Real-time ultrasound-guided thoracentesis in the intensive care unit: prevalence of mechanical complications

Background: The use of thoracic ultrasound during thoracentesis reduces complications. The aim of this study was to determine the prevalence of complications for real-time ultrasound-guided thoracentesis performed by intensivists. As a secondary objective, the change in oxygenation before and after the procedure was evaluated. Patients and methods: An observational prospective study was conducted. A total of 81 cases of real-time ultrasound-guided thoracentesis performed by intensivists in the intensive care unit (ICU) of Méderi Major University Hospital, Bogotá, Colombia, between August 2018 and August 2019 were analyzed. Thoracentesis performed by interventional radiologists and using techniques different from the focus of this study were excluded from the analysis. Results: There was one pneumothorax, for a prevalence rate of mechanical complications in this population of 1.2%. The mean partial oxygen pressure to inspired oxygen fraction ratio (PaO2/FiO2) prior to the procedure was 198.1 (95% CI 184.75–211.45), with a PaO2/FiO2 after the procedure of 224.6 (95% CI 213.08–226.12) (p and lt; 0.05). Conclusions: Real-time ultrasound-guided thoracentesis performed by intensivists is a safe procedure and leads to a significant improvement in oxygenation rates. Future studies are required to determine the impact of these results on other outcomes, such as mortality, ICU stay, and days of mechanical ventilation. © 2020, The Author(s)

Identificación de la Curva de Aprendizaje en el Implante de Catéteres Centrales en Modelos de Aprendizaje Simulado en Residentes de Medicina Crítica y Cuidado Intensivo

Se trata de una investigación de tipo mixto cualitativa y analítico cuantitativa en la cual se desea establecer la curva de aprendizaje en el paso de catéteres guiados por ecografía de residentes de medicina crítica y cuidado intensivo, que se están entrenando en modelos de simulación médica, como parte de su proceso formativo en el área de cuidado crítico. Esta investigación surge al observar la tasa de complicaciones presentadas sobre los pacientes cuando residentes o médicos recién graduados sin la suficiente experiencia realizan este tipo de procedimientos. Para esto se busca definir los factores que pueden afectar la capacidad de los residentes para realizar el procedimiento mediante una observación participante, grupos focales, estudio longitudinal analítico y generar la curva de aprendizaje, la cual establece en el eje horizontal la experiencia medida en número de ensayos de cada residente en el simulador, y en el eje vertical el aprendizaje o la competencia medida en eficiencia o productividad

Tracheo-innominate fistula as a late complication of prolonged intubation in a patient with mycobacterium tuberculosis: a case report

Abstract Background The tracheo-innominate fistula is a rare and potentially life-threatening entity that occurs in approximately less than 1% of patients after a tracheostomy. It occurs when the anterior wall of the trachea erodes and comes into contact with the posterior wall of the innominate artery or brachiocephalic trunk due to excessive pressure from the hyperinflation of the cuff over the mucosa, creating a fistulous tract. Clinically, it manifests as massive tracheal bleeding that puts the patient's life at imminent risk. Case presentation We present the case of a 60-year-old Latin American male patient with a history of SARS CoV-2 pneumonia approximately 4 months earlier, who required prolonged orotracheal intubation and tracheostomy due to subglottic stenosis, which required tracheal dilations. The patient was admitted to the emergency department due to hemoptysis associated with hemodynamic instability and later on presented with massive tracheal bleeding. The chest-CT angiography evidenced a tracheo-innominate fistula that required surgical management. A concomitant Mycobacterium Tuberculosis infection was also diagnosed during his hospitalization. Conclusions There are currently many gaps in our knowledge about the tracheo-innominate fistula, mainly in terms of its incidence following the SARS-CoV-2 pandemic, as well as the role that concomitant infections and their treatments, such as tuberculosis, play in the development of these events. During the pandemic, the cases of intubated patients and patients with tracheostomies increased, giving way to new and unexpected complications, we have yet to study in depth

Real-time ultrasound-guided thoracentesis in the intensive care unit: prevalence of mechanical complications

Abstract Background The use of thoracic ultrasound during thoracentesis reduces complications. The aim of this study was to determine the prevalence of complications for real-time ultrasound-guided thoracentesis performed by intensivists. As a secondary objective, the change in oxygenation before and after the procedure was evaluated. Patients and methods An observational prospective study was conducted. A total of 81 cases of real-time ultrasound-guided thoracentesis performed by intensivists in the intensive care unit (ICU) of Méderi Major University Hospital, Bogotá, Colombia, between August 2018 and August 2019 were analyzed. Thoracentesis performed by interventional radiologists and using techniques different from the focus of this study were excluded from the analysis. Results There was one pneumothorax, for a prevalence rate of mechanical complications in this population of 1.2%. The mean partial oxygen pressure to inspired oxygen fraction ratio (PaO2/FiO2) prior to the procedure was 198.1 (95% CI 184.75–211.45), with a PaO2/FiO2 after the procedure of 224.6 (95% CI 213.08–226.12) (p &lt; 0.05). Conclusions Real-time ultrasound-guided thoracentesis performed by intensivists is a safe procedure and leads to a significant improvement in oxygenation rates. Future studies are required to determine the impact of these results on other outcomes, such as mortality, ICU stay, and days of mechanical ventilation. </jats:sec

Real-time ultrasound-guided thoracentesis in the intensive care unit: prevalence of mechanical complications

"Background: The use of thoracic ultrasound during thoracentesis reduces complications. The aim of this study was to determine the prevalence of complications for real-time ultrasound-guided thoracentesis performed by intensivists. As a secondary objective, the change in oxygenation before and after the procedure was evaluated. Patients and methods: An observational prospective study was conducted. A total of 81 cases of real-time ultrasound-guided thoracentesis performed by intensivists in the intensive care unit (ICU) of Méderi Major University Hospital, Bogotá, Colombia, between August 2018 and August 2019 were analyzed. Thoracentesis performed by interventional radiologists and using techniques different from the focus of this study were excluded from the analysis. Results: There was one pneumothorax, for a prevalence rate of mechanical complications in this population of 1.2%. The mean partial oxygen pressure to inspired oxygen fraction ratio (PaO2/FiO2) prior to the procedure was 198.1 (95% CI 184.75–211.45), with a PaO2/FiO2 after the procedure of 224.6 (95% CI 213.08–226.12) (p and lt; 0.05). Conclusions: Real-time ultrasound-guided thoracentesis performed by intensivists is a safe procedure and leads to a significant improvement in oxygenation rates. Future studies are required to determine the impact of these results on other outcomes, such as mortality, ICU stay, and days of mechanical ventilation. © 2020, The Author(s).