ABSTRACT
Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.
Subject(s)
Humans , Male , Female , Aorta, Thoracic/surgery , Axillary Artery/surgery , Catheterization/methods , Brachiocephalic Trunk/surgery , Postoperative Complications , Catheterization/adverse effects , Catheterization/mortality , Treatment Outcome , Hospital MortalityABSTRACT
This study aimed to investigate the clinical characteristics, prognosis, and factors for survival of patients who underwent early-start peritoneal dialysis (PD) within 24 h after catheter insertion three years after PD. This study was conducted from January 1, 2013 to December 31, 2017. All adult patients who were diagnosed with end-stage renal disease (ESRD) and underwent PD for the first time within 24 h after catheter insertion in our hospital were included. All patients with PD were followed-up until they withdrew from PD, switching to hemodialysis, were transferred to other medical centers, underwent renal transplantation, died or were lost to follow-up, or continued to undergo dialysis until the end of the study period. The follow-up observation lasted three years. The number of eligible patients was 110, and switching to hemodialysis and death were the main reasons for patients to withdraw from PD. The 1-, 2-, and 3-year technical survival rates of patients were 89.1, 79.1, and 79.1% respectively, while the 1-, 2- and 3-year survival rates were 90, 81.8, and 81.8%, respectively. The Charlson comorbidity index, age, hemoglobin, serum albumin, diabetic nephropathy, chronic glomerulonephritis, and hypertensive renal damage were independent risk factors that affected the prognosis of PD patients. Under the condition of ensuring the quality of the PD catheter insertion, early-start PD within 24 h after catheter insertion is a safe treatment approach for ESRD patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Catheterization/methods , Catheters, Indwelling , Peritoneal Dialysis/methods , Kidney Failure, Chronic/therapy , Prognosis , Time Factors , Catheterization/mortality , Body Mass Index , Proportional Hazards Models , Multivariate Analysis , Risk Factors , Age Factors , Peritoneal Dialysis/mortality , Kaplan-Meier Estimate , Kidney Failure, Chronic/mortalityABSTRACT
Los catéteres de derivación externa en patología neuroquirúrgicas como la hemorragia subaracnoidea, accidentes vascular cerebral hemorrágico, traumatismo cranoencefálico grave y tumores cerebrales, son utilizados con frecuencia en la práctica diaria, siendo la infección la más común de sus complicaciones y como causante de las mismas se menciona: la manipulación del catéter en el mismo acto quirúrgico; en la sala de internados no se cumplen las medidas de aislamiento en forma externa como lo demuestra la presencia de gérmenes habituales del medio hospitalario aislados en el clutivo de líquido cefalorraquídeo y en la punta del catéter. Contribuyen además la permanencia de catérter por mas de 5 días y la frecuencia de cambio muy prolongada. El objetivo es observar la frecuencia de edad, sexo, determinar patologías que requirieron la utilización de los catéteres de derivación externa, los días de permanencia y la frecuencia de cambio. Además identificar los gérmenes aislados en cultivos, hallar la letalidad relacionada con dicha causa. Los hallazgos más relevantes fueron el sexo masculino en 58%, el grupo erario entre los 60 y 70 años, las patologías en que se requirieron CDE fueron el accidente vascular cerebral intraparenquimatoso (28%), la hemorragia subaracnoidea (19%) y el traumatismo craneoencefálico grave (19%), se hallaron LCR infectados en 28% de los casos y los gérmenes aislados en cultivos: acinetobacter sp (61%) y klebsiella pneumoniae (15%). Se utilizó la cefazolina como profiláctico en 64% de los casos y se registró 20% de mortalidad. La correlación entre los datos hallados en las literaturas internacionales difiere en aspectos profilácticos y nos ayudan a unificar criterios y extremas estrategias de prevención de las infecciones a fin de disminuir la morbilidad y mortalidad relacionadas a las infecciones.
Subject(s)
Catheterization/adverse effects , Catheterization/mortality , Cross Infection/etiology , Cross Infection/prevention & control , Cerebrospinal FluidABSTRACT
OBJETIVO: Estabelecer a circulação extracorpórea através de canulação da artéria subclávia direita por meio de incisão supraclavicular. MÉTODO: Foram estudados, no período de outubro de 2001 a março de 2002, quatro pacientes com diagnóstico de dissecção aguda de aorta tipo A de Stanford, sendo realizada em todos os casos canulação da artéria subclávia direita por via supraclavicular e realização de perfusão cerebral anterógrada durante o período de parada circulatória total. RESULTADOS: A artéria subclávia direita foi canulada diretamente e não houve nenhuma complicação neurovascular relacionada ao procedimento. A circulação extracorpórea foi mantida com fluxo adequado durante toda a operação. Houve 1 óbito hospitalar, não relacionado ao procedimento. DISCUSSÃO: Um dos passos mais importantes na melhora dos resultados operatórios é a perfusão sistêmica anterógrada, realizada através do sistema arterial e a subclávia para isso permite a perfusão da luz verdadeira. A abordagem supraclavicular nos proporciona um campo operatório adequado e facilidade para a realização da perfusão cerebral anterógrada que também é importante neste arsenal para uma redução da mortalidade operatória. CONCLUSÃO: A incisão supraclavicular nos proporciona um acesso factível com boa exposição da artéria subclávia direita em uma região em que ela apresenta um bom calibre e com poucas estruturas adjacentes que poderiam ser lesadas. Além disso, possibilita a canulação de forma direta e com boa posição da cânula arterial