Critical Care Research and Practice最新文献

{"title":"COVID-19: A Single-Center ICU Experience of the First Wave in the Philippines.","authors":"Onion Gerald V Ubaldo, Jose Emmanuel M Palo, Jude Erric L Cinco","doi":"10.1155/2021/7510306","DOIUrl":"10.1155/2021/7510306","url":null,"abstract":"<p><p>On January 30, 2020, the WHO declared the novel coronavirus of 2019 a pandemic, causing millions of cases and thousands of deaths worldwide, exposing the vulnerabilities of healthcare systems around the world with each country having its own experience. These ranged from patient clinical profiles to management recommendations and to government interventions. There is a paucity of published data regarding Philippine experience. This study is a retrospective, descriptive study of ninety-one COVID-19 probable patients admitted in the COVID ICU of The Medical City from March 16 to May 7, 2020. We described clinical and demographic characteristics amongst COVID-19-confirmed and -negative patients. Therapeutic interventions including COVID-19 investigational drug use and other organ failure strategies were noted and tested for association with ICU survivors and nonsurvivors. We observed that there was no therapeutic intervention that was associated with improved outcomes, with some interventions showing trends favoring the ICU nonsurvivor group. These interventions include, but are not limited to, the use of hydroxychloroquine and tocilizumab, and prone positioning. We also observed that a higher SAPS-3 score was associated with the COVID-19 positive group and the ICU nonsurvivor group. On PubMed search, there seems to be no Philippine-specific literature regarding COVID-19 ICU experience. Further investigations to include more variables are recommended.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2021 ","pages":"7510306"},"PeriodicalIF":1.7,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10656969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart-Protective Mechanical Ventilation in Postoperative Cardiosurgical Patients.","authors":"Vadim Mazurok,&nbsp;Igor Kasherininov,&nbsp;Andrey Bautin,&nbsp;Olga Kulemina,&nbsp;Ryta Rzheutskaya","doi":"10.1155/2021/6617809","DOIUrl":"https://doi.org/10.1155/2021/6617809","url":null,"abstract":"<p><strong>Background: </strong>This study compared the hemodynamic effects and gas exchange under several different ventilator settings-with regard to tidal volume, respiratory rate, and end-expiratory pressure-in patients after coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Prospective interventional cohort study with a controlled group in a single cardiosurgical ICU involving 119 patients following on-pump CABG surgery. During the 1st postoperative hour, the intervention group patients were ventilated with Vt 10 ml × kg^-1, RR 14/min, PEEP 5 cmH₂O (\"conventional ventilation\"). During the 2nd hour, RR was reduced to 8/min (\"reduced RR ventilation\"). At 3 hrs, Vt was decreased to 6 ml × kg^-1, RR returned to 14/min, and PEEP increased to 10 cmH₂O (\"low Vt-high PEEP ventilation\").</p><p><strong>Results: </strong>Patients in the \"low Vt-high PEEP\" ventilation period showed significantly lower alveolar ventilation and thoraco-pulmonary compliance than during \"reduced RR\" ventilation. Mean airway pressure and Vds/Vt peaked during low Vt-high PEEP ventilation; however, driving pressure was lower. Vt decrease and PEEP increase did not lead to oxygenation improvement and worsened CO₂ elimination. Hemodynamically, the study revealed significant cardiac output decrease during low Vt-high PEEP ventilation. In 23.2% of patients, catecholamine therapy was initiated.</p><p><strong>Conclusions: </strong>In postoperative cardiosurgical patients, MV with Vt 6 ml × kg^-1 and PEEP 10 cm H₂O is characterized by worsened oxygenation and elimination of CO₂ and a less favorable hemodynamic profile than ventilation with Vt 10 ml × kg^-1 and PEEP 5 cmH₂O. <i>New and Noteworthy</i>. (i) Patients after CABG may be especially sensitive to low tidal volume and increased PEEP as it negatively affects hemodynamic profile by means of the right heart preload decrease and afterload increase. (ii) Mechanical ventilation settings aiming to minimize mean airway pressure reduce the negative effects of positive inspiratory pressure and are favorable for hemodynamics.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2021 ","pages":"6617809"},"PeriodicalIF":1.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10292843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey.","authors":"Mazen Alqahtani, Faizan Kashoo, Msaad Alzhrani, Fuzail Ahmad, Mohammed K Seyam, Mehrunnisha Ahmad, Adel A Alhusaini, Ganeswara Rao Melam, Syamala Buragadda","doi":"10.1155/2020/6610027","DOIUrl":"10.1155/2020/6610027","url":null,"abstract":"<p><strong>Background: </strong>Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia.</p><p><strong>Aim: </strong>To determine the current standard of ICU PT practice, attitude, and barriers.</p><p><strong>Methods: </strong>A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU.</p><p><strong>Results: </strong>The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (<i>n</i> = 111, 89%) and stroke (<i>n</i> = 102, 82.3%) as compared to congestive heart failure (<i>n</i> = 20, 16.1%) and pulmonary infections (<i>n</i> = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (<i>n</i> = 102, 82.2%) and positioning (<i>n</i> = 73, 58.8%), whereas functional electrical stimulation (<i>n</i> = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (<i>n</i> = 89, 71.7%) followed by inadequate training (<i>n</i> = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (<i>n</i> = 8, 6.4%).