presiones en el corazón y los vasos sanguíneos pulmonares como parte del monitoreo hemodinámico, principalmente en pacientes de cirugía cardiaca. El dispositivo USCOM se trata de una técnica no invasiva que utiliza la tecnología Doppler para obtener las medidas de volumen sistólico y sus derivados. Se realiza la siguiente comparación de medición de GC entre estos dos dispositivos en pacientes con choque séptico. Se realizó un estudio tipo observacional, prospectivo, longitudinal y comparativo en pacientes con choque séptico entre 18 y 60 años de edad ingresados en la UTI en el periodo de mayo-junio del 2017. Ante la disminución del uso del catéter de la arteria pulmonar debido a la controversia de no mejorar la mortalidad en los pacientes de las unidades de terapia intensiva (UTI), la colocación de dicho catéter ha caído en desuso; sin embargo, el GC medido por el catéter de Swan-Ganz sigue siendo el «estándar de oro¼ para la medición en tiempo real del GC y las resistencias sistémicas y pulmonares. La medición del GC por CAP versus USCOM se correlaciona de tal forma que puede emplearse en la medición por USCOM en un paciente con choque séptico, al cual no se le pretenda invadir para determinar sus condiciones hemodinámicas.

Abstract: The pulmonary artery catheter (CAP) is a device used in intensive care units (ICUs) to measure pressures in the heart and pulmonary blood vessels as part of hemodynamic monitoring primarily in cardiac surgery patients. The USCOM device is a non-invasive technique that uses Doppler technology to obtain measurements of systolic volume and its derivatives. The following CO measurement comparison is performed between these two devices in patients with septic shock. An observational, prospective, longitudinal and comparative study was conducted in patients with septic shock aged between 18 and 60 years admitted to intensive care in the period May-June 2017. In view of the decrease in the use of the pulmonary artery catheter due to the controversy of not improving the mortality in the patients of the Intensive Care Units, the placement of this catheter has fallen into disuse; however, cardiac output measured by the Swan Ganz catheter remains the «gold standard¼ for real-time measurement of cardiac output and systemic and pulmonary resistance. The CO measurement by PAC versus USCOM correlates, in such a way, that USCOM measurement can be used in a patient with septic shock, who is not expected to invade to determine their hemodynamic conditions.

Resumo: O cateter de artéria pulmonar (CAP) é um dispositivo utilizado em unidades de terapia intensiva (UTI) para medir as pressões nos vasos sanguíneos cardíacos e pulmonares, como parte da monitorização hemodinâmica, principalmente em pacientes submetidos a cirurgia cardíaca. O dispositivo USCOM é uma técnica não invasiva que utiliza a tecnologia Doppler para obter medidas do volume sistólico e seus derivados. A seguinte comparação da medição do DC é feita entre esses dois dispositivos em pacientes com choque séptico. Foi realizado um estudo observacional, prospectivo, longitudinal e comparativo em pacientes com choque séptico com idade entre 18 e 60 anos internados na unidade de terapia intensiva no período de maio a junho de 2017. Dada a diminuição do uso do cateter de artéria pulmonar devido à controvérsia de não melhorar a mortalidade nos pacientes das Unidades de Terapia Intensiva, a colocação do referido cateter caiu em desuso; no entanto, o débito cardíaco medido pelo cateter de Swan Ganz continua sendo o «padrão ouro¼ para a medição em tempo real do débito cardíaco e resistências sistêmicas e pulmonares. A medida do DC por CAP vs USCOM está correlacionada, de tal forma que a medida por USCOM pode ser usada em um paciente com choque séptico, que não se destina a invadir para determinar suas condições hemodinâmicas.

