Lesser incidence of accidental catheter removal with femoral versus radial arterial access

Background Arterial catheterization is a frequent procedure in Intensive Care Units (ICUs). Accidental catheter removal (ACR) can cause severe and potentially life-threatening complications such as severe bleeding and vascular damage. Few data are available on accidental arterial catheter removal, and no studies have been found comparing the incidence of ACR between different arterial catheter sites. Objective To compare the incidence of ACR in femoral and radial arterial catheters. Research design Retrospective study. Setting A polyvalent ICU. Subjects All consecutive patients subjected to femoral or radial arterial catheterization. Measures The incidence of ACR per 100 catheter-days between groups was compared using Poisson regression. We considered ACR as the presence of unintended removal produced by the patient or healthcare personnel. Results A total of 2419 radial and 1085 femoral arterial catheters were inserted and remained in situ during 14,742 and 6497 days, respectively. We detected 45 cases of ACR with the femoral access and 162 cases with the radial access. The ACR rate was lower with the femoral access (4.1% vs 6.7% in the case of the radial access; p=0.003). Poisson regression analysis confirmed a lower incidence of ACR with the femoral versus the radial access (0.69 vs 1.10 ACR events per 100 catheter-days; OR 0.6, p=0.006, CI95% 0.01-0.83).Conclusions The incidence of ACR was found to be lower with the femoral than with the radial arterial catheters. In order to improve patient safety, it could be interesting to exhaustively monitor the incidence of ACR and adopt preventive measures, since ACR can give rise to serious complications (AU)

Antecedentes La cateterización arterial es un procedimiento frecuente en los pacientes de las Unidades de Cuidados Intensivos (UCI). La retirada accidental del catéter (ACR) puede conllevar graves complicaciones, potencialmente vitales, como la hemorragia y la lesión vascular. Existen pocos datos sobre la ACR de los catéteres arteriales y no hemos encontrado estudios que hayan comparado la incidencia de ACR entre los diferentes accesos de canalización arterial. Objetivo Comparar la incidencia de ACR entre los catéteres arteriales localizados en el acceso femoral y radial. Diseño del estudio Estudio retrospectivo. Lugar Una UCI polivalente. Sujetos Todos los pacientes consecutivos sometidos a canalización de arteria femoral o radial. Medidas La incidencia de ACR por 100 días de catéter entre grupos fue comparada mediante la regresión de Poisson. Se consideró ACR cuando se producía la retirada no programada del catéter por parte del propio paciente o por el personal. Resultados Se insertaron 2.419 catéteres en arteria radial que permanecieron durante 14.742 días, y 1.085 catéteres en arteria femoral que permanecieron durante 6.497 días. Se detectaron 45 casos de ACR en el sitio femoral y 162 casos en el sitio radial. Hubo una menor tasa de ACR en el sitio femoral que en el radial (4,1% vs 6,7%; p=0,003). La regresión de Poisson mostró una menor incidencia de ACR en el sitio femoral que en el radial (0,69 vs 1,10 eventos de ACR por 100 días de catéter; OR 0,6, p = 0,006, IC95% 0,01-0,83).Conclusiones Encontramos una menor incidencia de ACR en el sitio femoral que en el radial. Pensamos, que para mejorar la seguridad de los pacientes podría ser interesante monitorizar exhaustivamente la incidencia de ACR e implementar medidas preventivas, debido a que la ACR puede conllevar complicaciones graves (AU)

Lesser incidence of accidental catheter removal with femoral versus radial arterial access.

