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1.
REME rev. min. enferm ; 23: e-1267, jan.2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1048093

ABSTRACT

OBJETIVOS: identificar fatores que alteram a confiabilidade da temperatura axilar em relação à temperatura de cateter artéria pulmonar. MÉTODOS: estudo de medidas repetidas utilizando 67 aferições de temperatura axilar coletadas de 24 pacientes internados em centros de terapia intensiva de dois hospitais da região metropolitana de Belo Horizonte entre 2017 e 2018. Realizada análise descritiva e regressão linear dos dados. RESULTADOS: foram encontradas acurácia de 0,48 e precisão de 0,47 referentes à temperatura axilar aferida com termômetro digital comparada com a temperatura de cateter de artéria pulmonar. Os fatores que alteram a confiabilidade da temperatura axilar foram o índice de massa corporal e a dose de dobutamina. CONCLUSÃO: os fatores encontrados foram inéditos em relação à alteração da confiabilidade da temperatura axilar e poderão auxiliar enfermeiros na tomada de decisão ao escolherem um método mais preciso para estimativa da temperatura real do corpo. Ainda é necessária a realização de estudos com amostragem maior para avaliação dos fatores intervenientes da confiabilidade de técnicas de temperatura não invasivas, como a temperatura axilar.(AU)


Objectives: to identify factors that alter the reliability of axillary temperature in relation to pulmonary artery catheter temperature. Methods: studying repeated measures using 67 axillary temperature measurements collected from 24 patients admitted to intensive care centers of two hospitals in the metropolitan region of Belo Horizonte between 2017 and 2018. Descriptive analysis and linear regression of the data were performed. Results: accuracy of 0.48 and precision of 0.47 were found for axillary temperature measured with a digital thermometer compared with pulmonary artery catheter temperature. Factors that change the reliability of axillary temperature were body mass index and dobutamine dose. Conclusion: the found factors were unprecedented in relation to the change in axillary temperature reliability and may help nurses in their decision making by choosing a more accurate method to estimate the actual body temperature. Studies with larger sampling are still necessary to evaluate the intervening factors of the reliability of noninvasive temperature techniques, such as axillary temperature.(AU)


Objetivos: identificar los factores que alteran la fiabilidad de la temperatura axilar en relación con la temperatura del catéter de la arteria pulmonar. Métodos: estudio de mediciones repetidas utilizando 67 mediciones de temperatura axilar de 24 pacientes ingresados en centros de cuidados intensivos de dos hospitales de la región metropolitana de Belo Horizonte entre 2017 y 2018. Análisis descriptivo y regresión lineal de los datos. Resultados: se encontró precisión de 0,48 y precisión de 0,47 para la temperatura axilar medida con termómetro digital en comparación a la temperatura del catéter de la arteria pulmonar. Los factores que alteran la fiabilidad de la temperatura axilar fueron el índice de masa corporal y la dosis de dobutamina. Conclusión: los factores encontrados no tienen precedentes en relación con la alteración en la confiabilidad de la temperatura axilar y pueden ayudar a los enfermeros en la toma de decisiones al elegir un método más preciso para estimar la temperatura corporal real. Son necesarios estudios con muestras más amplias para evaluar los factores que intervienen en la fiabilidad de las técnicas de temperatura no invasivas, como la temperatura axilar.(AU)


Subject(s)
Pulmonary Artery , Axilla , Thermometers , Body Temperature , Catheterization, Swan-Ganz , Risk Factors
2.
Article in English | WPRIM (Western Pacific) | ID: wprim-762252

ABSTRACT

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.


Subject(s)
Anesthesia , Catheterization, Swan-Ganz , Echocardiography, Transesophageal , Electrocardiography , Heart , Humans , Jugular Veins , Male , Middle Aged , Mitral Valve , Mitral Valve Prolapse , Situs Inversus , Thoracic Surgery
3.
Kosin Medical Journal ; : 240-244, 2018.
Article in English | WPRIM (Western Pacific) | ID: wprim-718460

ABSTRACT

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.