Eficacia y seguridad de la técnica de colocación de catéter de arteria pulmonar guiado por ultrasonido / Efficiency and safety of placement of pulmonary artery catheter guided by ultrasound / Eficiência e segurança da colocação do cateter de artéria pulmonar guiado por ultrassom

Resumen: Introducción: Se ha discutido el uso de catéter en la arteria pulmonar (Swan-Ganz) por no ofrecer cambios en la mortalidad de los pacientes críticos; sin embargo, aún es una herramienta útil para monitoreo hemodinámico. Objetivo: Ofrecer una alternativa en la colocación de catéter Swan-Ganz mediante ultrasonido en menor tiempo y sin complicaciones. Material y métodos: Se realizó un estudio piloto, prospectivo, observacional, transversal y descriptivo. Se colocaron 26 pacientes con diversas patologías que ameritaban aporte aminérgico o inotrópico y catéter de arteria pulmonar. Se evaluaron los tiempos de colocación y complicaciones asociadas tras su colocación. Resultados: Se obtuvo media de 91.46 segundos de colocación (rango de 60-122 segundos) tras introducir la punta del catéter por venodisección y 0% de complicaciones en 26 pacientes. Discusión: El uso del ultrasonido ofrece un método alterno de colocación del catéter sin apoyo de fluoroscopia, curvas de monitoreo o presiones intracavitarias y reduce complicaciones. Conclusiones: La colocación de Swan-Ganz por ultrasonido es un método alterno y seguro con un tiempo medio de 91 segundos para su inserción. Se requiere una muestra mayor para determinar si es eficaz el método y quizás un estudio multicéntrico.

Abstract: Background: Use of a pulmonary artery catheter (Swan-Ganz) has been discussed because it does not offer changes in the mortality of critically ill patients; however, it is still a useful tool for hemodynamic monitoring. Objective: To offer an alternative in the placement of Swan-Ganz catheter by ultrasound in less time and without complications. Material and methods: A pilot, prospective, observational, cross-sectional and descriptive study was conducted. Placing 26 patients with various pathologies that required aminergic or inotropic delivery, a pulmonary artery catheter; evaluating placement times and associated complications after placement. Results: A mean of 91.46 seconds of placement (range of 60-122 seconds) was obtained after insertion of the tip of the catheter by venodisection and 0% of complications in 26 patients. Discussion: The use of ultrasound offers an alternate method of placement of the catheter without fluoroscopy support, monitoring curves or intracavitary pressures; and reduces complications. Conclusions: The placement of Swan-Ganz by ultrasound is an alternative and safe method for placement with an average time of 91 seconds in its insertion. A larger sample is required to determine if the method is effective and perhaps a multicenter study.

Resumo: Introdução: O uso de cateter na artéria pulmonar (Swan-Ganz) tem sido discutido por não oferecer mudanças na mortalidade de pacientes em estado crítico, no entanto, ainda é uma ferramenta útil para a monitorização hemodinâmica. Objetivo: Oferecer uma alternativa na colocação do cateter de Swan-Ganz com ultrassom em menos tempo e sem complicações. Material e métodos: Foi realizado um estudo piloto, prospectivo, observacional, transversal e descritivo. Colocando 26 pacientes com diferentes patologias que requeriam suporte aminérgico ou inotrópico e cateter de artéria pulmonar; avaliando o tempo e complicações associadas após a colocação. Resultados: Obteve-se uma média de 91.46 segundos de colocação (intervalo de 60-122 segundos) após a introdução da ponta do cateter por venodissecção e 0% de complicações em 26 pacientes. Discussão: O uso do ultrassom oferece um método alternativo de colocação do cateter sem apoio de fluoroscopia, curvas de monitoramento ou pressões intracavitárias; e reduz as complicações. Conclusões: A colocação do cateter de Swan Ganz por ultrassom é um método alternativo e seguro, com um tempo médio de 91 segundos na sua inserção. É necessária uma amostra maior para determinar se o método é eficaz e talvez um estudo multicêntrico.

A double-knotted pulmonary artery catheter with large loop in the right internal jugular vein: A case report / 고신대학교의과대학학술지

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.

