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Central Venous (central + venous)
Terms modified by Central Venous Selected AbstractsComplement Activation in Emergency Department Patients With Severe SepsisACADEMIC EMERGENCY MEDICINE, Issue 4 2010John G. Younger Abstract Objectives:, This study assessed the extent and mechanism of complement activation in community-acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation. Methods:, A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose-binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients. Results:, Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5-fold; Factor Bb 6.1-fold; C3 0.8-fold; C3a 11.6-fold; C5a 1.8-fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty-four hours of structured resuscitation did not, on average, affect any of the mediators studied. Conclusions:, Patients with community-acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation. ACADEMIC EMERGENCY MEDICINE,2010; 17:353,359 © 2010 by the Society for Academic Emergency Medicine [source] Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsivenessACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009J. SNYGG Background: Static vascular filling pressures suffer from poor predictive power in identifying the volume-responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction. Methods: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO® monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed-wave Doppler echocardiography were determined in the left (,VTILV) and right (,VTIRV) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO. Results: Receiver,operator characteristics (ROC) demonstrated the largest area under the curve for ,VTIRV [0.81 (0.70,0.93)] followed by PPV [0.76 (0.64,0.88)] [mean (and 95% CI)]. SPV, ,VTILV and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC. Conclusion: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction. [source] Effects of hyperoncotic or hypertonic,hyperoncotic solutions on polymorphonuclear neutrophil count, elastase- and superoxide-anion production: a randomized controlled clinical trial in patients undergoing elective coronary artery bypass graftingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2007G. P. Molter Background:, Hypertonic,hyperoncotic solutions may be an effective treatment for systemic inflammatory response syndrome (SIRS). With regard to the immunomodulatory effects of these drugs, previous studies demonstrated controversial results. Therefore, the present study investigated the influence of different hyperoncotic and hypertonic,hyperoncotic solutions on polymorphonuclear neutrophil leukocyte (PMNL) count, elastase and superoxide-anion production in patients undergoing elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Methods:, Fifty patients scheduled for elective CABG with cardiopulmonary bypass were randomly assigned to five groups: (i) NaCl 0.9%, 750 ml/m2 body surface area (BSA); (ii) hydroxyethylic starch 10%, 250 ml/m2 BSA and NaCl 0.9%, 400 ml/m2 BSA; (iii) dextran 10%, 250 ml/m2 BSA and NaCl 0.9%, 300 ml/m2 BSA; (iv) hypertonic sodium chloride 7.2%/hyperoncotic hydroxyethylic starch 10%, 150 ml/m2 BSA; and (v) hypertonic sodium chloride 7.2%/hyperoncotic dextran 10%, 150 ml/m2 BSA. Blood samples were drawn from arterial, central venous and coronary artery sinus catheters peri-operatively. PMNL count, superoxide-anion production and elastase were recorded. Results:, PMNL counts and elastase activity increased in all groups after reperfusion. Superoxide-anion production showed only minor changes. Between groups, no significant differences were demonstrated. Conclusions:, Infusion of clinically relevant doses of hypertonic,hyperoncotic solution did not affect PMNL count, elastase- or superoxide-anion production during elective CABG with cardiopulmonary bypass. [source] Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humansACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2005J. J. Van Lieshout Background:, The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart. Methods:, This study evaluates the interdependence of SV and thoracic electrical admittance of thoracic fluid content (TA) vs. the central venous (CVP), mean pulmonary artery (MPAP) and pulmonary artery wedge (PAWP) pressures during head-up (HUT) and head-down (HDT) tilt in nine healthy humans. Results:, From the supine position to 20° HDT, SV [112 ± 18 ml; mean ± standard deviation (SD)], TA (30.8 ± 7.1 mS) and CVP (3.6 ± 0.9 mmHg) did not change significantly, whereas MPAP (from 13.9 ± 2.7 to 16.1 ± 2.5 mmHg) and PAWP (from 8.8 ± 3.4 to 11.3 ± 2.5 mmHg; P < 0.05) increased. Conversely, during 70° HUT, SV (to 65 ± 24 ml) decreased, together with CVP (to 0.9 ± 1.4 mmHg; P < 0.001), MPAP (to 9.3 ± 3.8 mmHg; P < 0.01), PAWP (to 0.7 ± 3.3 mmHg; P < 0.001) and TA (to 26.7 ± 6.8 mS; P < 0.01). However, from 20 to 50 min of HUT, SV decreased further (to 48 ± 21 ml; P < 0.001), whereas the central pressures did not change significantly. Conclusions:, During both HUT and HDT, SV of the heart changed with the thoracic fluid content rather than with the central vascular pressures. These findings confirm that the function of the heart relates to its volume rather than to its so-called filling pressures. [source] Comparison of different near-infrared spectroscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in childrenPEDIATRIC ANESTHESIA, Issue 2 2008NICOLE NAGDYMAN Summary Background:, We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO2) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO2) and central SvO2 from the superior caval vein (SVC) during elective cardiac catheterization in children. Methods:, A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO2 in the left jugular bulb and with SvO2. rSO2 was compared with SjO2 from the right jugular bulb and SvO2. Linear regression analysis and Pearson's correlation coefficient were calculated and Bland,Altman analyses were performed. Results:, Cerebral TOI and SjO2 were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO2 with r = 0.74 (P < 0.0001). Bland,Altman plots showed a mean bias of ,4.3% with limits of agreement of 15.7% and ,24.3% for TOI and SjO2 and a mean bias of ,4.9% with limits of agreement of 10.3% and ,20.1% for TOI and SvO2. Cerebral rSO2 and SjO2 showed a significant correlation (r = 0.83, P < 0.0001) and rSO2 and SvO2 showed excellent correlation with r = 0.93 (P < 0.0001). Bland,Altman plots showed a mean bias of ,5.2% with limits of agreement of between 8.4% and ,18.8% for rSO2 and SjO2 and a mean bias of 5.6% with limits of agreement of 13.4% and ,2.2% for rSO2 and SvO2. Conclusions:, Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO2 and SvO2 values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO2 and SvO2. [source] Percutaneous transtracheal emergency ventilation with a self-made device in an animal modelPEDIATRIC ANESTHESIA, Issue 10 2007RAIK SCHAEFER Summary Background:, Special equipment for emergency percutaneous transtracheal ventilation is often not immediately available. We used a self-made device consisting of a three-way stopcock connected between a G-15 transtracheal airway catheter and an oxygen supply in a simulated 'cannot intubate, cannot ventilate' scenario and tested the hypothesis that the effectiveness of the device depends on the body weight of the experimental animals. Methods:, With approval of the local animal protection committee, two groups of six pigs each with a body weight of 21 ± 2 and 36 ± 6 kg, respectively, were tracheally intubated and mechanically ventilated after induction of anesthesia. Hemodynamic monitoring included cardiac output and arterial, central venous and pulmonary artery pressures. An emergency transtracheal airway catheter was inserted into the trachea and a situation of partial expiratory airway obstruction was created. Each animal was ventilated for 15 min via the transtracheal airway catheter with the self-made device (FiO2 1.0 at an oxygen flow of 15 l·min,1; respiratory rate of 60 min,1; I/E ratio approximately 1 : 1). Results:, Whereas satisfactory oxygenation was achieved in all animals, sufficient ventilation was obtained only in the lightweight animals. Conclusions:, Adequate oxygenation could be provided by jet-like transtracheal ventilation with a simple self-made device using easily available materials. Sufficient ventilation depends on the body weight of the animals. [source] Role of cardiac-renal neural reflex in regulating sodium excretion during water immersion in conscious dogsTHE JOURNAL OF PHYSIOLOGY, Issue 1 2002Kenju Miki The present study was undertaken to determine the role of cardiopulmonary mechanoreceptors in inducing the sustained reduction of renal sympathetic nerve activity (RSNA) and concomitant changes in sodium excretion