</p><p><strong>Conclusion: </strong>PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"6610027"},"PeriodicalIF":1.7,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38829465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Area under the Curve-Based Dosing of Vancomycin in Critically Ill Patients Using 6-Hour Urine Creatinine Clearance Measurement.","authors":"Bita Shahrami, Farhad Najmeddin, Saeideh Ghaffari, Atabak Najafi, Mohammad Reza Rouini, Mojtaba Mojtahedzadeh","doi":"10.1155/2020/8831138","DOIUrl":"10.1155/2020/8831138","url":null,"abstract":"<p><strong>Background: </strong>The area under the curve- (AUC-) guided vancomycin dosing is the best strategy for individualized therapy in critical illnesses. Since AUC can be calculated directly using drug clearance (CL_van), any parameter estimating CL_van will be able to achieve the goal of 24-hour AUC (AUC_24 h). The present study was aimed to determine CL_van based on 6-hour urine creatinine clearance measurement in critically ill patients with normal renal function.</p><p><strong>Method: </strong>23 adult critically ill patients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min who received vancomycin infusion were enrolled in this pilot study. Vancomycin pharmacokinetic parameters were determined for each patient using serum concentration data and a one-compartment model provided by MONOLIX software using stochastic approximation expectation-maximization (SAEM) algorithm. Correlation of CL_van with the measured creatinine clearance in 6-hour urine collection (CL_6 h) and estimated creatinine clearance by the Cockcroft-Gault formula (CL_CG) was investigated.</p><p><strong>Results: </strong>Data analysis revealed that CL_6 h had a stronger correlation with CL_van rather than CL_CG (<i>r</i> = 0.823 vs. 0.594; <i>p</i> < 0.001 vs. 0.003). The relationship between CL_van and CL_6 h was utilized to develop the following equation for estimating CL_van: CL_van (mL/min) = ─137.4 + CL_6 h (mL/min) + 2.5 IBW (kg) (<i>R</i> ^<i>2</i>  = 0.826, <i>p</i> < 0.001). Regarding the described model, the following equation can be used to calculate the empirical dose of vancomycin for achieving the therapeutic goals in critically ill patients without renal impairment: total daily dose of vancomycin (mg) = (─137.4CL_6-h (mL/min) + 2.5 IBW (kg)) × 0.06 AUC_24 h (mg.hr/L).</p><p><strong>Conclusion: </strong>For AUC estimation, CL_van can be obtained by collecting urine in a 6-hour period with good approximation in critically ill patients with normal renal function.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"8831138"},"PeriodicalIF":1.7,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39151885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Promotion among Critically Ill Patients: Earplugs/Eye Mask versus Ocean Sound-A Randomized Controlled Trial Study.","authors":"Abhilasha Chaudhary, Vinay Kumari, Neetu Neetu","doi":"10.1155/2020/8898172","DOIUrl":"10.1155/2020/8898172","url":null,"abstract":"<p><strong>Background: </strong>Poor sleep quality is common in the intensive care unit (ICU), where several factors including environmental factors contribute to sleep deprivation.</p><p><strong>Objective: </strong>This study aims to assess and compare the effectiveness of earplugs and eye mask versus ocean sound on sleep quality among ICU patients.</p><p><strong>Design: </strong>A true experimental crossover design was used. <i>Setting</i>. Medical ICU of the Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana, India. <i>Participants.</i> Sixty-eight patients admitted in the medical ICU were randomly allocated by lottery methods into group 1 and group 2.</p><p><strong>Methods: </strong>Nocturnal nine-hour (10 : 00 pm to 7 : 00 am) for a four-night period were measured. Earplugs and eye mask versus ocean sound were crossed over between two groups. Subjective sleep quality of four nights was assessed using a structured sleep quality scale. Scores for each question range from 0 to 3, with a higher score indicating poor sleep quality.</p><p><strong>Results: </strong>Repeated measures ANOVA showed that there was a significant change in the sleep quality score (<i>p</i>=0.001), which showed that sleep quality score was improved after the administration of earplugs and eye mask and ocean sound. Fisher's LSD post hoc comparison showed a significant difference (<i>p</i>=0.001).</p><p><strong>Conclusion: </strong>Earplugs and eye mask were better than ocean sound in improving sleep quality. Earplugs, eye mask, and ocean sound are safe and cost effective, which could be used as an adjuvant to pharmacological interventions to improve sleep quality among ICU patients. However, further research in this area needs to be conducted. This trial is registered with NCT03215212.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"8898172"},"PeriodicalIF":1.8,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39151886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Based Rapid Development and Implementation of a Novel Barrier Enclosure for Use in COVID-19 Patients: The SplashGuard CG.","authors":"Tine François, Laurence Tabone, Arielle Levy, Laurence Alix Seguin, Taher Touré, Carl Eric Aubin, Philippe Jouvet","doi":"10.1155/2020/3842506","DOIUrl":"10.1155/2020/3842506","url":null,"abstract":"<p><strong>Background: </strong>The current COVID-19 pandemic has resulted in over 54,800,000 SARS-CoV-2 infections worldwide with a mortality rate of around 2.5%. As observed in other airborne viral infections such as influenza and SARS-CoV-1, healthcare workers are at high risk for infection when performing aerosol-generating medical procedures (AGMP). Additionally, the threats of a global shortage of standard personal protective equipment (PPE) prompted many healthcare workers to explore alternative protective enclosures, such as the \"aerosol box\" invented by a Taiwanese anesthetist. Our study includes the design process of a protective barrier enclosure and its subsequent clinical implementation in the management of critically ill adults and children infected with SARS-CoV-2.