Efficacy of PiCCO monitoring in guiding volume therapy in patients with sepsis complicated with a-cute kidney injury / 中华麻醉学杂志

Objective To evaluate the efficacy of pulse indicator continuous cardiac output (PiC-CO) monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury. Methods Eighty-five patients with sepsis complicated with acute kidney injury were divided into PiCCO group (n= 37) and routine group (n = 48) according to whether PiCCO monitoring was used to guide vol-ume therapy. The hemodynamic parameters at 6 and 24 h after volume therapy, fluid volume, consumption of vasoactive drugs, renal function, fatality in intensive care unit and 28-day fatality were recorded. Re-sults Compared with routine group, the volume of fluid for resuscitation at 24 h after volume therapy, and central venous pressure were significantly decreased (P<0. 05), the time of continuous renal replace-ment therapy was shortened, the urine volume was increased, the blood creatinine level was decreased, and the fatality rate in intensive care unit and 28-day fatality rate were decreased in group PiCCO (P<0. 05). Conclusion For the patients with sepsis complicated with acute kidney injury, PiCCO monitoring can reasonably guide volume therapy and is helpful in improving the prognosis.

Consistency of TEE technique and PAC method in monitoring cardiac volume load and cardiac hemodynamic changes / 心血管康复医学杂志

Objective: To evaluate the consistency of transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) method in monitoring cardiac volume load and cardiac hemodynamic indexes.Methods: A total of 45 patients undergoing coronary artery bypass grafting in our hospital were selected.The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were monitored during surgery by TEE and PAC respectively.Consistency of monitored data was compared between two methods.Results: Both TEE and PAC indicated that compared with baseline level, after loading, there were significant rise in RVEDV [TEE: (38±6)ml vs.(51±9ml), PAC: (153±17)ml vs.(188±19)ml], RVESV [TEE: (19±4)ml vs.(33±5)ml, PAC: (92±16)ml vs.(110±23)ml], P0.05.Before therapy, RVEDV, RVESV and RVEF monitored by PAC and TEE showed significant positive correlation, and all relevant coefficients were >0.8 (r=0.844, 0.862, 0.916, P0.8 (r=0.892, P<0.01).Conclusion: In clinical monitor, the consistency of TEE and PAC is high,the former is non-traumatic,and is more convenient for clinical use.

Cuidado sistematizado: protocolo de colocación y cuidados del paciente con cateter de Swan Ganz / Systemized care: protocol placement and patient care with Swan Ganz catheter

En las unidades de cuidados criticos la utilizacion del cateter Swan Ganz permite monitorizar parametros hemodinamicos fundamentales para el control del paciente critico, para el diagnostico y tratamiento de aquellos que hemodinamicamente estan inestables, donde el cuidado de enfermeria es primordial no solo en los procedimientos de preparación de materiales a utilizar, asistencia en la colocación, sino tambien en el mantenimiento, cuidados y finalmente retirada del mismo..

Right ventricle perforation after Swan-Ganz catheterization in a patient undergoing CABG surgery: A case report

We report an extremely rare case of right ventricle perforation by a Swan-Ganz catheter during open heart surgery. Even when pulmonary artery catheters are inserted with the utmost care, serious complications such as hematoma formation, pneumothorax, hemothorax, perforation of the cardiac chambers, and rupture of the pulmonary artery may occur. We present a case of primary closure of a right ventricle perforation discovered during coronary artery bypass graft surgery. In this case, the Swan-Ganz catheter was found penetrating the anterior wall of the right ventricle during the surgery. The location of the Swan-Ganz catheter, the stiffness of the catheter caused by hypothermia, and excessive surgical manipulation were supposed to be the etiologies. Therefore, the location of the Swan-Ganz catheter and increased stiffness from hypothermia should be taken into consideration during heart surgery.

