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Military Medicine Jun 2024Uncontrolled torso hemorrhage is the primary cause of potentially survivable deaths on the battlefield. Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta...
The Efficacy of Whole Blood Resuscitation During Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to Mitigate Post-occlusion Circulatory Collapse: A Translational Model in Large Swine.
INTRODUCTION
Uncontrolled torso hemorrhage is the primary cause of potentially survivable deaths on the battlefield. Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), in conjunction with damage control resuscitation, may be an effective management strategy for these patients in the prehospital or austere phase of their care. However, the effect of whole blood (WB) transfusion during REBOA on post-occlusion circulatory collapse is not fully understood.
MATERIALS AND METHODS
Yorkshire male swine (n = 6 per group, 70-90 kg) underwent a 40% volume-controlled hemorrhage. After a 10-minute hemorrhagic shock period, a REBOA balloon was inflated in Zone 1. Fifteen minutes after inflation, 0, 1, or 3 units (450 mL/unit) of autologous WB was infused through the left jugular vein. Thirty minutes after initial balloon inflation, the balloon was deflated slowly over 3 minutes. Following deflation, normal saline was administered (up to 3,000 mL) and swine were observed for 2 hours. Survival (primary outcome), hemodynamics, and blood gas values were compared among groups. Statistical significance was determined by log-rank test, one-way ANOVA, and repeated measures ANOVA.
RESULTS
Survival rates were comparable between groups (P = .345) with 66% of control, 33% of the one-unit animals, and 50% of the 3-unit animals survived until the end of the study. Following WB infusion, both the 1-unit and the 3-unit groups had significantly higher blood pressure (P < .01), pulmonary artery pressure (P < .01), and carotid artery flow (P < .01) compared to the control group.
CONCLUSIONS
WB transfusion during Zone 1 REBOA was not associated with increased short-term survival in this large animal model of severe hemorrhage. We observed no signal that WB transfusion may mitigate post-occlusion circulatory collapse. However, there was evidence of supra-normal blood pressures during WB transfusion.
PubMed: 38870040
DOI: 10.1093/milmed/usae305 -
Vascular Health and Risk Management 2024Guidewire loss is a rare complication of central venous catheterization. A 65-year-old male was hospitalized in a high-dependency unit for exacerbation of chronic...
Guidewire loss is a rare complication of central venous catheterization. A 65-year-old male was hospitalized in a high-dependency unit for exacerbation of chronic obstructive pulmonary disease, pneumonia, erythrocytosis, and clinical signs of heart failure. Upon admission, after an unsuccessful right jugular approach, a left jugular central venous catheter was placed. The next day, chest radiography revealed the catheter located in the left parasternal region, with suspected retention of the guidewire, visually confirmed by the presence of its proximal end inside the catheter. The left parasternal location of the catheter and the typical projection of the guidewire in the coronary sinus, later confirmed by echocardiography, raised suspicion of a persistent left superior vena cava (PLSVC). Agitated saline injected into the left antecubital vein confirmed bubble entry from the coronary sinus into the right atrium. After clamping the guidewire, the catheter was carefully retrieved along with the guidewire without any complications. This is the first reported case of guidewire retention in PLSVC and coronary sinus. It underscores the potential causes of guidewire loss and advocates preventive measures to avoid this potentially fatal complication.
Topics: Humans; Male; Aged; Coronary Sinus; Catheterization, Central Venous; Central Venous Catheters; Persistent Left Superior Vena Cava; Device Removal; Treatment Outcome; Catheters, Indwelling; Vena Cava, Superior; Phlebography
PubMed: 38859874
DOI: 10.2147/VHRM.S453977 -
The Journal of Vascular Access Jun 2024There is limited knowledge about gaze patterns of intensive care unit (ICU) trainee doctors during the insertion of a central venous catheter (CVC). The primary...
BACKGROUND
There is limited knowledge about gaze patterns of intensive care unit (ICU) trainee doctors during the insertion of a central venous catheter (CVC). The primary objective of this study was to examine visual patterns exhibited by ICU trainee doctors during CVC insertion. Additionally, the study investigated whether differences in gaze patterns could be identified between more and less experienced trainee doctors.