BACKGROUND: Arterial catheterization is a frequent procedure in Intensive Care Units (ICUs). Accidental catheter removal (ACR) can cause severe and potentially life-threatening complications such as severe bleeding and vascular damage. Few data are available on accidental arterial catheter removal, and no studies have been found comparing the incidence of ACR between different arterial catheter sites. OBJECTIVE: To compare the incidence of ACR in femoral and radial arterial catheters. RESEARCH DESIGN: Retrospective study. SETTING: A polyvalent ICU. SUBJECTS: All consecutive patients subjected to femoral or radial arterial catheterization. MEASURES: The incidence of ACR per 100 catheter-days between groups was compared using Poisson regression. We considered ACR as the presence of unintended removal produced by the patient or healthcare personnel. RESULTS: A total of 2419 radial and 1085 femoral arterial catheters were inserted and remained in situ during 14,742 and 6497 days, respectively. We detected 45 cases of ACR with the femoral access and 162 cases with the radial access. The ACR rate was lower with the femoral access (4.1% vs 6.7% in the case of the radial access; p=0.003). Poisson regression analysis confirmed a lower incidence of ACR with the femoral versus the radial access (0.69 vs 1.10 ACR events per 100 catheter-days; OR 0.6, p=0.006, CI95% 0.01-0.83). CONCLUSIONS: The incidence of ACR was found to be lower with the femoral than with the radial arterial catheters. In order to improve patient safety, it could be interesting to exhaustively monitor the incidence of ACR and adopt preventive measures, since ACR can give rise to serious complications.

Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial.

Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469-1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.

Manejo de la vía aérea con remifentanilo en el síndrome de Pterigium múltiple (Enfermedad de Escobar) / No disponible

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[Anesthetic management for left ventricular epicardial lead implantation with minimally invasive thoracoscopic guidance]. / Manejo anestésico para la implantación de electrodos epicáirdicos en el ventrículo izquierdo, mediante cirugía mínimamente invasiva asistida.

Medical treatment for left ventricular (LV) systolic dysfunction and congestive heart failure has improved quality of life for patients but mortality rates have remained unaffected. For a subgroup of such patients with interventricular conduction delays and ventricular contraction dyssynchrony, cardiac resynchronization by placement of a LV epicardial lead is a new approach to management. We report 3 cases in which such electrodes were implanted under the guidance of minimally invasive thoracoscopy. In the first 2 cases it was decided to place the LV electrode using thoracoscopic guidance because of complications or technical difficulties in the percutaneous procedure. In the third case thoracoscopy was used because of deterioration of the patient's condition after implantation of a double-chamber pacemaker and shifting of the lead to the right ventricle. The literature on the anesthetic management of such patients is scarce. Although sedation with general anesthesia and single-lung ventilation is indicated for percutaneous procedures, that technique also proved adequate for the thoracoscopic procedures.

Mascarilla laríngea Proseal / Proseal laryngeal mask

La mascarilla laríngea Proseal está introducida en lapráctica clínica desde el año 2000. Son muchos los artículosque se han publicado en este tiempo sobre su utilización,generalmente en casos clínicos concretos. En estetrabajo se presenta una revisión del dispositivo y susposibles indicaciones, contraindicaciones, técnicas deinserción, complicaciones de uso; así como una comparacióncon la mascarilla laríngea clásica o convencional.Para ello hemos revisado la literatura médica existentehasta octubre del 2005 mediante búsqueda en MEDLINE,utilizando los términos de búsqueda “ProSeal laryngealmask airway, anaesthesia”

The Proseal laryngeal mask was introduced into clinicalpractice in 2000. Since then, many publications,most of them case reports, have discussed the use of thismask. This review considers the possible indications andcontraindications for use of this device, techniques forinsertion, and complications. The Proseal is comparedwith the conventional laryngeal mask. We reviewed theliterature indexed on MEDLINE through October 2005using the search terms Proseal laryngeal mask, airway,and anesthesia

Manejo anestésico para la implantación de electrodos epicárdicos en el ventrículo izquierdo, mediante cirugía mínimamente invasiva asistida / Anesthetic management for left ventricular epicardial lead implantation with minimally invasive thoracoscopic guidance

El tratamiento médico de los pacientes con disfunciónsistólica del ventrículo izquierdo (VI) y afectos de insuficienciacardiaca congestiva (ICC), ha mejorado su calidadde vida pero no así la mortalidad. Existe un subgrupode estos pacientes, con alteraciones en laconducción interventricular y asincronía de la contracciónventricular, en los que la terapia de resincronizacióncardiaca (TRC), se consideró una nueva alternativaen su manejo mediante implantación de un electrodoepicárdico en VI. Se exponen tres casos en los que seprocedió a su implantación mediante cirugía mínimamenteasistida. En los dos primeros casos se decidió laimplantación del electrodo epicárdico a VI, mediantecirugía mínimamente invasiva, por complicaciones odificultad técnica del procedimiento percutáneo y en eltercer caso por deterioro clínico del paciente, tras lacolocación de marcapasos bicameral, y desplazamientode electrodo epicárdico a ventrículo derecho.La literatura es escasa en el manejo anestésico deestos pacientes. Si bien para técnicas percutáneas serecurrió a la sedación, con anestesia general medianteventilación unipulmonar, se logró un manejo adecuadoen el procedimiento asistido por toracoscopia