Subject(s)
Carcinoma, Hepatocellular , Catheterization , Catheterization, Swan-Ganz , Catheters , Echocardiography, Transesophageal , Fluoroscopy , Humans , Jugular Veins , Liver Transplantation , Pulmonary Artery
4.
In. Vieira, Joaquim Edson; Rios, Isabel Cristina; Takaoka, Flávio. Anestesia e bioética / Anesthesia and bioethics. São Paulo, Atheneu, 8; 2017. p.785-840.
Monography in Portuguese | LILACS (Americas) | ID: biblio-847828
5.
Notas enferm. (Córdoba) ; 16(27): 21-24, jul.2016.
Article in Spanish | LILACS (Americas) | ID: lil-789997

ABSTRACT

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..


Subject(s)
Humans , Critical Care , Catheterization, Swan-Ganz/nursing
6.
Rev. bras. cardiol. invasiva ; 24(1-4): f:35-l:37, jan.-dez. 2016. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-878997

ABSTRACT

Introdução: As complicações no cateterismo cardíaco direito estão quase sempre relacionadas ao local de acesso. As veias do antebraço podem ser um alvo para reduzir tais complicações durante o procedimento. No entanto, dados relativos à ampla aplicação desta técnica são escassos. Métodos: Série de casos que relata nossas primeiras experiências com o cateterismo cardíaco direito por acesso venoso antecubital. Resultados: Tentamos realizar o cateterismo cardíaco direito em 20 pacientes com abordagem antecubital em janeiro de 2016. A abordagem antecubital foi bem-sucedida em 19 casos (95,0%). Todos os acessos venosos foram obtidos guiados por ultrassonografia. Os cateterismos cardíacos direito e esquerdo foram realizados simultaneamente em 12 casos (60,0%). O cateterismo cardíaco esquerdo foi realizado através da artéria radial direita em 11 casos (91,7%), e da artéria braquial direita em 1 caso (8,3%). O acesso antecubital foi obtido pela veia basílica em 18 (94,7%) casos, e pela veia cefálica em 1 (5,3%) caso. Conclusões: O cateterismo cardíaco direito através das veias da prega antecubital parece ser viável e seguro. Outros estudos controlados são necessários para estabelecer o melhor local de acesso para realizar o cateterismo cardíaco direito


Background: Complications in right heart catheterization are almost all access-site related. Forearm veins may be a target to reduce access-site complications during the procedure. However, data regarding wide application of this technique is scarce. Methods: This is a case-series that reports our first experiences in right heart catheterization through the antecubital approach. Results: We attempted to perform right heart catheterization in 20 patients using antecubital approach on January 2016. The antecubital approach was successful in 19 (95.0%) cases. All venous access were obtained with ultrasound guidance. Simultaneous right and left heart catheterization was performed in 12 cases (60.0%). Left heart catheterization was performed through right radial artery in 11 cases (91.7%) and through the right brachial artery in 1 case (8.3%). Antecubital access was obtained through the basilic vein in 18 (94.7%) cases and through the cephalic vein in 1 (5.3%) case. Conclusions: Right heart catheterization through the antecubital fossa veins appears to be feasible and safe. Further controlled studies are required to establish the best access site to perform right heart catheterization


Subject(s)
Humans , Male , Female , Middle Aged , Cardiac Catheterization/methods , Catheterization, Swan-Ganz/methods , Forearm , Ultrasonography/methods , Brachial Artery , Radial Artery , Surgical Procedures, Operative , Upper Extremity
7.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci; Accorsi, Tarso augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. São Paulo, Manole, 2016. p.154-158.
Monography in Portuguese | LILACS (Americas) | ID: biblio-971587
8.
Bahrain Medical Bulletin. 2016; 38 (1): 36-40
in English | IMEMR (Eastern Mediterranean) | ID: emr-175705
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-32719

ABSTRACT

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.


