Central Venous Pressure Monitoring Research Articles

Surgery for phaeochromocytomas and paragangliomas: Current practice in the United Kingdom.

There is wide variability in the perioperative management of phaeochromocytoma and paraganglioma (PPGL) in different centres. This study aimed to summarise the management of PPGLs as reported in the United Kingdom Registry for Endocrine and Thyroid Surgery (UKRETS) database and to determine current perioperative management of PPGLs by surveying UK clinicians. Data recorded on UKRETS from 2005 to 2021 were subjected to descriptive analyses. British Association of Endocrine and Thyroid Surgeons members were invited to participate in an open survey relating to the perioperative management of patients with PPGLs. A total of 2,007 operations for PPGL from 49 participating centres were included. The median annual workload in each centre was four cases. Operations were performed predominantly laparoscopically (69%). The median length of stay (4 days) was the same in groups of surgeons stratified by volume. The survey had 29 respondents from 22 centres across the UK, and a formal protocol for perioperative management exists in 48% of the centres. Phenoxybenzamine (72%) was preferred for alpha-blockade. The practice of admitting patients for optimisation from 1 to 7 days before the day of surgery was common (62%). Central venous pressure and blood glucose monitoring were mentioned as routine intraoperative adjuncts by 72% of the responders. There is significant variation in the workload and perioperative management of PPGLs in the UK. This is potentially detrimental to patient outcomes and a consensus document might be beneficial to harmonise practice across the UK.

Intraoperative monitoring of stroke volume variation versus central venous pressure in liver surgery: a meta-analysis of randomized clinical trials

Intraoperative monitoring of stroke volume variation versus central venous pressure in liver surgery: a meta-analysis of randomized clinical trials

Early persistent exposure to high CVP is associated with increased mortality and AKI in septic shock: A retrospective study

PurposeThis study's objective was to investigate the association between exposure to different intensities of central venous pressure (CVP) over time in patients with septic shock with 28-day mortality and acute kidney injury (AKI). Materials and methodsWe obtained data from the AmsterdamUMCdb, which includes data on patients ≥18 years old with septic shock undergoing CVP monitoring. The primary outcome was mortality by day 28. Piecewise exponential additive mixed models were used to estimate the strength of the association over time. Results9668 patients were included in the study. They exhibited 8.2% overall mortality at 28 days and 41.1% AKI incidence. Daily time-weighted average CVP was strongly associated with increased mortality at 28 days, primarily within 24 h of ICU admission. The mortality rate of patients was lowest when the CVP was 6–12 cmH2O. When the time of high CVP (TWA-CVP >12 cmH2O) exposure within the first 24 h was >5 h, the risk of death increased by 2.69-fold. Additionally, patients exposed to high CVP had a significantly increased risk of developing AKI. ConclusionsThe optimal CVP range for patients with septic shock within 24 h of ICU admission is 6–12 cmH2O. Mortality increased when patients were exposed to high CVP for >5 h.

Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?

Sepsis is a clinical syndrome encompassing physiologic and biological abnormalities caused by a dysregulated host response to infection. Sepsis progression into septic shock is associated with a dramatic increase in mortality, hence the importance of early identification and treatment. Over the last two decades, the definition of sepsis has evolved to improve early sepsis recognition and screening, standardize the terms used to describe sepsis and highlight its association with organ dysfunction and higher mortality. The early 2000s witnessed the birth of early goal-directed therapy (EGDT), which showed a dramatic reduction in mortality leading to its wide adoption, and the surviving sepsis campaign (SSC), which has been instrumental in developing and updating sepsis guidelines over the last 20 years. Outside of early fluid resuscitation and antibiotic therapy, sepsis management has transitioned to a less aggressive approach over the last few years, shying away from routine mixed venous oxygen saturation and central venous pressure monitoring and excessive fluids resuscitation, inotropes use, and red blood cell transfusions. Peripheral vasopressor use was deemed safe and is rising, and resuscitation with balanced crystalloids and a restrictive fluid strategy was explored. This review will address some of sepsis management's most important yet controversial components and summarize the available evidence from the last two decades.

Extra-Thoracic Subclavian Vein Access: The Tips And Tricks

The success of any trans-venous procedure involves the rate liming step, which is the access. The procedure cannot be performed without the access site. It is the key that open the success of the procedure. There are many procedures that require extra-thoracic subclavian vein. These procedures may include: central venous pressure monitoring, administration of multiple medications and drips, high volume/flow resuscitation, emergency venous access, inability to obtain peripheral venous access, repetitive blood sampling, administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids; insertion of transvenous cardiac pacemakers, hemodialysis or plasmapheresis and insertion of pulmonary artery catheters. In this review, we discuss the various techniques of accessing the vein and it tips and tricks..