Medical treatment for left ventricular (LV) systolicdysfunction and congestive heart failure has improvedquality of life for patients but mortality rates haveremained unaffected. For a subgroup of such patientswith interventricular conduction delays and ventricularcontraction dyssynchrony, cardiac resynchronization byplacement of a LV epicardial lead is a new approach tomanagement. We report 3 cases in which such electrodeswere implanted under the guidance of minimally invasivethoracoscopy. In the first 2 cases it was decided toplace the LV electrode using thoracoscopic guidancebecause of complications or technical difficulties in thepercutaneous procedure. In the third case thoracoscopywas used because of deterioration of the patient's conditionafter implantation of a double-chamber pacemakerand shifting of the lead to the right ventricle.The literature on the anesthetic management of suchpatients is scarce. Although sedation with general anesthesiaand single-lung ventilation is indicated for percutaneousprocedures, that technique also proved adequatefor the thoracoscopic procedures

[Proseal laryngeal mask]. / Mascarilla laríngea Proseal.

The Proseal laryngeal mask was introduced into clinical practice in 2000. Since then, many publications, most of them case reports, have discussed the use of this mask. This review considers the possible indications and contraindications for use of this device, techniques for insertion, and complications. The Proseal is compared with the conventional laryngeal mask. We reviewed the literature indexed on MEDLINE through October 2005 using the search terms Proseal laryngeal mask, airway, and anesthesia.

Fase de remisión en niños con diabetes tipo 1 / Remission phase in children with type 1 diabetes

Objetivos. l. Relacionar la aparición de la fase de remisión (FR) en diabéticos tipo 1 menores de 14 años con variables conocidas en el momento del diagnóstico y con la pauta de tratamiento insulínico instaurada al debut. 2. Valorar si la existencia de esta fase influye en el requerimiento insulínico y en el control metabólico en los cinco primeros años de evolución de la diabetes. Pacientes y métodos. Estudio retrospectivo de los niños con diabetes tipo 1 con debut antes de los 14 años de edad. Se definió FR como aquella en la que el requerimiento insulínico era menor de 0,5 U/kg/día. Resultados. Se incluyeron en el estudio 121 pacientes (71 varones) de edades comprendidas entre 1,0 y 13,7 años en el momento del diagnóstico. 78 pacientes (64,5 por ciento) presentaron FR. En los varones 53/71 presentaron FR, frente a 25/50 en mujeres (p<0,01). En los menores de 5 años la proporción de FR fue de 20/46, menor que en los otros segmentos de edad (p<0,001). En los tratados con insulinoterapia intensiva la proporción de FR fue de 35/48 frente a 43/73 en los tratados de forma convencional (No significación). La dosis de insulina al alta hospitalaria fue menor en el grupo con FR (0,56 U/kg/d frente a 0,78) (p<0,001). La duración de la FR fue de 10,6 (7,2) meses, rango l-30. E1 requerimiento insulínico y los valores de hemoglobina glicada media solo fueron menores en el grupo con FR en el primer año de evolución. Conclusiones. l. Los diabéticos tipo 1 menores de 14 años que presentan FR son con mayor frecuencia los varones, los mayores de 5 años y los que reciben menor dosis de insulina al debut. La insulinoterapia intensiva no aumenta la prevalencia de FR. 2. No existen diferencias en el requerimiento insulínico ni en el control metabólico entre los dos y cinco años de diabetes entre los niños que presentan FR y los que no. (AU)

Respuesta del tirotropinoma a análogos de somatostatina. A propósito de un caso / Response of thyrotropinoma to somatostatin-analogues. Report a case

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High glucose induces cell death of cultured human aortic smooth muscle cells through the formation of hydrogen peroxide.