Subject(s)
Catheterization, Swan-Ganz , Catheters , Coronary Artery Bypass , Heart Ventricles , Hematoma , Hemothorax , Humans , Hypothermia , Pneumothorax , Pulmonary Artery , Rupture , Thoracic Surgery , Transplants
10.
Ann Card Anaesth ; 2015 Jul; 18(3): 312-316
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-162329

ABSTRACT

Background: The pulmonary artery catheter (PAC) has historically been used to measure cardiac filling pressures of which pulmonary capillary wedge pressure (PCWP) has been used as a surrogate of left atrial pressure (LAP) and left ventricular end‑diastolic pressure. Increasingly, the use of the PAC has been questioned in the perioperative period with multiple large studies unable to clearly demonstrate benefit in any group of patients, resulting in a declining use in the perioperative period. Alternative methods for the noninvasive estimation of left‑sided filling pressures are required. Echocardiography has been used to provide noninvasive estimation of PCWP and LAP, based on evaluating mitral inflow velocity with the E and A waves and looking at movement of the mitral annulus with tissue Doppler (e’). Aim: The aim of our study was to assess the relationship between PCWP and E/e’ in cardiac surgical patients with transesophageal echocardiography (TOE). Design: A prospective observational study. Setting: Cardiac surgical patients in a single quaternary referral university teaching hospital. Methods: The ratio of mitral inflow velocity (E wave) to mitral annular tissue velocity (e’) (the E/e’ ratio) and PCWP of 91 patients undergoing general anesthesia and cardiac surgery were simultaneously recorded, with the use of TOE and a PAC. Results: The correlation between E/e’ and PCWP was modest with a Spearman rank correlation coefficient of 0.29 (P = 0.005). The area under the receiver operating characteristic curve for using E/e’ to predict elevated PCWP (≥18 mmHg) was 0.6825 (95% confidence interval: 0.57–0.80), indicating some predictive utility. The optimum threshold value of E/e’ was 10 which had 71% sensitivity and 60% specificity to predict a PCWP ≥18 mmHg. Conclusions: Noninvasive measurements of E/e’ in general cardiac surgical patients have only a modest correlation and does not reliably estimate PCWP.


Subject(s)
Aged , Aged, 80 and over , Anesthesia, General , Atrial Pressure/physiology , Cardiac Surgical Procedures , Catheterization, Swan-Ganz , Echocardiography, Transesophageal , Humans , Middle Aged
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-770853

ABSTRACT

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.


Subject(s)
Arterial Pressure , Catheterization, Swan-Ganz , Catheters , Coronary Sinus , Echocardiography , Echocardiography, Transesophageal , Heart Ventricles , Humans , Jugular Veins , Male , Middle Aged , Mitral Valve , Pulmonary Artery , Sternotomy , Vascular Malformations , Veins , Vena Cava, Superior
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-204515

ABSTRACT

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.


Subject(s)
Arterial Pressure , Catheterization, Swan-Ganz , Catheters , Coronary Sinus , Echocardiography , Echocardiography, Transesophageal , Heart Ventricles , Humans , Jugular Veins , Male , Middle Aged , Mitral Valve , Pulmonary Artery , Sternotomy , Vascular Malformations , Veins , Vena Cava, Superior
13.
Yonsei Medical Journal ; : 913-920, 2015.
Article in English | WPRIM (Western Pacific) | ID: wprim-40874

ABSTRACT

PURPOSE: We compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery. MATERIALS AND METHODS: Fifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index > or =2 L/min/m2: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints. RESULTS: Patient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2+/-4.8 days vs. 10.8+/-4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652+/-519 mL vs. 11430+/-463 mL, p=0.004). CONCLUSION: NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization.


Subject(s)
Aged , Aged, 80 and over , Cardiac Output/physiology , Cardiac Surgical Procedures/methods , Catheterization, Swan-Ganz , Female , Goals , Heart Valves/surgery , Hemodynamics , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Monitoring, Intraoperative/methods , Monitoring, Physiologic/methods , Postoperative Complications/epidemiology , Postoperative Period
14.
Arch. méd. Camaguey ; 18(6): 633-641, nov.-dic. 2014. tab
Article in Spanish | LILACS (Americas), CUMED | ID: lil-728470

ABSTRACT

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.