Evaluation of a Nurse-Driven Fluid Management Protocol to Improve Outcomes in Critically Ill Patients.

This article reports results of a nurse-driven fluid management protocol in a medical-surgical intensive care unit (ICU). Use of static measures such as central venous pressure monitoring, heart rate, blood pressure, and urine output is poor predictors of fluid responsiveness and can result in inappropriate fluid administration. Indiscriminate administration of fluid can result in prolonged mechanical ventilation time, increased vasopressor requirements, increased length of stay, and greater costs. Use of dynamic preload parameters such as stroke volume variation (SVV), pulse pressure variation, or changes in stroke volume with a passive leg raise has been shown to be more accurate predictors of fluid responsiveness. Improved patient outcomes including decreased length of hospital stay, reduction in kidney injury, decreased mechanical ventilation time and requirements, and reduced vasopressor requirements have been demonstrated by using dynamic preload parameters. ICU nurses were educated on cardiac output and dynamic preload parameters and a nurse-driven fluid replacement protocol was established. Knowledge scores, confidence scores, and patient outcomes were measured pre- and post-implementation. The results indicated that there was no change in knowledge scores between pre- and postimplementation groups (mean = 80%). There was a statistically significant increase in nurse confidence in using SVV (P = .003); however, this change is not clinically significant. There was no statistically significant difference in other confidence categories. The study indicated that ICU nurses were resistant to adoption of a nurse-driven fluid management protocol. While anesthesia clinicians are familiar with technologies to evaluate fluid responsiveness in the perioperative setting, the new technology posed challenges to ICU confidence. This project demonstrates that traditional methods of nursing education did not provide the support needed for implementation of a novel approach to fluid management, and that there is a need for further improvement in educational strategies.

The forgotten relevance of central venous pressure monitoring.

The forgotten relevance of central venous pressure monitoring.

ANESTHETIC MANAGEMENT OF LIVER RESECTION IN PEDIATRIC HEPATOBLASTOMA PATIENTS

Background – Children who present for liver resection are a challenge to anesthesiologists. They require adequate preoperative assessment and planning to improve their postoperative outcomes. A balanced technique providing organ protective anesthesia and hemodynamic stability ensures optimal surgical results. Anaesthesia for hep Result: atic resection has seen great changes with improvements in surgical technique and a better understanding of the underlying physiology. Good communication and interdisciplinary strategization between the pediatric oncologist, surgeon and the anesthesiologist also facilitate a good outcome. A retrospective review was performed on 20 cases of pediatric hepatoblastoma planned for partial hepatectomy in a pediatric tertiary care center in South India, over a 3-year period. Conclusion: In this study, general anesthesia with epidural analgesia and goal directed uid management with monitoring of central venous pressure and mean blood pressure during liver resection was found to be acceptable for pediatric liver resection without any signicant complications

Discussion on the zero-calibration and the zero line in the measurement of central venous pressure and invasive arterial blood pressure

To figure out the timing of zeroing and the location of the zero line in the central venous pressure (CVP) monitoring and invasive arterial blood pressure (IBP) monitoring, and to provide scientific and accurate data for patients management. The liquid vessel models were used to simulate the pressure measurement process of the continuous pressure monitoring system. Based on the theory of fluid mechanics and the knowledge of blood pressure physiology and cardiovascular anatomy, the composition and influencing factors of the pressure in the fluid-filled catheter system during the zeroing and placing the transducer in the zero line of CVP and IBP, were analyzed. The pressure in the liquid-filled catheter system was composed of atmospheric pressure, the pressure of pumping bag, the gravity of the water column (the vertical distance between the liquid level of Murphy's dropper and pressure transducer, ΔH), and the resistance of tube wall. This pressure value is set as a pressure of 0 mmHg (1 mmHg ≈ 0.133 kPa). In the process of pressure measurement, when the pressure transducer was placed at a horizontal position of 10 cm below the highest liquid level of the vessel, the pressure measured at different catheter tip positions was all 10 cmH2O (1 cmH2O ≈ 0.098 kPa); When the pressure transducer was placed at the horizontal position of the highest liquid level of the vessel, the measured pressure is 0 mmHg. Zeroing should repeatedly be performed only when one or more conditions (atmospheric pressure, pressure of pumping bag, gravity of ΔH water column and resistance of tube wall) are changed. In the measurement process, the pressure transducer should be placed at the zero line position at any time to eliminate the influence of hydrostatic pressure and to ensure the objective and accurate value.

