Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively

Open source patient data management system for intensive care

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management System (PDMS). To respond to the needs of a Surgical Intensive Care Unit, we developed a PDMS based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQl data base system. The client software was developed in C. The application offers the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications and scoring systems functionalities. The PDMS was used to care more than two thousands patients with the expected reliability and functionalities. © 2007 The authors. All rights reserved.SCOPUS: cp.pinfo:eu-repo/semantics/publishe

Successful treatment in monkshood (aconite) poisoning with magnesium sulfate.

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Tongue necrosis as a complication of vasoconstrictor agents in the intensive care setting

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Drotrecogin alfa (activated) for severe sepsis: Could we consider a shorter treatment period in patients with a favorable course?

Purpose: The objective of this study was to develop a model to identify patients in whom drotrecogin alfa (activated) (DAA) might be administered for periods shorter than the recommended 96 hours. Methods: We did a retrospective chart review of all 124 patients treated with a standard 96-hour infusion of DAA in a 31-bed department of intensive care. Using a stepwise approach, we identified and combined parameters that could help predict outcomes to achieve the best sensitivity associated with 100% specificity. Results: Twenty-one (17%) of the 124 patients had a favorable outcome (left the intensive care unit within 5 days of DAA initiation); of these, 11 had an increase in arterial pH in the first 24 hours of treatment compared with 22 (21%) of the 103 patients with intermediate (intensive care unit stay >5 days after DAA initiation) or unfavorable (died within 5 days of DAA initiation) outcomes (P = not significant). Eight (72.7%) of these 11 patients and no other patient showed a decrease in sequential organ failure assessment score of at least 50% during the first 24 hours (P < .001). By combining these 2 variables, we could identify, with 100% specificity, 8 of the patients with a favorable outcome (38%) who made a prompt recovery. Conclusions: A simple model based on sequential organ failure assessment score and arterial pH can help identify patients with a rapid favorable course in whom a shorter duration of DAA treatment may be justified. © 2009 Elsevier Inc. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Impact of balanced tetrastarch raw material on perioperative blood loss: A randomized double blind controlled trial

Background As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can originate from different vegetable sources, they might have different clinical effects. The purpose of this prospective, randomized, double-blind controlled trial was to compare two balanced tetrastarch solutions, one maize-derived and one potato-derived, on perioperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods We randomly assigned 118 patients undergoing elective cardiac surgery into two groups, to receive either a maize- or a potato-derived HES solution. Study fluids were administered perioperatively (including priming of CPB) until the second postoperative day (POD2) using a goal directed algorithm. The primary outcome was calculated postoperative blood loss up to POD2. Secondary outcomes included short-term incidence of acute kidney injury (AKI), and long-term effect (up to one yr) on renal function. Results Preoperative and intraoperative characteristics of the subjects were similar between groups. Similar volumes of HES were administered (1950 ml [1250-2325] for maize-HES and 2000 ml [1500-2700] for potato-HES; P=0.204). Calculated blood loss (504 ml [413-672] for maize-HES vs 530 ml [468-705] for potato-HES; P=0.107) and the need for blood components were not different between groups. The incidence of AKI was similar in both groups (P=0.111). Plasma creatinine concentration and glomerular filtration rates did vary over time, although changes were minimal. Conclusions Under our study conditions, HES 130/0.4 or 130/0.42 raw material did not have a significant influence on perioperative blood loss. Moreover, we did not find any effect of tetrastarch raw material composition on short and long-term renal function. Clinical trial registration EudraCT number: 2011-005920-16.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Successful treatment of monkshood (aconite napel) poisoning with magnesium sulfate.

Case ReportsJournal Articleinfo:eu-repo/semantics/publishe

Is there a correlation between circulating levels of citrulline and intestinal dysfunction in the critically ill?

Objective: The aim of this study was to assess the correlation between plasma citrulline and Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, survival, inflammation (C-reactive protein [CRP]), inotrope use, serum levels of prealbumin and albumin, and renal failure in the critically ill patient. Methods: This prospective observational singlecenter controlled study included 91 adult patients over a 2-year period. Inclusion criteria were patients staying in the intensive care unit for >48 hours. Patients renal status was categorized as those with a glomerular filtration rate (GFR) >60 mL/min without renal support, a GFR >60 mL/min with renal support, a GFR 36 ?mol/L). The relationship between the recorded parameters and these different cut-off values of plasma citrulline concentrations was analyzed. Results: Ninety-one patients (34% female and 66% male) with a mean (SD) age of 69.3 (11.9) years, a mean (SD) body mass index of 24.8 (5.34) kg/m2, a mean (SD) APACHE II score of 22.4 (7.92), a mean (SD) SOFA score of 8 (4.4), and a mean (SD) plasma citrulline of 21.7 (13.1) μmol/L were enrolled. Only patients with intestinal dysfunction had low plasma citrulline level <15 μmol/L (P = .014). No correlations between serum levels of CRP, albumin, or prealbumin; renal failure; inotrope use; SOFA score; and APACHE II score were found with plasma citrulline level. Conclusion: Low plasma citrulline levels in patients correlate well with intestinal dysfunction. (Nutr Clin Pract. 2012;27:527-532) © 2012 American Society for Parenteral and Enteral Nutrition.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Cardiac lymphoma presenting as concentric pseudo-hypertrophic cardiomyopathy in a previously unrecognised HIV patient.

Case ReportsLetterSCOPUS: le.jinfo:eu-repo/semantics/publishe

Successful treatment in monkshood (aconite) poisoning with magnesium sulfate.

info:eu-repo/semantics/publishe