RESUMEN
Inferior vena cava collapsibility index [IVC-CI] has been shown to correlate with both clinical and invasive assessment of intravascular volume status, but has important limitations such as the requirement for advanced sonographic skills, the degree of difficulty in obtaining those skills, and often challenging visualization of the IVC in the postoperative patient. The current study aims to explore the potential for using femoral [FV] or internal jugular [IJV] vein collapsibility as alternative sonographic options in the absence of adequate IVC visualization. A prospective, observational study comparing IVC-CI and Fem- and/or IJV-CI was performed in two intensive care units [ICU] between January 2012 and April 2014. Concurrent M-mode measurements of IVC-CI and FV- and/or IJV-CI were collected during each sonographic session. Measurements of IVC were obtained using standard technique. IJV-CI and FV-CI were measured using high-frequency, linear array ultrasound probe placed in the corresponding anatomic areas. Paired data were analyzed using coefficient of correlation/determination and Bland-Altman determination of measurement bias. We performed paired ultrasound examination of IVC-IJV [n = 39] and IVC-FV [n = 22], in 40 patients [mean age 54.1; 40% women]. Both FV-CI and IJV-CI scans took less time to complete than IVC-CI scans [both, P < 0.02]. Correlations between IVC-CI/FV-CI [R[2] = 0.41] and IVC-CI/IJV-CI [R[2] = 0.38] were weak. There was a mean -3.5% measurement bias between IVC-CI and IJV-CI, with trend toward overestimation for IJV-CI with increasing collapsibility. In contrast, FV-CI underestimated collapsibility by approximately 3.8% across the measured collapsibility range. Despite small measurement biases, correlations between IVC-CI and FV-/IJV-CI are weak. These results indicate that IJ-CI and FV-CI should not be used as a primary intravascular volume assessment tool for clinical decision support in the ICU. The authors propose that IJV-CI and FV-CI be reserved for clinical scenarios where sonographic acquisition of both IVC-CI or subclavian collapsibility are not feasible, especially when trended over time. Sonographers should be aware that IJV-CI tends to overestimate collapsibility when compared to IVC-CI, and FV-CI tends to underestimates collapsibility relative to IVC-CI
RESUMEN
To assess the post-operative morbidity after ileal conduit diversion at our institution. The records of 84 patients with a mean age of 62.1 [range 22 -89] years who underwent ileal conduit diversion at our institution between 1992 and 2002 were reviewed and all post-operative complications occurring later than 3 months after the intervention were analyzed. Overall, 242 ileal conduit-related complications [71 major and 171 minor] developed in 72 of 84 patients [85.7%]. The mean and median follow-up were 38.6 and 24 months, respectively [range 3 to 108 months]. A total of 38 surgical procedures/interventions were needed in 33 patients [39.3%]. 62/72 patients [86.1%] developed complications within the first 5 years. 32 stoma-related complications were recorded in 22/84 [26.2%] patients. Fifty-nine percent [n = 42] of the major complications occurred in the 30 patients who had been subjected to diversion for non-malignant indications and had a longer mean follow-up [4.5 years] than the 54 patients who had been operated for malignancy [mean follow-up 2.5 years]. Patients with benign disease fared better in survival as expected, but the longer they survived, the higher was the incidence of complications and the reintervention rate. In view of the high complication rate, especially in patients with a long life expectancy and benign conditions, objective guidelines regarding the choice of urinary diversion will help surgeons in decision making, patient selection and counseling