Design and application of a central venous pressure measurement tool

Central venous pressure (CVP) reflects the comprehensive condition of effective blood volume, cardiac function and vascular tone. Clinical monitoring of CVP can indirectly understand and evaluate the dynamic changes of blood volume in patients, and provide a reference for patients to venous fluid. At present, the traditional manual measurement method is widely used for measurement, which has some shortcomings such as zero shift, cumbersome operation (requires two health care workers to cooperate). In order to overcome the above problems, the author invented a new fixable CVP measurement tool and obtained the national utility model patent (ZL 2021 2 1451705.7). The tool is mainly composed of a base plate, a movable frame and a measuring department, etc. When used, the base plate is placed into the back of the patient and pressed and fixed, the movable frame is adjusted, the zero point is found, and the measurement data is read from the measuring department. It has the advantages of simple and convenient operation, small measurement error, wide applicability (different body types) and so on, which is suitable for clinical promotion.

Correlation between Glasgow Coma Scale with central venous pressure and near-infrared spectroscopy in patients with acquired brain injury in the intensive care unit of Adam Malik Hospital Medan

Abstract Background Acquired brain injury (ABI) is caused by trauma or nontrauma to the brain after birth. Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure. After traumatic brain injury, there is an increase in air content in the brain and an increase in volume of blood flow to the brain, which can cause increased intracranial pressure, herniation of brain tissue, impaired cerebral perfusion, and brain damage. Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure. Near-infrared spectroscopy (NIRS) and central venous pressure (CVP) monitoring are also associated with cerebral perfusion. This study aimed to determine the relationship between the Glasgow Coma Scale (GCS) scores and CVP and NIRS values in patients with ABI. Methods This prospective analytical study used a cross-sectional design to compare GCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit (ICU) of Haji Adam Malik Hospital Medan. GCS, CVP, and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed, or median (interquartile range) values if the data were not normally distributed. The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed, or the Spearman test if the data were not normally distributed. Results In this study, the mean GCS score and CVP values were 7.04 ± 2.69 and 5.63 ± 25.82 mmHg, respectively. The right tissue oxygen saturation (StO2) was 55.61% ± 18.72%, and the left StO2 was 57.57% ± 17.48% with normally distributed data. There was no correlation between GCS scores and CVP values (P = 0.829), and no correlation between moderate GCS scores and right and left StO2 (P = 0.343; P = 0.121); however, there was a significantly strong positive correlation between severe GCS scores and right and left StO2 (P = 0.028, r = 0.656; P = 0.005, r = 0.777). Conclusion There was no significant correlation between GCS scores and CVP values, and no correlation between moderate GCS scores and NIRS values; however, there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Errors in pressure measurements due to changes in pressure transducer levels during adult cardiac surgery: a prospective observational study

BackgroundBlood pressure measurement is an essential element during intraoperative patient management. However, errors caused by changes in transducer levels can occur during surgery.MethodsThis single center, prospective, observational study enrolled 25 consecutive patients scheduled for elective cardiac surgery with invasive arterial and central venous pressure (CVP) monitoring. Hydrostatic pressures caused by level differences (leveling pressure) between a reference point (on the center of the left biceps brachii muscle) and the transducers (fixed on the right side of the operating table) for arterial and central lines were continuously measured using a leveling transducer. Adjusted pressures were calculated as measured pressure – leveling pressure. Hypotension (mean arterial pressure < 80, <70, and < 60 mmHg), and CVP (< 6, ≥6 and < 15, or ≥ 15 mmHg) and pulmonary artery pressure (PAP, mean > 20 mmHg) levels were determined using unadjusted and adjusted pressures.ResultsTwenty-two patients were included in the analysis. Leveling pressure ≥ 3 mmHg and ≥ 5 mmHg observed at 46.0 and 18.7% of pooled data points, respectively. Determinations of hypotension using unadjusted and adjusted pressures showed disagreements ranging from 3.3 to 9.4% depending on the cutoffs. Disagreements in defined levels of CVP and PAP were observed at 23.0 and 17.2% of the data points, respectively.ConclusionsThe errors in pressure measurement due to changes in transducer level were not trivial and caused variable disagreements in the determination of MAP, CVP, and PAP levels. To prevent distortions in intraoperative hemodynamic management, strategies should be sought to minimize or adjust for these errors in clinical practice.Trial registrationcris.nih.go.kr (KCT0006510).