Índice cardíaco medido por catéter de Swan-Ganz comparado con el ecocardiograma transtorácico / Cardiac index measured by Swan-Ganz catheter compared to transthoracic echocardiogram

Introducción: el catéter de Swan-Ganz sigue siendo el estándar de oro para la valoración hemodinámica. Las técnicas más nuevas ofrecen alternativas menos invasivas. El objetivo de este estudio es comparar el cálculo del índice cardíaco mediante ecocardiograma transtorácico frente a la medición del mismo con el catéter de Swan-Ganz. Materiales y métodos: estudio prospectivo, observacional y comparativo, de pacientes mayores de 18 años, ingresados al área de Cuidados Intensivos del Hospital Carlos Andrade Marín, durante un año. Se incluyeron pacientes mayores de 18 años en shock con monitoreo hemodinámico utilizando catéter de Swan- Ganz y que contaban con ventanas ecocardiográficas adecuadas; en total 13 pacientes en ese período de tiempo. Criterios de exclusión: pacientes sin ventanas ecocardiográficas adecuadas o monitoreo sin catéter de Swan-Ganz. El análisis de comparación de los promedios se realizó mediante la prueba de la t de Student y para la correlación entre las técnicas se utilizó el coeficiente de Pearson. Resultados: fueron 13 pacientes, con promedio de edad de 57 años, siendo el diagnóstico principal sepsis. La comparación de los promedios de los valores aplicando la prueba de la t de Student, se obtuvo un valor de 0,220 p = 0,829. El índice de correlación de Pearson entre las dos técnicas fue de 0,94 p < 0,001. Conclusiones: el índice cardíaco estimado por ecocardiografía se correlacionó fuertemente con la medición del índice cardíaco mediante el catéter de Swan-Ganz; las diferencias entre los promedios de las dos mediciones no se mostraron diferentes estadísticamente.

Introduction: the Swan Ganz catheter remains the gold standard for hemodynamic evaluation. Newer techniques offer less invasive alternatives. The objective of this study is to compare the calculated cardiac index versus echocardiogram by measuring the same with the Swan Ganz catheter. Materials and methods: prospective, observational and comparative study of patients over 18 years old admitted to the Intensive Care Unit of the Carlos Andrade Marin Hospital, for one year. Patients older than 18 were included in shock with hemodynamic monitoring using Swan Ganz catheter and had adequate echocardiographic windows, a total of 13 patients at that time. Exclusion criteria: patients without proper monitoring without echocardiographic windows or Swan Ganz catheter. The comparison analysis of the means was performed by Student t test, and for correlation between techniques, the Pearson coeffcient was used. Results: there were 13 patients with a mean age of 57, the main diagnosis was sepsis. Comparison of the averages of the test values using the Student t value 0.220 P = 0.829 was obtained. The Pearson correlation index between the two techniques was 0.94 p <0.001. Conclusions: echocardiography estimated cardiac index was strongly correlated with cardiac index measurement by Swan Ganz catheter, the differences between the averages of the two measurements did not show statistical difference.

Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization / 대한구급학회지

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization / 대한중환자의학회지

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Monitorização hemodinâmica em unidade de terapia intensiva: uma perspectiva do Brasil / Hemodynamic monitoring in the intensive care unit: a Brazilian perspective

Objetivo: No Brasil, não há dados sobre as preferências do intensivista em relação aos métodos de monitorização hemodinâmica. Este estudo procurou identificar os métodos utilizados por intensivistas nacionais, as variáveis hemodinâmicas por eles consideradas importantes, as diferenças regionais, as razões para escolha de um determinado método, o emprego de protocolos e treinamento continuado. Métodos: Intensivistas nacionais foram convidados a responder um questionário em formato eletrônico durante três eventos de medicina intensiva e, posteriormente, por meio do portal da Associação de Medicina Intensiva Brasileira, entre março e outubro de 2009. Foram pesquisados dados demográficos e aspectos relacionados às preferências do entrevistado em relação à monitorização hemodinâmica. Resultados: Responderam ao questionário 211 profissionais. Nos hospitais privados, foi evidenciada maior disponibilidade de recursos de monitorização hemodinâmica do que nas instituições públicas. O cateter de artéria pulmonar foi considerado o mais fidedigno por 56,9%, seguido do ecocardiograma, com 22,3%. O débito cardíaco foi considerado a variável mais importante. Outras variáveis também julgadas relevantes foram débito cardíaco, saturação de oxigênio venoso misto/saturação de oxigênio venoso central, pressão ...