METHODS
In a real-life, prospective observational study conducted at the interdisciplinary ICU at the University Hospital Zurich, Switzerland, ICU trainee doctors underwent eye-tracking during CVC insertion in a real ICU patient. Using mixed-effects model analyses, the primary outcomes were dwell time, first fixation duration, revisits, fixation count, and average fixation time on different areas of interest (AOI). Secondary outcomes were above eye-tracking outcome measures stratified according to experience level of participants.
RESULTS
Eighteen participants were included, of whom 10 were inexperienced and eight more experienced. Dwell time was highest for CVC preparation table ( = 0.02), jugular vein on ultrasound image ( < 0.001) and cervical puncture location ( < 0.001). Concerning experience, dwell time and revisits on jugular vein on ultrasound image ( = 0.02 and = 0.04, respectively) and cervical puncture location ( = 0.004 and = 0.01, respectively) were decreased in more experienced ICU trainees.
CONCLUSIONS
Various AOIs have distinct significance for ICU trainee doctors during CVC insertion. Experienced participants exhibited different gaze behavior, requiring less attention for preparation and handling tasks, emphasizing the importance of hand-eye coordination.
PubMed: 38856000
DOI: 10.1177/11297298241258628 -
World Journal of Critical Care Medicine Jun 2024Discerning the etiology of acute kidney injury (AKI) in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes. The conventional... (Review)
Review
Discerning the etiology of acute kidney injury (AKI) in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes. The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload. In the recent past, point-of-care ultrasonography (POCUS) has emerged as a valuable adjunct to clinical assessment, offering advantages in terms of diagnostic accuracy, rapidity, cost-effectiveness, and patient satisfaction. This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI. The review distinguishes basic and advanced POCUS, emphasizing a 5-point basic POCUS protocol for efficient assessment. This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy, lung ultrasound for detecting extravascular lung water, inferior vena cava (IVC) ultrasound for estimating right atrial pressure, internal jugular vein ultrasound as an alternative to IVC assessment, and focused cardiac ultrasound for assessing left ventricular (LV) systolic function and identifying potential causes of a plethoric IVC. Advanced POCUS delves into additional Doppler parameters, including stroke volume and cardiac output, LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload. POCUS, when employed judiciously, enhances the diagnostic precision in evaluating AKI in cirrhotic patients, guiding appropriate therapeutic interventions, and minimizing the risk of fluid-related complications.
PubMed: 38855271
DOI: 10.5492/wjccm.v13.i2.93812 -
Anales de Pediatria Jun 2024
Topics: Humans; Jugular Veins; Dilatation, Pathologic; Male; Female; Child
PubMed: 38853060
DOI: 10.1016/j.anpede.2024.05.010 -
Surgical and Radiologic Anatomy : SRA Jul 2024This study aims to assess the anatomical possibilities of the jugular bulb (JB).
PURPOSE
This study aims to assess the anatomical possibilities of the jugular bulb (JB).
METHODS
Fifty archived CBCT scans were analyzed.
RESULTS
The average distance between the internal acoustic canal (IAC) and the JB was 7.97 mm on both sides (Right: SD = 2.56 mm, range 3.16-13.3 mm; Left: SD = 2.5 mm, range 2.9-13.6 mm). JB walls' pneumatization was classified into eight patterns. Deep petrosal cells (DPCs) prevailed in the lateral wall of the JB. The absence of pneumatization (NP) was commonly found on the left side. The presence of infralabyrinthine and hypotympanic cells varied. Less common types included accessory occipital cells (AOCs), posteromedial tracts (PMTs), and basi-occipital cells (BOCs), which determined a consistent variation of the lateral wall pneumatization patterns. Pneumatization of the medial wall was not observed in 50 right sides and 49 left sides. The inferior wall analysis revealed symmetry in AOC distribution and a predominant occurrence of NP. Cases with hypotympanum (HT) in the lateral wall showed a statistically significant IAC-JB distance increase by an average of 4.67 mm compared to NPs. Specific pneumatizations, particularly HT on the lateral side, have a significant effect on the IAC-JB distance, showing a clear pattern of increasing distance from DPC to NP and then to HT. A significant distance increase in HT pneumatization was noted. There were also recorded instances of JB hypoplasia and hyperplasia, JB diverticula, dehiscent JBs, and high JBs.
