Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study.

INTRODUCTION: This study aimed to ascertain the associations of thromboelastography (TEG® ) and standard laboratory test (SLTs) values with the presence of bleeding in critically ill patients with known coagulopathy. METHODS: Three groups of coagulopathic patients with (a) hepatic failure, (b) postoperative period after prolonged cardiac surgery, and (c) complex abdominal surgery with sepsis were prospectively included in this study. On intensive care unit (ICU) admission, patients were stratified into two groups according to whether they had major bleeding (MB) (evident overt bleeding, important bleeding apparent on imaging studies, and/or need for moderate-massive blood transfusion and hemodynamic instability). Blood samples were drawn for the SLTs (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count, and fibrinogen level [Clauss]) and TEG whole blood coagulation assays. Receiver operating characteristic (ROC) curves were generated to determine the efficiency of TEG and SLTs for detecting bleeding. The correlations between SLTs and TEG parameters with similar coagulation profiles were evaluated by Spearman rank-order analysis. RESULTS: Eighty-three patients were included, and bleeding was confirmed in 45 (54%). The fibrinogen level demonstrated the best accuracy for detecting bleeding with an area under the curve and 95% confidence intervals [AUC (95% CI)] of 0.74 (0.63-0.85) with the best cutoff value of ≤ 2 g/L. Regarding TEG-MA, the AUC (CI) obtained with the optimal cutoff value of ≤ 51 mm was 0.68 (0.56-0.80). CONCLUSIONS: Both conventional clotting tests and TEG values were poorly associated with bleeding in this critically ill cohort of patients with coagulopathy.

Reliability of the portable coagulometer qLabs to accurately measure the activated thromboplastin time and international normalized ratio: a prospective study in critically ill patients.

: The current prospective study was aimed at investigating whether a portable coagulometer (qLabs) can be used to reliably monitor activated thromboplastin time (aPTT) and international normalized ratio (INR) in critically ill patients, as compared with standard central laboratory measurement. Both precision and accuracy of INR and aPTT measured by qLabs were assessed in this observational study by finger prick group (N = 30 patients) and blood droplet group from central venous catheter drawn (N = 60). For accuracy, clinical agreement percentage was ±0.3 for INR and ±10 s for aPTT. Precision of INR measurement in qLabs showed excellent intraclass correlation coefficient (ICC > 90%). Precision of aPTT measurement in qLabs was less acceptable for both finger prick [ICC: 0.70; Bland-Altman plot: 2.2 s (-19.8, 24.2)] and blood droplet [ICC: 0.50; Bland-Altman plot: 0.4 s (-70.9, 71.8)] groups. Accuracy of qLabs was acceptable for INR assessment (clinical agreement 90 and 81%, for finger prick and blood droplet groups, respectively), but not for aPTT (clinical agreement 55 and 68%, respectively). Accuracy of finger prick and blood droplet measurements in qLabs was better for INR and aPTT values near-to-normal (1.2 and 37 s, respectively). INR values from qLabs were consistent with the 'gold standard'. qLabs measurement is only reliable for aPTT values near-to-normal.

Doble inervación del músculo braquial en la población chilena / Dual innervation of the brachialis muscle in the Chilean population

La doble inervación del músculo braquial está dada por el nervio musculocutáneo y por ramos provenientes del nervio radial según lo describen algunos textos anatómicos y numerosos trabajos científicos. Sin embargo, no existe consenso en la frecuencia con la que ésta se presenta. El objetivo de este estudio es verificar la presencia y determinar la frecuencia de la contribución del nervio radial en la inervación del músculo braquial. En el presente trabajo se utilizaron 30 miembros superiores previamente fijados con solución fijadora y conservadora. Se realizó disección de la región braquial para determinar la presencia de ramos del nervio radial inervando al músculo braquial, verificando la presencia de ramos que penetraban en el músculo y tomando muestras de estos ramos en el sitio donde perforaban al músculo para su estudio histológico. Fue posible observar la presencia de ramos del nervio radial que penetraban en el músculo braquial en un 90 porciento de los casos; en ellos el punto motor de estos ramos se ubicó siempre en el tercio distal del músculo. De acuerdo a los resultados obtenidos en el presente trabajo, la doble inervación del músculo braquial observada por autores clásicos y reportada en estudios en diversas poblaciones, está presente en alto porcentaje de la muestra. Estos hallazgos pueden servir de referencia para procedimientos quirúrgicos, estudios electromiográficos y sonográficos.

The dual innervation of the brachialis muscle by the musculocutaneos nerve and branches from the radial nerve has been described by some anatomical texts and several scientific papers; however, there is no consensus about the frequency with which this occurs. In this study we proposed to check the presence and determine the frequency of the contribution of radial nerve in the innervations of the brachialis muscle. In this study we used 30 upper limbs fixed in fixative and conservative solution. Dissection of the brachial region was carried out, checking the branches that penetrated the muscle and taking samples of these branches to histological study. It was possible to observe the presence of branches of the radial nerve innervating the brachialis muscle in a 90 percent of the sample used in this study; the motor point of these branches was always located in the distal third of this muscle. According with the results of this study, the dual innervations of the brachial muscles observed by classical authors and reported by several investigations is also present in a high percentage of the sample. These findings can serve as reference for surgical procedures, electromyographic and ultrasound studies.