Objective: In Brazil, there are no data on the preferences of intensivists regarding hemodynamic monitoring methods. The present study aimed to identify the methods used by national intensivists, the hemodynamic variables they consider important, the regional differences, the reasons for choosing a particular method, and the use of protocols and continued training. Methods: National intensivists were invited to answer an electronic questionnaire during three intensive care events and later, through the Associação de Medicina Intensiva Brasileira portal, between March and October 2009. Demographic data and aspects related to the respondent preferences regarding hemodynamic monitoring were researched. Results: In total, 211 professionals answered the questionnaire. Private hospitals showed higher availability of resources for hemodynamic monitoring than did public institutions. The pulmonary artery catheter was considered the most trusted by 56.9% of the respondents, followed by echocardiograms, at 22.3%. Cardiac output was considered the most important variable. Other variables also considered relevant were mixed/central venous oxygen saturation, pulmonary artery occlusion pressure, and right ventricular end-diastolic volume. Echocardiography was the most used method (64.5%), followed by pulmonary artery catheter (49.3%). Only half of respondents used treatment protocols, and 25% worked in continuing education programs in hemodynamic monitoring. ...

Impacto en el diagnóstico y tratamiento del monitoreo hemodinámico con catéter de Swan Ganz en el paciente grave inestable / Impact of hemodynamic monitoring with Swan-Ganz catheter in the diagnosis and treatment in unstable seriously ill patients

FUNDAMENTO: el catéter de la arteria pulmonar o de Swan Ganz es un método técnico de diagnóstico y se desarrolla en los laboratorios de fisiología y hemodinámica, en el mismo se perfeccionó a punto de proporcionarle un recurso incuestionable para el control y seguimiento por el anestesiólogo en el período perioperatorio de pacientes de cirugía de alto riesgo. OBJETIVO: evaluar la repercusión del monitoreo hemodinámico invasivo con catéter de Swan Ganz. MÉTODO: se realizó un estudio prospectivo descriptivo en la sala de Cuidados Intensivos del Hospital Universitario Manuel Ascunce Domenech desde enero de 1992 a enero de 2014. Se estudió un universo de 500 pacientes, con edad comprendida entre 15 y 70 años y con diagnóstico de inestabilidad hemodinámica de origen cardiogénico 298 pacientes y no cardiogénico 202. RESULTADOS: su uso motivó cambios en el diagnóstico o adición de otro en 317 pacientes 63,4 %. En relación al tratamiento se realizaron cambios o modificaciones en 450 pacientes en total, lo que significó un 90 %. CONCLUSIONES: el uso racional y bien discutido del catéter de Swan Ganz resultó de suma utilidad para el manejo de pacientes graves con inestabilidad hemodinámica, lo que permitió una mejor interpretación de estados fisiopatológicos confusos y modalidades terapéuticas oportunas y de difícil decisión.

OBJECTIVE: to evaluate the repercussion of the invasive hemodynamic monitoring with Swan-Ganz catheter; to show the benefits and repercussions of its hemodynamic use in the diagnosis and treatment of unstable seriously ill patients in the first 72 hours of evolution. METHOD: a prospective, descriptive study was conducted in the Intensive Care room of the Manuel Ascunce Domenech Teaching Hospital from January, 1992 to January 2014. A universe of 500 patients aged 15-70 years old was studied; 298 of them were diagnosed with hemodynamic instability of a cardiogenic origin and 202 with hemodynamic instability of a non-cardiogenic origin. RESULTS: its use motivated changes in the diagnosis, or the addition of another diagnosis, in 317 patients 63, 4 %. Regarding the treatment, changes or modifications were made in a total of 450 patients, which represented a 90 %. CONCLUSIONS: the rational and well-discussed use of the Swan-Ganz catheter was very useful for the handling of very ill patients with hemodynamic instability difficult to handle. This allowed a better interpretation of confusing physiopathological conditions, as well as applying opportune therapeutic methods and of difficult decision.