Management of massive transfusion and coagulation during bilateral hand transplantation surgery

Dear Editor, Massive transfusion (MT) aims to limit hypoperfusion till surgical hemostasis could be attained and takes into account volume status, tissue oxygenation, management of bleeding, and coagulation abnormalities.[1] However, it may not be possible to follow recommended protocols of MT strictly during hand transplant surgeries as, in addition to restoring blood volume, ensuring good perfusion and avoidance of thrombus formation in transplanted hands is critical. A 46 year-old-female, bilateral hand amputee, was posted for bilateral upper extremity allotransplantation (supracondylar level on the right side and mid-arm level on the left side). The donor was a 45 year-old-female who was declared brain dead following trauma. The recipient received standardized general anesthesia and immunosuppressants as per protocol. Femoral arterial, internal jugular, femoral venous, and two 16G saphenous catheters were placed. Her initial hemoglobin was 13.2 g/dL. Reperfusion of transplanted hands was done around 6 h intraoperatively following which there was major surgical bleeding and hemoglobin dropped <5 g/dL multiple times despite aggressive fluid replacements. The surgery lasted 15 h, and she received 12 units of packed red blood cells (PRBCs), 4 units of fresh frozen plasma (FFP), 2 L of hydroxyethyl starch, 600 mL albumin, 15 L of Kabilyte (acetated intravenous fluid), and 40 mL of 10% calcium gluconate. Intraoperative fluid management was guided by continuous arterial and central venous pressure monitoring, frequent arterial blood gas analysis including electrolyte levels, platelet count, prothrombin time, and thromboelastography (TEG). She required noradrenaline infusion up to 0.2 mcg/kg to maintain mean arterial pressure >65 mmHg, and urine output was >1 mL/kg/h. Intraoperatively, perfusion of transplanted hands was impeded by arterial and venous thrombi which required multiple thrombectomy and reanastomoses and fasciotomies for decompression. Therefore, a certain degree of coagulopathy was accepted to prevent further thrombus formation and hence MT protocols were not strictly followed. The aim was to maintain good perfusion of hands with target hemoglobin of 10 g/dL with hemodilution to facilitate perfusion across anastomoses. In 48 h, she had received a total of 21 units of PRBC and 9 units of FFP. Coagulation parameters were maintained at safe acceptable levels [Table 1]. Other than hypothermia, she did not develop any major complications such as renal or lung injury secondary to MT.Table 1: Laboratory investigation results and interventionsMT is defined as replacement of one entire blood volume within 24 h, transfusion of >10 units of PRBCs in 24 h, transfusion of >4 units of PRBCs in 1 h, or replacement of 50% of total blood volume within 3 h.[2] Consumption of coagulation factors during massive bleeding and dilution of remaining factors due to volume expanders add to coagulopathy and altered hemostasis.[3] Coagulation tests are usually time-consuming and may not greatly help in guiding therapy during ongoing massive bleeding. TEG tests the entire hemostatic system including platelet function and fibrinolytic system. Therefore it is useful in managing complicated coagulopathies with timely intervention.[2] Ideally, MT protocols are to be activated after transfusion of 4–10 units which have a predefined ratio of RBCs, FFP/cryoprecipitate, and platelet units (1:1:1 or 2:1:1 ratio).[4,5] It is concluded that during bilateral hand transplantation surgeries, management of MT should be individualized taking into account hemoglobin levels, coagulation profile, and perfusion of transplanted hands. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Non-invasive assessment of volume status of children with edema due to steroid sensitive nephrotic syndrome using urinary indices and inferior venacava ultrasonography

Background: It is clinically difficult to assess the intravascular volume status of children with edema in nephrotic syndrome. This makes decision-making challenging, regarding the use of diuretics or albumin infusion in the management of edema. Ideally, hormonal assay and central venous pressure monitoring are accurate but difficult to do as these methods are invasive and expensive to be applied to every child presenting with edema of nephrotic syndrome. Hence, the need for reliable non-invasive investigations to assess the volume status of children with edema. Aims and Objectives: The aim of the study was to assess the volume status of children with edema due to steroid sensitive nephrotic syndrome using noninvasive methods such as urinary indices (Fractional excretion of sodium (FeNa) and urine Potasium index (K index)) and inferior venacava diameter (IVCD) by ultrasonography and to determine the association between them. Materials and Methods: In this analytical cross-sectional study, 82 subjects fitting the inclusion criteria were included in the study. FeNa, K index and IVCD were determined. The volume status was assessed and association between the three calculated (Fischer exact test). Results: Out of 82 children, 56.1%, 68.3%, and 63.5% based on FeNa, K index, and IVCD respectively were having hypervolemic volume status. There is a statistically significant association between FeNa and K index and between urinary indices and IVCD. Conclusion: The present study supports the overfill hypothesis of edema formation. IVCD like urinary indices is a non-invasive and reliable investigation to determine volume status in nephrotic child with edema.