Subject(s)
Humans , Catheterization, Swan-Ganz , Patient Acuity , Hemodynamics , Monitoring, Physiologic , Epidemiology, Descriptive , Prospective Studies
15.
Rev. bras. ter. intensiva ; 26(4): 360-366, Oct-Dec/2014. tab
Article in Portuguese | LILACS (Americas) | ID: lil-732923

ABSTRACT

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. ...


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Critical Care/methods , Intensive Care Units/statistics & numerical data , Monitoring, Physiologic/methods , Attitude of Health Personnel , Brazil , Catheterization, Swan-Ganz/statistics & numerical data , Critical Care/statistics & numerical data , Echocardiography/statistics & numerical data , Health Care Surveys , Hemodynamics/physiology , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Surveys and Questionnaires
16.
Ann Card Anaesth ; 2014 Oct; 17(4): 302-305
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-153704

ABSTRACT

We present a case of severe tracheobronchial compression from a complex aorto‑subclavian aneurysm in a patient with Turner’s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.


Subject(s)
Adult , Airway Obstruction/complications , Anesthesiology/methods , Anesthetics, Inhalation , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/surgery , Bronchial Diseases/complications , Cardiopulmonary Bypass/methods , Catheterization, Swan-Ganz/methods , Circulatory Arrest, Deep Hypothermia Induced/methods , Constriction, Pathologic/complications , Echocardiography, Transesophageal/methods , Female , Humans , Methyl Ethers , Positive-Pressure Respiration/methods , Subclavian Artery/abnormalities , Subclavian Artery/surgery , Tracheal Stenosis/complications , Turner Syndrome/surgery
17.
Ann Card Anaesth ; 2014 Oct; 17(4): 273-277
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-153696

ABSTRACT

Aims and Objectives: Cardiac output (CO) measurement is essential for many therapeutic decisions in anesthesia and critical care. Most available non‑invasive CO measuring methods have an invasive component. We investigate “pulse wave transit time” (estimated continuous cardiac output [esCCO]) a method of CO measurement that has no invasive component to its use. Materials and Methods: After institutional ethical committee approval, 14 adult (21–85 years) patients undergoing surgery and requiring pulmonary artery catheter (PAC) for measuring CO, were included. Postoperatively CO readings were taken simultaneously with thermodilution (TD) via PAC and esCCO, whenever a change in CO was expected due to therapeutic interventions. Both monitoring methods were continued until patients’ discharge from the Intensive Care Unit and observer recording values using TD method was blinded to values measured by esCCO system. Results: Three hundred and one readings were obtained simultaneously from both methods. Correlation and concordance between the two methods was derived using Bland‑Altman analysis. Measured values showed significant correlation between esCCO and TD (r = 0.6, P < 0.001, 95% confidence limits of 0.51-0.68). Mean and (standard deviation) for bias and precision were 0.13 (2.27) L/min and 6.56 (2.19) L/min, respectively. The 95% confidence interval for bias was ‑ 4.32 to 4.58 L/min and for precision 2.27 to10.85 L/min. Conclusions: Although, esCCO is the only true non‑invasive continuous CO monitor available and even though its values change proportionately to TD method (gold standard) with the present degree of error its utility for clinical/therapeutic decision‑making is questionable.


Subject(s)
Adult , Aged , Aged, 80 and over , Cardiac Output/physiology , Catheterization, Swan-Ganz/methods , Female , Humans , Male , Middle Aged , Monitoring, Intraoperative/methods , Monitoring, Intraoperative/statistics & numerical data , Monitoring, Physiologic/methods , Monitoring, Physiologic/statistics & numerical data , Prospective Studies , Pulse Wave Analysis/methods , Pulse Wave Analysis/statistics & numerical data , Thermodilution/methods , Thermodilution/statistics & numerical data , Young Adult
18.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Article in Spanish | LILACS (Americas) | ID: lil-734394