Postoperative Life-Threatening Recurrent Ventricular Arrhythmia Triggered by the Swan-Ganz Catheter in a Patient Undergoing Off-Pump Coronary Artery Bypass Surgery

Recurrent ventricular arrhythmia can be fatal and cause serious complications, particularly when it is caused immediately after an operation. Incorrect placement of a Swan-Ganz catheter can trigger life-threatening ventricular arrhythmia, but even intensive care specialists tend to miss this fact. Here, we report a case of recurrent ventricular arrhythmia causing a severe hemodynamic compromise; the arrhythmia was induced by a severely angulated Swan-Ganz catheter. The recurrent ventricular arrhythmia was not controlled by any measures including repositioning of the catheter, until the complete removal of the Swan-Ganz catheter. It is necessary to keep in mind that the position of the pulmonary artery catheter should be promptly checked if there is intractable recurrent ventricular arrhythmia.

Pulmonary alveolar hemorrhage from a pulmonary artery false aneurysm after Swan-Ganz catheterization in a thoracic aortic aneurysm patient: a case report / 대한마취과학회지

Pulmonary artery (PA) rupture caused by a PA Swan-Ganz catheter is a rare complication but remains fatal in almost 50% of cases. False aneurysm of the PA is a rare presentation of PA rupture and should be considered as a possible diagnosis in a patient with a new lung mass after PA catheterization. We present a case of sudden-onset pulmonary alveolar hemorrhage during cardiovascular surgery due to a traumatic PA false aneurysm. The Swan-Ganz catheter might have been displaced by the thoracic aortic aneurysm with displacement of the catheter causing the false aneurysm and bleeding.

Técnica para avaliação da pressão arterial pulmonar de equinos durante o exercício progressivo em esteira rolante / Technique for pulmonary arterial pressure measurement in horses during the incremental exercise on a treadmill

The aim of this study was to illustrate the surgical implantation of Swan Ganz introducers into the jugular vein, as well as the pulmonary artery cannulation procedure using ten mixed breed (MB) adult horses. We also proposed to demonstrate pulmonary arterial pressure (PAP) values measured through the implanted Swan Ganz during one incremental submaximal exercise test performed on a treadmill. Surgical implantation of the Swan Ganz introducers has demonstrated to be easy and quick to perform. None of the animals showed signs of discomfort following the surgery and ergometric test was carried out as proposed. PAP increased proportionally with exercise intensity, and the major average values were recorded at the higher effort time points. The PAP average values increased (P<0.05) when treadmill speed reached 7.5m/s (39±3mmHg) and 8.5m/s (41±3mmHg), comparing to average values at rest (26±3mmHg). However, the PAP values observed at the maximal effort performed by the MB horses of this trial (41±3mmHg), are under the values described for other breeds at similar effort tests. The technique described in the present study contributes for the standardization of research protocols using arterial pulmonary access via Swan Ganz catheter implantation in horses. The ergometric test was effective to promote PAP changes according to the effort, showing PAP values for MB horses that can guide further investigations.