CONCLUSION
This study establishes a novel classification of JB pneumatizations to aid in the understanding of the temporal bone anatomy.
Topics: Humans; Anatomic Variation; Cone-Beam Computed Tomography; Female; Male; Adult; Middle Aged; Aged; Jugular Veins; Adolescent; Young Adult; Jugular Foramina; Aged, 80 and over; Retrospective Studies
PubMed: 38847825
DOI: 10.1007/s00276-024-03401-1 -
Cureus May 2024Percutaneous central venous catheterization, despite ultrasound guidance, is known to carry significant risks. While central venous catheters are widely used in clinical...
Percutaneous central venous catheterization, despite ultrasound guidance, is known to carry significant risks. While central venous catheters are widely used in clinical practice, they are also associated with various complications, including incorrect positioning during insertion. Arterial puncture is a well-recognized complication, and although unintended subclavian or carotid artery cannulation is rare, it can lead to serious consequences. We present two cases, in which a dual-lumen, non-tunneled temporary hemodialysis catheter was inadvertently inserted into the left common carotid artery and in the left innominate vein.
PubMed: 38846204
DOI: 10.7759/cureus.59814 -
Indian Journal of Dermatology 2024
PubMed: 38841239
DOI: 10.4103/ijd.ijd_1101_23 -
The Journal of the Canadian... Apr 2024Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on...
BACKGROUND
Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on their etiology. Although uncommon, clinicians should be aware of the clinical presentation of UEDVT as timely diagnosis and early treatment is critical in preventing possible post-thrombotic complications.
CASE PRESENTATION
We report a rare case of axillary-subclavian and internal jugular vein thrombosis in the absence of clear risk factors in a 78-year-old male weightlifter who presented to the office with two-week duration of left upper extremity pain and swelling following strenuous exercise at the gym.
SUMMARY
The combination of unusual thrombi location, in addition to the unusual absence of existing thoracic-outlet compression or indwelling medical hardware, makes our case of UEDVT especially uncommon. Clinicians should be aware of this rare disease due to the debilitating effects both in the short and long term.
PubMed: 38840961
DOI: No ID Found -
The Journal of Vascular Access Jun 2024To investigate the technical advantages of a modified no-touch technique (MNTT) in constructing arteriovenous fistulas (AVF) compared to the conventional technique (CT)...
BACKGROUND
To investigate the technical advantages of a modified no-touch technique (MNTT) in constructing arteriovenous fistulas (AVF) compared to the conventional technique (CT) and assess its potential to reduce neointimal hyperplasia in the outflow vein.
METHODS
Forty-seven New Zealand rabbits were randomly divided into three groups: control, CT, and MNTT. Rabbits in control group were observed using ultrasound and then euthanized to obtain external jugular vein (EJV) for Hematoxylin-eosin (H-E). We established common carotid artery (CCA)-EJV AVF using MNTT in the MNTT group and the CT in the CT group. AVF patency and complications were compared between the CT and MNTT groups. Rabbits with patent AVF in both groups were observed using ultrasound 2 weeks after surgery to evaluate changes in the vessel diameter and blood flow spectrum of the AVFs. H-E staining measured the intima thickness of EJV adjacent to the anastomosis and histologic characteristics of the AVF at 2 and 4 weeks after surgery.
RESULTS
Five rabbits died after surgery with common symptoms of sneezing, coughing, runny nose, anorexia, and diarrhea; two in the MNTT group and three in the CT group. There were significant differences in the diameter ( = 0.010) and peak systolic velocities (PSV) ( = 0.001) of EJV between the CT and MNTT groups 2 weeks after surgery. Spiral laminar flow (SLF) was observed in CCA and EJV adjacent to anastomosis in the MNTT group. Additionally, histological observations showed less venous neointimal hyperplasia in the MNTT group than in the CT group 4 weeks after surgery.
CONCLUSION
The rabbit model of CCA-EJV AVF established using MNTT demonstrated fewer comlications, larger vein diameters, and reduced venous neointimal hyperplasia, indicating that this maybe an ideal animal model to further investigate the application of MNTT in AVF surgery.
PubMed: 38836593
DOI: 10.1177/11297298241256172