ABSTRACT

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Subject(s)
Humans , Acute Coronary Syndrome/therapy , Cardiology , Catheterization, Swan-Ganz , Consensus , Catheterization, Swan-Ganz/adverse effects , Catheterization, Swan-Ganz/standards , Evidence-Based Medicine , Heart Failure/therapy , Risk Assessment
20.
São Paulo; s.n; 2014. 69 p. ilus, tab, graf.
Thesis in Portuguese | LILACS (Americas) | ID: lil-720636

ABSTRACT

Fundamento: medidas adjuvantes têm sido propostas para o tratamento de pacientes com insuficiência cardíaca, algumas não farmacológicas, como o uso do calor. Apesar dos resultados positivos para pacientes clinicamente estáveis, não existem trabalhos relacionados ao tratamento com calor na fase descompensada da insuficiência cardíaca em pacientes em uso de drogas vasoativas. Objetivos: avaliar os efeitos hemodinâmicos agudos do calor aplicado através da manta térmica em pacientes com insuficiência cardíaca descompensada (ICD) refratária. Para isso foi estabelecido como desfechos o aumento do índice cardíaco e a redução da resistência vascular sistêmica no primeiro dia de seguimento. Como objetivo secundário, avaliar se sessões repetidas de calor por cinco dias consecutivos promoveria ou sustentaria os efeitos hemodinâmicos obtidos agudamente e, se reduziria os níveis de BNP ao longo do seguimento. Métodos: ensaio clínico randomizado aberto, prospectivo, com grupo controle em pacientes portadores de ICD. O estudo foi dividido em duas fases. Na primeira fase foram estudados pacientes em um único dia e foi avaliado o efeito agudo do calor antes e após a intervenção. Na segunda fase o calor foi avaliado através de sessões diárias por cinco dias consecutivos. Foi utilizada a manta térmica por radiação infravermelha para o aquecimento dos pacientes. As medidas hemodinâmicas foram avaliadas por método invasivo através do cateter de Swan-Ganz e de maneira não invasiva pelo método de modelflow. Os pacientes estavam em uso de inotrópico endovenoso contínuo, no perfil hemodinâmico C segundo a classificação clínico-hemodinâmica de Stevenson e foram considerados refratários após tentativa de retirada da droga vasoativa sem sucesso. A população do estudo foi dividida em 2 grupos: grupo T (termoterapia) e grupo C (controle). O grupo T foi submetido à vasodilatação térmica através da manta térmica na temperatura de 50°C por 40 minutos adicionalmente ao tratamento...


Background: adjuvant measures have been proposed for the treatment of heart failure patients, some non-pharmacological, such as the use of heat. Despite the positive results for clinically stable patients, there are no studies related to use thermal therapy in patients with decompensated heart failure (DHF) and in use of vasoactive drugs. Objectives: To evaluate the acute hemodynamic effects of heat applied through the thermal blanket in patients with refractory decompensated heart failure. It was established as outcomes the increase of cardiac index and decrease of systemic vascular resistance on the first day of follow-up. Secondary objective was to evaluate whether repeated sessions of heat for five consecutive days would promote or sustain the hemodynamic effects obtained acutely, and if it would reduce BNP levels during the follow-up. Methods: open label randomized clinical trial, with control group, in patients with DHF. The study was divided into two phases. In the first phase, patients were studied in a single day and the acute effects of heat were evaluated before and after intervention. In the second phase, the effects of heat were evaluated by daily sessions for five consecutive days. An infrared thermal blanket was used to heating the patients. Hemodynamic measurements were assessed through invasive Swan-Ganz catheter and noninvasively by the method of modelflow. The patients were receiving continuous intravenous inotropic therapy and were classified in the profile C according to Stevenson´s clinical and hemodynamic classification and were considered refractory after failure in the attempted of withdraw the vasoactive drugs. The study population was divided into 2 groups: group T (thermal therapy) and group C (control). Group T was submitted to vasodilation through the thermal blanket at 50 °C for 40 minutes in addition to drug treatment. Patients in group C maintained the drug treatment and the thermal blanket was positioned in the same way for...


Subject(s)
Humans , Male , Female , Adult , Catheterization, Swan-Ganz , Heart Failure , Hemodynamics , Hyperthermia, Induced , Infrared Rays/therapeutic use , Vasodilation
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