Objetivou-se ilustrar a técnica cirúrgica de implantação de introdutores para cateter de Swan Ganz na veia jugular, bem como o procedimento de canulação da artéria pulmonar de dez equinos adultos sem raça definida (SRD). Realizando medidas através do cateter de Swan Ganz implantado, objetivou-se ainda demonstrar os valores de pressão arterial pulmonar (PAP) durante um teste de esforço progressivo de intensidade submáxima realizado em esteira rolante. A técnica cirúrgica de implantação de introdutores para o cateter de Swan Ganz empregada, demonstrou-se de fácil e rápida realização. Os animais não apresentaram complicações frente ao introdutor implantado e o teste ergométrico foi realizado conforme proposto. A PAP se elevou ao longo do exercício seguindo o incremento de velocidade, sendo os maiores valores médios observados nos momentos de maior intensidade do esforço. Os valores médios de PAP aumentaram (p<0,05) às velocidades de 7,5m/s (39±3 mmHg) e 8,5m/s (41±3 mmHg), quando comparados aos valores mensurados no repouso (26±3mmHg). Entretanto, os valores de PAP encontrados no máximo de esforço realizado pelos equinos SRD deste ensaio (41±3mmHg), encontram-se abaixo dos valores descritos para outras raças para a mesma intensidade de esforço. A descrição detalhada da técnica ilustrada no presente trabalho, pode contribuir substancialmente na padronização de protocolos experimentais que propõem o acesso arterial pulmonar por meio da implantação de cateter de Swan Ganz em equinos. O teste ergométrico proposto foi eficaz em promover variações de PAP de acordo com o esforço realizado, demonstrando valores para equinos SRD que poderão ser usados como base para futuras avaliações.

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada / Continuous noninvasive hemodynamic monitoring in decompensated heart failure

FUNDAMENTO: A avaliação clínico-hemodinâmica à beira do leito e o uso do cateter de artéria pulmonar para a estimativa de dados hemodinâmicos têm sido utilizados na insuficiência cardíaca descompensada. Entretanto, não existem dados com o uso da monitorização hemodinâmica contínua não invasiva. OBJETIVO: Comparar as medidas obtidas com a monitorização hemodinâmica não invasiva com as invasivas em pacientes com insuficiência cardíaca descompensada e refratária ao tratamento. MÉTODOS: As medidas hemodinâmicas não invasivas foram obtidas através da monitorização contínua da pressão arterial sistêmica pelo modelo de ondas de pulso (modelflow) e foram comparadas com as medidas obtidas pela passagem do cateter de artéria pulmonar, simultaneamente. RESULTADOS: Foram realizadas 56 medidas em 14 pacientes estudados em dias e horários diferentes. O índice de correlação entre as medidas da pressão arterial sistólica foi de r = 0,26 (IC 95% = 0,00 a 0,49, p = 0,0492) e da diastólica de r = 0,50 (IC 95% = 0,27 a 0,67, p < 0,0001). A correlação foi de r = 0,55 (IC 95% = 0,34 a 0,71, p 0,0001) para o índice cardíaco e de r = 0,32 (IC 95% = 0,06 a 0,53, p = 0,0178) para a resistência vascular sistêmica. CONCLUSÃO: Houve correlação entre as medidas hemodinâmicas não invasivas quando comparadas às medidas do cateter de artéria pulmonar. A monitorização hemodinâmica contínua não invasiva pode ser útil para pacientes internados com insuficiência cardíaca descompensada.

BACKGROUND: The clinical and hemodynamic assessment at the bedside and the use of pulmonary artery catheter for the estimation of hemodynamic data have been used in decompensated heart failure. However, there are no data on the use of continuous noninvasive hemodynamic monitoring. OBJECTIVE: To compare the data obtained through noninvasive hemodynamic monitoring with invasive ones in patients with decompensated heart failure and refractory to treatment. METHODS: The non-invasive hemodynamic measurements were obtained through continuous monitoring of systemic blood pressure by the pulse wave model (Modelflow) and compared with measurements obtained by the passage of a pulmonary artery catheter, simultaneously. RESULTS: A total of 56 measurements were performed in 14 patients studied on different days and time periods. The correlation index between systolic blood pressure measurements was r = 0.26 (95% CI = 0.00 to 0.49, p = 0.0492) and diastolic ones, r = 0.50 (95% CI = 0.27 to 0.67, p <0.0001). The correlation was r = 0.55 (95% CI = 0.34 to 0.71, p <0.0001) for cardiac index and r = 0.32 (95% CI = 0.06 to 0 53, p = 0.0178) for systemic vascular resistance. CONCLUSION: There was a correlation between the hemodynamic measurements when compared to noninvasive pulmonary artery catheter measurements. The continuous noninvasive hemodynamic monitoring may be useful for hospitalized patients with decompensated heart failure.