Ultrasound guidance versus anatomical landmarks for subclavian vein catheterization: a prospective study.

BACKGROUND: Several clinical practice guidelines strongly support the use of ultrasound guidance (USG) for internal jugular vein catheterization. The level of evidence concerning the use of USG for subclavian vein (SCV) cannulation remains low. AIM: To compare the effectiveness and safety of USG and anatomical landmarks approaches for cannulation of SCV. METHODS: This was a prospective randomized study. Patients aged over 18 years old who requiring elective central venous catheterization were included. Non-inclusion criteria were thrombosis of the vein or major coagulopathy. All catheterizations were performed by two anaesthesiology residents. Patients were randomized into two groups: ultrasound guidance group (US group) and anatomical landmarks (LM group). The main outcome was the success rate. The secondary outcomes were the first attempt success rate and the incidence of complications. RESULTS: Seventy patients were included (35 in each group). The success rate was higher in US group compared to LM group without statistical significance (100% vs 85.7%; p=0.054). The first attempt success rate was significantly higher in the US group (82.9% vs. 40%; p <10-3). The incidence of mechanical complications was significantly lower in the US group compared to LM group (5.7% vs. 37.1%; p=0,001). CONCLUSION: according to our study, US guidance for SCV catheterization seems to be an interesting alternative to anatomical landmarks approaches.

The Ability of Carbon Dioxide-Derived Indices to Predict Adverse Outcome After Cardiac Surgery.

OBJECTIVE: The objective of this study was to assess whether the central venous-to-arterial carbon dioxide partial-pressure difference (ΔPCO2) and the ratio of the ΔPCO2 to the arterial-venous difference in oxygen content (ΔPCO2/Ca-vO2) predict postoperative complications (PC) after cardiac surgery. DESIGN: Prospective, observational, noninterventional study. PARTICIPANTS: The study comprised 60 patients undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: The primary endpoint was the occurrence of PC. Data were first analyzed in two groups based on the occurrence of PC. Then, receiver operating characteristic curves of the ΔPCO2 and the ΔPCO2/Ca-vO2 ratio were analyzed for the prediction of PC. MEASUREMENTS AND MAIN RESULTS: Among the study participants, 22 (36.7%) experienced PC. The death rate was 18.3%. The present study found that the ΔPCO2 and the ΔPCO2/Ca-vO2 ratio predicted the occurrence of PC with areas under the curve of 0.702 and 0.666, respectively. The best thresholds of these markers were 8.3 mmHg for the ΔPCO2 and 2.16 mmHg/mL for the ΔPCO2/Ca-vO2 ratio. A significant difference was found for these indicators between the groups with and without PC. The ΔPCO2 and the ΔPCO2/Ca-vO2 ratio were significantly correlated to EuroSCORE II, duration of aortic clamping, majority of prognostic scores the first two days postoperatively, and the lactate level. The ΔPCO2/Ca-vO2 ratio is predictive of hyperlactatemia >2 mmol/L, with an area under the curve of 0.787. CONCLUSION: The ΔPCO2 and the ΔPCO2/Ca-vO2 ratio predict the occurrence of complications in cardiac surgery.