Alterations of the vessel structure, which is mainly determined by smooth muscle cells through cell growth and/or cell death mechanisms, are characteristic of diabetes complications. We analysed the influence of high glucose (22 mM) on cultured human aortic smooth muscle cell growth and death, as hyperglycaemia is considered one of the main factors involved in diabetic vasculopathy. Growth curves were performed over 96 h in medium containing 0.5% foetal calf serum. Cell number increased by 2 - 4 fold over the culture period in the presence of 5.5 mM (low) glucose, while a 20% reduction in final cell number was observed with high glucose. Under serum-free conditions, cell number remained constant in low glucose cultures, but a 40% decrease was observed in high glucose cultures, suggesting that high glucose may induce increased cell death rather than reduced proliferation. Reduced final cell number induced by high glucose was also observed after stimulation with 5 or 10% foetal calf serum. The possible participation of oxidative stress was investigated by co-incubating high glucose with different reactive oxygen species scavengers. Only catalase reversed the effect of high glucose. Intracellular H(2)O(2) content, visualized with 2',7'-dichlorofluorescein and quantified by flow cytometry, was increased after high glucose treatment. To investigate the cell death mechanism induced by high glucose, apoptosis and necrosis were quantified. No differences were observed regarding the apoptotic index between low and high glucose cultures, but lactate dehydrogenase activity was increased in high glucose cultures. In conclusion, high glucose promotes necrotic cell death through H(2)O(2) formation, which may participate in the development of diabetic vasculopathy.

Thapsigargin induces apoptosis in cultured human aortic smooth muscle cells.

Vascular remodeling is a key feature of many pathologic states, including atherosclerosis, or hypertension. Vascular smooth muscle cells participate in determining the vessel structure by several mechanisms such as cell migration, cell growth, or cell death (necrosis or apoptosis). Here we report that thapsigargin, an inhibitor of endoplasmic reticulum Ca2+ -adenosine triphosphatase (ATPase), is able to induce apoptosis in human vascular smooth muscle cells (HVSMCs). Apoptosis was assessed by three different methods: differential chromatin binding dye staining. cytoplasmic histone-associated DNA fragments detection by enzyme-linked immunosorbent assay (ELISA) and terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). When HVSMCs were treated for 1 h with thapsigargin (100 nM-10 microM), there was a concentration-dependent increase in both parameters 24 h after the thapsigargin pulse. When a time-course experiment was performed, both parameters were significantly enhanced from 3 to 6 h after the exposure to thapsigargin. We conclude that thapsigargin promotes apoptosis in HVSMCs, providing a useful tool for the study of programmed cell death in human vascular smooth muscle.

Regression of primary gastric B-cell mucosa-associated lymphoid tissue (MALT) lymphoma after eradication of Helicobacter pylori.

OBJECTIVE: primary gastric B-cell lymphoma of the mucosa-associated lymphoid tissue type has been linked to infection of the gastric mucosa with Helicobacter pylori. The eradication of this pathogen with antibiotics can lead to regression of this type of lymphoma. The objective of this study was to describe the clinical, endoscopic and histologic evolution in 6 patients with primary gastric B-cell lymphoma of the mucosa-associated lymphoid tissue type treated with eradication of H. pylori. METHOD: descriptive study of a retrospective case series. Patients with low-grade gastric mucosa-associated lymphoid tissue type lymphoma were initially treated with eradication therapy for H. pylori. We evaluated their clinical, endoscopic and histologic course in sequential follow-up visits after initial therapy. RESULTS: six patients who satisfied all selection criteria were studied. In five of six patients H. pylori was eradicated and the lymphoma showed regression within 6 to 24 months. In one patient transition of low-grade to high-grade gastric lymphoma occurred. CONCLUSIONS: these results, along with similar findings from other studies, suggest eradication of H. pylori should be the initial treatment of choice for low-grade B-cell gastric mucosa-associated lymphoid tissue type lymphoma in the early stages. The most appropriate duration of follow-up is unknown, but prolonged follow-up is indicated to detect recurrences.