Value of Central Venous Pressure Monitoring in the Patients with Sepsis-Associated Acute Kidney Injury.

Although the measurement of central venous pressure (CVP) is a common clinical tool, the role of CVP monitoring in the outcome of sepsis is controversial because threshold values of CVP are uncertain, and there are only limited data on short-term survival of patients with septic acute kidney injury (AKI). This retrospective cohort study was based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (source of the training dataset). Multivariate regression analysis was performed to clarify the relation between CVP measurement and clinical outcomes, and a univariate regression model after propensity score matching was utilized to validate our findings. A mortality prediction model for septic AKI and a risk stratification scoring approach were developed, and the emergency intensive care unit (eICU) database was used for external validation. Of the 9170 patients in the training set, 2446 (26.7%) underwent CVP measurement. No significant association was found between CVP monitoring and 28-day mortality among patients with septic AKI (odds ratio = 0.479; 95% confidence interval 0.213-1.076, P = 0.075), even after adjustments (propensity score matching; P = 0.178). Length of ICU stay and hospital stay was markedly reduced in patients undergoing CVP measurement within 3 hours (median 6.2 and 10.9 days, respectively, P < 0.001). The addition of the mean perfusion pressure initial, CVP, and the magnitude of the CVP change within 48 hours to the model significantly increased model discrimination (area under the receiver operating characteristic curve: 0.867 and 0.780, respectively, P < 0.001). These findings suggest that CVP measurement alone has little effect on the outcome of septic AKI. Nonetheless, initial CVP levels and the dynamic changes in CVP within the first 48 hours after ICU admission and the mean perfusion pressure initial can improve the accuracy of outcome prediction models.

Invasive hemodynamic monitoring for fluid management in septic shock patients

Aim Sepsis is still one of the most common causes of death, despite advances in treatment and technologies. Invasive monitoring in sepsis can improve survival. In this study, we aimed to compare the efficacy of hemodynamic monitoring in the fluid treatment of patients with septic shock. Material and Method Forty septic shock patients were divided into two groups. Group I (n = 20) was monitored with central venous pressure, and Group II (n = 20) with a cardiac output device (EV1000). Arterial blood gases were analyzed four times daily for the groups, and lactate values, diuresis status, need for dialysis, and inotrope need was recorded. For Group I, the central venous pressure and mean arterial pressure values were recorded for group II, cardiac output, cardiac index, stroke volume, stroke volume index, and mean arterial pressure values. Results There was a significant difference between the mean arterial pressures of the groups on the 1st and 2nd days (p = 0.034 and p = 0.026, respectively). In Group II, mean arterial pressures were higher on days 1 and 2. There was no significant difference between the other data recorded. Conclusion We observed no significant difference between central venous pressure monitoring and invasive monitoring in septic shock patient follow-up.

To Evaluate the Effect between Normal Saline and Heparin Solution in Arterial Line Flushing on Platelet Count – A Cross Sectional Study

Introduction: Arterial catheters are widely used in intensive care units for continuous blood pressure monitoring and blood sampling. The patency of these lines is maintained by continuous flushing, usually with the addition of the anticoagulant heparin to the flushing solution. Normal saline solution can maintain patency of arterial and central venous pressure monitoring catheters. Aim of the Study: The aim of this study was to evaluate the effect between normal saline and heparin solution in arterial line flushing on platelet count. Methods: This was a prospective cross- sectional study conducted in the Department of Cardiac surgery of National Institute of Cardiovascular Disease (NICVD), Sher-E-Bangla Nagar, Dhaka, Bangladesh during the period from July 2016 to June 2017. This study included sixty patients who underwent single valve replacement surgery and shifted to the ICU with arterial line catheter. The patients who fulfilled the inclusion criteria were divided into two groups- Group A (with heparin solution) and Group B (with normal saline). Result: In total 60 patients from both the groups completed the study. In our study we found the mean ± SD of age among group A &amp; B was (36.3±6.7) &amp; (35.7±10.3) respectively. We found the mean± SD of platelet count at 1st POD was (206530±64441) &amp; (212543±48768); at 3rd POD was (226517±60185) &amp; (245957±52826); at 7th POD was (240517±57379) &amp; (257713±53655); at 14th POD was (245850±52680) &amp; (244337±56796) in Group A &amp; B respectively. Conclusion: In our study we didn’t find any statistically significant difference regarding the patients’ demographic characteristics and there were no statistically significant difference of platelet counts between Group A and Group B at preoperative period, post pump, 1st POD, 2nd POD, 3rd POD, 4th POD, 7th POD and 14th POD.