occurring during water immersion (WI) in intact dogs. Seven cardiac-denervated dogs were chronically instrumented for measuring RSNA, systemic arterial (Pa), central venous (Pcv) and left atrial pressures (Pla). WI initially decreased RSNA in cardiac denervated dogs by 10.0 ± 5.5 %; thereafter the RSNA fell to a nadir of 18.5 ± 5.6 % (P < 0.05) at 40,80 min of WI and then returned toward the pre-immersion level. Renal sodium excretion increased significantly by 211 ± 69 % (P < 0.05) only during the first 20,40 min of WI. WI increased Pa, Pcv and Pla in a step manner from 94 ± 3 to 108 ± 3 mmHg (P < 0.05), from 1.4 ± 0.5 to 12.3 ± 1.0 mmHg (P < 0.05) and from 4.9 ± 0.6 to 15.4 ± 1.2 mmHg (P < 0.05), respectively. These responses in RSNA and sodium excretion to WI in the cardiac-denervated dogs were significantly (P < 0.05) attenuated compared with those in a previous group of intact dogs. These data suggest that the attenuated responses of neural and excretory response to WI observed in cardiac-denervated dogs can be attributed to an interruption of afferent input originating from the cardiopulmonary mechanoreceptors to the central nervous system. [source] Comparison of central venous oxygen saturation and mixed venous oxygen saturation during liver transplantationANAESTHESIA, Issue 4 2009A. El Masry Summary Central venous catheterisation is commonly performed during major surgery and intensive care, and it would be useful if central venous oxygen saturation could function as a surrogate for mixed venous oxygen saturation. We studied 50 patients undergoing living related liver transplantation. Blood samples were taken simultaneously from central venous and pulmonary artery catheters at nine time points during the pre-anhepatic, anhepatic, and postanhepatic phases. Four hundred and fifty sets of measurement were obtained. There was a good correlation between central venous oxygen saturation and mixed venous oxygen saturation. The mean (SD) difference (95% limit of agreement) was lowest at the first time point (1.06 (0.65)%, ,1.94% to 2.7%) and then increased throughout the study but remained acceptable. The change in mixed venous oxygen and central venous oxygen saturations occurred mostly in parallel and as a result changes in mixed venous oxygen saturation were reflected adequately in the change in central venous oxygen saturation. The correlation between mixed venous oxygen saturation and cardiac output was poor. [source] Microbiological factors associated with neonatal necrotizing enterocolitis: protective effect of early antibiotic treatmentACTA PAEDIATRICA, Issue 10 2003TG Krediet Aim: The incidence of necrotizing enterocolitis (NEC) strongly increased in an neonatal intensive care unit (NICU) in 1997 and 1998 compared with previous years, which coincided with increased incidence of nosocomial sepsis. Specific risk factors related to this NICU and a possible relationship between NEC and nosocomial sepsis were studied retrospectively, including all patients with NEC since 1990 and matched controls. Methods: Clinical and bacteriological data from the period before the development of NEC and a similar period for the controls were collected retrospectively and corrected for birthweight and gestational age. Statistical analysis was performed by a stepwise regression model. Results: Data of 104 neonates with NEC and matched controls were analysed. The median day of onset of NEC was 12 d (range 1,63 d). Significant risk factors for NEC were: insertion of a peripheral artery catheter [odds ratio (OR) 2.3, 95% confidence interval (95% CI) 1.3-3.9] and a central venous catheter (OR 5.6, 95% CI 3.1-10.1), colonization with Klebsiella sp. (OR 3.4, 95% CI 1.5-7.5) and Escherichia coli (OR 2.1, 95% CI 1.CM1.5), and the occurrence of sepsis, in particular due to coagulase-negative staphylococci (OR 2.6, 95% CI 1.4-5.1). The risk for NEC was decreased after the early use (<48h after birth) of amoxicillin-clavulanate and gentamicin (OR 0.3, 95% CI 0.2-0.6). Conclusion: Insertion of central venous and peripheral arterial catheters is positively associated with NEC, as is colonization with the Gram-negative bacilli Klebsiella and E. coli and the occurrence of sepsis, particularly due to coagulase-negative staphylococci. Early treatment with amoxicillin-clavulanate and gentamicin is negatively associated with NEC and may be protective against NEC. [source] | ||||||||||