RESUMO
A short cut review was carried out to establish whether the insertion of a femoral central venous pressure line causes more thrombotic complications than insertion of a jugular line. Altogether 90 papers were found using the reported search, of which eight presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Veia Femoral , Trombose/etiologia , Idoso , Emergências , Fraturas Ósseas/complicações , Fraturas Ósseas/terapia , Humanos , Masculino , Edema Pulmonar/complicações , Edema Pulmonar/terapiaRESUMO
A short cut review was carried out to establish whether femoral central venous lines were as reliable as subclavian or jugular lines at assessing right atrial filling pressure. Altogether 141 papers were found using the reported search, of which seven presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Assuntos
Pressão Venosa Central/fisiologia , Veia Femoral , Acidentes de Trânsito , Determinação da Pressão Arterial/normas , Cateterismo Venoso Central/métodos , Feminino , Humanos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Vancomycin is effective in reducing the risk of mediastinits and topical vancomycin has been hypothesised to give high local dose concentrations while avoiding high systemic levels, thus avoiding the risk of bacterial resistance to this second-line antibiotic. However, this theory has never been tested and the degree to which vancomycin is absorbed systemically is unknown. METHODS: Fourteen patients undergoing elective coronary artery bypass grafts (CABG) received 500mg of topical vancomycin prior to sternotomy closure. Serum samples were taken at 30, 60, 120, 180 and 720min post-operatively. In addition, samples were taken from the drain bottles and urine samples taken daily for 5 days. Vancomycin levels were measured by fluorescence polarisation immunoassay, using the reverse dilution method to give a detection limit of 0.8mg/l. RESULTS: Vancomycin was detected in almost all serum samples. Peak concentration was at 30min and the mean value was 2.96mg/l (range, 0.99-5.00mg/l). This mean fell to 1.32mg/l at 6h. Of the 500mg of vancomycin applied, a mean of only 8.8mg was found to have been lost into the drain bottles in the first 24h (range, 0.17-12.5mg). When 5 consecutive days of urine collection was achieved, a mean of 151mg of vancomycin was excreted (range, 40-195mg) and vancomycin was detectable in the urine till day 5. The mean concentration of vancomycin in the urine was maximal on day 1 and was 24.4mg/l (range, 4.49-44.98mg/l). CONCLUSIONS: Topical vancomycin causes significant systemic concentrations in the 6h post-surgery and can be detected in the urine for up to 5 days post-surgery.
Assuntos
Antibacterianos/administração & dosagem , Mediastinite/prevenção & controle , Vancomicina/administração & dosagem , Administração Tópica , Idoso , Análise de Variância , Antibacterianos/sangue , Antibacterianos/urina , Estudos de Coortes , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Vancomicina/sangue , Vancomicina/urinaRESUMO
A short cut review was carried out to establish whether the seldinger "over the wire" technique is better than other techniques of pneumothorax drainage. Altogether 28 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Assuntos
Tubos Torácicos , Drenagem/instrumentação , Pneumotórax/cirurgia , Adulto , Tubos Torácicos/efeitos adversos , Medicina Baseada em Evidências , Humanos , Masculino , Toracostomia/instrumentaçãoRESUMO
A short cut review was carried out to establish whether the odontoid peg view is useful to radiologically exclude cervical spine injury in children under 9 years of age. Altogether 156 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. In addition recent guidelines are noted. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Criança , Pré-Escolar , Medicina Baseada em Evidências , Humanos , Lactente , Recém-Nascido , Processo Odontoide/diagnóstico por imagem , Radiografia/métodosRESUMO
A short cut review was carried out to establish whether clinical examination can be used to exclude cervical spine injury in alert children. Altogether 298 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Traumatismos da Medula Espinal/diagnóstico por imagem , Criança , Medicina Baseada em Evidências , Humanos , Masculino , Seleção de Pacientes , RadiografiaRESUMO
A short cut review was carried out to establish whether the administration of antibiotics reduces the incidence of intrathoracic infection in patients who have had a chest drain inserted after trauma. Altogether 321 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.