Validity of Corrected Flow Time (FTc) as a Predictor of Fluid Responsiveness in Patients with Sepsis-induced Hypotension

PURPOSE: To determine the validity of corrected flow time (FTc) as a predictor of fluid responsiveness for patients with sepsis-induced hypotension in the emergency department. METHODS: A total of 26 adult patients, who presented in the emergency department with sepsis-induced hypotension with spontaneous breathing, were enrolled in this prospective, interventional study. These patients were monitored by Esophageal Doppler (ED); FTc, central venous pressure (CVP), stroke volume index (SVI), and inferior vena cava diameter (IVCD) were measured before and after fluid challenge. Responsiveness to fluid challenge was defined as an SVI increase> or =10%. Receiver operating characteristic (ROC) curves were constructed and compared to evaluate the overall performance of preload indices (CVP, FTc, IVCD) in terms of predicting fluid responsiveness. RESULTS: Of the hemodynamic parameters initially measured, there were statistically significant differences in FTc and CVP between the responsive and unresponsive groups. Before and after fluid challenge, noticeable changes were observed in mean arterial pressure (MAP), CVP and IVCD between the two groups. Only the responsive group demonstrated statistical difference in FTc. The areas under the curves for FTc (0.870; 95% CIs, 0.708-0.979; p=.009) were significantly greater than those for CVP and IVCD. CONCLUSION: The corrected flow time (FTc) method may be a good predictor of fluid responsiveness relative to sepsis-induced hypotension for patients in the emergency department.

Validity of Corrected Flow Time (FTc) as a Predictor of Fluid Responsiveness in Patients with Sepsis-induced Hypotension

PURPOSE: To determine the validity of corrected flow time (FTc) as a predictor of fluid responsiveness for patients with sepsis-induced hypotension in the emergency department. METHODS: A total of 26 adult patients, who presented in the emergency department with sepsis-induced hypotension with spontaneous breathing, were enrolled in this prospective, interventional study. These patients were monitored by Esophageal Doppler (ED); FTc, central venous pressure (CVP), stroke volume index (SVI), and inferior vena cava diameter (IVCD) were measured before and after fluid challenge. Responsiveness to fluid challenge was defined as an SVI increase> or =10%. Receiver operating characteristic (ROC) curves were constructed and compared to evaluate the overall performance of preload indices (CVP, FTc, IVCD) in terms of predicting fluid responsiveness. RESULTS: Of the hemodynamic parameters initially measured, there were statistically significant differences in FTc and CVP between the responsive and unresponsive groups. Before and after fluid challenge, noticeable changes were observed in mean arterial pressure (MAP), CVP and IVCD between the two groups. Only the responsive group demonstrated statistical difference in FTc. The areas under the curves for FTc (0.870; 95% CIs, 0.708-0.979; p=.009) were significantly greater than those for CVP and IVCD. CONCLUSION: The corrected flow time (FTc) method may be a good predictor of fluid responsiveness relative to sepsis-induced hypotension for patients in the emergency department.

Clinical Predictors of Cervical Abscess in Adult Emergency Department Patients Presenting a Sore Throat

PURPOSE: To evaluate clinical predictors of cervical abscess in adult patients who present a sore throat. METHODS: We prospectively studied adult patients (18 years of age or older) who presented with a sore throat at one of three hospitals (Chungnam national university hospital, Chungbuk national university hospital, and Konyang university hospital) from June 2010 to June 2011. The enrolled patients received a neck computed tomography scan, and their clinical manifestations were investigated. We evaluated several clinical variables in order to predict the existence of cervical abscess by use of multiple logistic regression analysis, and assessed the ability of the results of these variables to accurately diagnose cervical abscess using a receiver operating characteristic curve. RESULTS: A total of 109 patients were enrolled in this study. We identified two clinical variables (swelling and voice change) useful in predicting the existence of cervical abscess, and the AUC acquired by adding the scores of the two clinical factors was 0.89 (p<0.01). The sensitivity and specificity of these clinical factors to predict cervical abscess were 0.96 and 0.69 when the cut off value was determined to be 2. CONCLUSION: Two clinical factors (swelling and voice change) were useful in predicting the appearance of cervical abscesses. Consideration should be made for the need for incision and drainage of a cervical abscess if a patient presents swelling, or swelling and voice change.

Clinical Predictors of Cervical Abscess in Adult Emergency Department Patients Presenting a Sore Throat

PURPOSE: To evaluate clinical predictors of cervical abscess in adult patients who present a sore throat. METHODS: We prospectively studied adult patients (18 years of age or older) who presented with a sore throat at one of three hospitals (Chungnam national university hospital, Chungbuk national university hospital, and Konyang university hospital) from June 2010 to June 2011. The enrolled patients received a neck computed tomography scan, and their clinical manifestations were investigated. We evaluated several clinical variables in order to predict the existence of cervical abscess by use of multiple logistic regression analysis, and assessed the ability of the results of these variables to accurately diagnose cervical abscess using a receiver operating characteristic curve. RESULTS: A total of 109 patients were enrolled in this study. We identified two clinical variables (swelling and voice change) useful in predicting the existence of cervical abscess, and the AUC acquired by adding the scores of the two clinical factors was 0.89 (p<0.01). The sensitivity and specificity of these clinical factors to predict cervical abscess were 0.96 and 0.69 when the cut off value was determined to be 2. CONCLUSION: Two clinical factors (swelling and voice change) were useful in predicting the appearance of cervical abscesses. Consideration should be made for the need for incision and drainage of a cervical abscess if a patient presents swelling, or swelling and voice change.

Comparison of Compression Adjusted Ventilation to Conventional Ventilation: For Adequate Ventilation Rate During Cardiopulmonary Resuscitation

PURPOSE: The objective of this study is to determine whether application of ventilation in line with compression rate in performance of CPR for cardiac arrest patients was helpful in maintaining an adequate ventilation rate. METHODS: Volunteers who received education on the revised 2010 CPR guidelines were randomly assigned to either a conventional ventilation (CV) group or a compression-adjusted ventilation (CAV) group. During performance of CPR, compression rate and ventilation rate were measured every minute, and the participants' roles were changed every two minutes; CPR was performed for a total of eight minutes. RESULTS: A total of 57 volunteers participated in this study. No statistically significant difference was observed between the compression rate of the CV group and that of the CAV group. However, regarding adequacy of the ventilation rate, greater improvement was observed in the CAV group, compared with the CV group (adequate ventilation: 86.2% vs. 46.4%, p<0.001). In addition, the median value of the ventilation rate was 8.4/min (IQR: 7.7-9.6) in the CV group and 9.5/min (IQR: 9.0-10.0) in the CAV group (p=0.003). CONCLUSION: When no other valid approach is available, use of the CAV method is conducive to maintenance of an adequate ventilation rate.