Efficacy of Normal Saline as Flushing Solution to Maintain Indwelling Arterial Catheter Patency after Cardiac Single Valve Surgery

Introduction: Arterial catheters include radial, brachial, femoral, dorsalis pedis and axillary artery are used in the intensive care unit for continuous blood pressure monitoring, repeated blood sampling. Normal saline solution can maintain patency of arterial and central venous pressure monitoring catheters. Heparinized solutions had no effect on prolonging patency and improving function of catheters while the normal saline solution increases accuracy of coagulatory tests. Aim of the Study: The aim of this study was to examine the efficacy of Normal saline as flushing solution to maintain indwelling arterial catheter patency among patients after cardiac single valve surgery. Methods: This was a prospective cross-sectional study conducted in the Department of Cardiac surgery of National Institute of Cardiovascular Disease (NICVD), Sher-E-Bangla Nagar, Dhaka, Bangladesh during the period from July 2016 to June 2017. This study included sixty patients who underwent single valve replacement surgery and shifted to the ICU with arterial line catheter. The patients who fulfilled the inclusion criteria were divided into two groups- Group 1 (with heparin solution) and Group 2 (with normal saline). Result: In our study we found the mean ± SD of age among Group 1 &amp; 2 was (36.3±6.7) &amp; (35.7±10.3) respectively. We found 100% patients had arterial line patent in 1st POD in both groups. In 2nd POD 86.8% &amp; 76.7% and at 3rd POD 50.0% &amp; 43.3% patients had patency in Group 1 &amp; Group 2 respectively. We found the mean± SD of platelet count at 1st POD was (206530±64441) &amp; (212543±48768); at 3rd POD was (226517±60185) &amp; (245957±52826); at 7th POD was (240517±57379) &amp; (257713±53655); at 14th POD was (245850±52680) &amp; (244337±56796) in Group 1 &amp; 2 respectively which was significantly higher in Group 2. Conclusion: The use of heparin in normal saline for arterial line flushing does not significantly reduce platelet counts in cardiac valve surgery patients in comparison to use of normal ....

Increased mean perfusion pressure variability is associated with subsequent deterioration of renal function in critically ill patients with central venous pressure monitoring: a retrospective observational study

Purpose The mean perfusion pressure (MPP) was recently proposed to personalized management tissue perfusion pressure in critically ill patients. Increased MPP variability (MPPV) may be associated with organ injuries. Our objective was to determine if increased MPPV was associated with subsequent deterioration of renal function in critically ill patients. Methods We analyzed data stored in the eICU-CRD and MIMIC-IV databases. The exposure was MPPV, measured as the coefficient of variation (CV) using the MPP data of the first 24 h after first ICU admission. The primary endpoint was deterioration of renal function, defined as new-onset or progress of acute kidney injury between 24 and 72 h after ICU admission. Results The study population consisted of 8,590 patients from eICU-CRD and 6,723 patients from MIMIC-IV database. A total of 28.4% and 30.2% of the study population experienced deteriorated renal function, respectively. Patients with deteriorated renal function had significantly higher median MPP-CV compared with those without (12.2% vs 11.5% and 12.8% vs 12.5%, p < .001). In fully adjusted multivariate logistic models, higher MPP-CV (adjusted OR per 1-SD, 1.08; 95% CI, 1.02–1.13 and adjusted OR per 1-SD, 1.06; 95% CI, 1.00–1.12, respectively) was significantly associated with greater risk of primary endpoint. The pooled analyses showed heterogeneity in patients with cardiac surgery, medical sepsis and others. Conclusion Increased MPPV was associated with an increased risk of subsequent deterioration of renal function in critically ill patients with central venous pressure monitoring. Maintaining stable MPP may reduce the risk of renal function deterioration.