</p><p><strong>Methods and results: </strong>The barrier enclosure was designed for use in our tertiary care facility and named \"SplashGuard CG\" (CG for Care Givers). The device has been adapted using a multi- and interdisciplinary approach, with collaboration between physicians, respiratory therapists, nurses, and biomechanical engineers. Computer-aided design and simulation sessions throughout the entire process facilitated the rapid and safe implementation of the SplashGuard CG in different settings (intensive care unit, emergency department, and the operating room) during AGMPs such as bag-valve-mask ventilation, nasopharyngeal suctioning, intubation and extubation, and noninvasive ventilation. Indications for use and anticipatory precautions were communicated to all healthcare workers using the SplashGuard CG. The entire process was completed within one month.</p><p><strong>Conclusion: </strong>The rapid design, development, and clinical implementation of a new barrier enclosure, the \"SplashGuard CG,\" was feasible in this time of crisis thanks to close collaboration between medical and engineering teams and the use of recurring simulation sessions to test and improve the initial prototypes. Following this accelerated process, it is necessary to maintain team skills, monitor any undesirable effects, and evaluate and continuously improve this new device.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"3842506"},"PeriodicalIF":1.8,"publicationDate":"2020-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7747007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38766276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Fluid Overload on Attributable Morbidity after Cardiac Surgery: A Retrospective Study.","authors":"Vildan Koc, Laura Delmas Benito, Eldert de With, E Christiaan Boerma","doi":"10.1155/2020/4836862","DOIUrl":"10.1155/2020/4836862","url":null,"abstract":"<p><strong>Introduction: </strong>Although the detrimental effects of excessive perioperative fluid administration are generally well established, data in the setting of cardiac surgery remain less robust.</p><p><strong>Methods: </strong>In this retrospective single-center observational study, the total fluid balance in the first 12 hours during and after surgery was evaluated. Primary endpoint was the relationship between total fluid balance and the incidence of prolonged mechanical ventilation. For this purpose, data were divided into quartiles (Q); prolonged mechanical ventilation and prolonged length of stay (LOS) in the ICU were defined as Q4. Secondary endpoints were prolonged LOS in the ICU, incidence of acute kidney injury (AKI; defined as a 1.5-fold increase in serum creatinine during, relative to baseline), and ICU mortality.</p><p><strong>Results: </strong>In a 3-year period, 748 patients were included. In a univariate analysis, the median duration of mechanical ventilation was 2.9 h [2.4-3.7] in Q1 of the fluid balance and increased significantly to 4.7 h [3.1-9.2] in Q4 of the fluid balance (<i>p</i> < 0.001). In addition, patients in Q4 of the fluid balance had a significantly longer LOS in the ICU, as well as a higher incidence of AKI and ICU mortality. In a multivariate analysis, Q4 of the fluid balance was independently associated with prolonged mechanical ventilation (OR 4.9, CI 2.9-8.4, <i>p</i> < 0.001) and prolonged LOS in the ICU (OR 11.3 CI 6.1-20,9, <i>p</i> < 0.001), but not with the incidence of AKI or ICU mortality.</p><p><strong>Conclusions: </strong>Perioperative fluid administration in cardiac surgery patients was independently associated with prolonged mechanical ventilation and prolonged LOS in the ICU.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"4836862"},"PeriodicalIF":1.7,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4836862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit.","authors":"Gopala Krishna Alaparthi,&nbsp;Aishwarya Gatty,&nbsp;Stephen Rajan Samuel,&nbsp;Sampath Kumar Amaravadi","doi":"10.1155/2020/7840743","DOIUrl":"https://doi.org/10.1155/2020/7840743","url":null,"abstract":"Purpose Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients' status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"7840743"},"PeriodicalIF":1.7,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7840743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38352150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure.","authors":"Andrei Karpov, Anish R Mitra, Sarah Crowe, Gregory Haljan","doi":"10.1155/2020/6688120","DOIUrl":"10.1155/2020/6688120","url":null,"abstract":"<p><strong>Design: </strong>This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. <i>Setting and Patients</i>. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. <i>Measurements and Results</i>. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team.</p><p><strong>Conclusions: </strong>The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"6688120"},"PeriodicalIF":1.7,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/6688120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38705803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Venous Catheter Insertion: A Scoring System for Evaluation of Both the Procedure and the Operator (CVCI Score/Gaber Score).","authors":"Sayed Gaber,&nbsp;Ahmed Yehia,&nbsp;Beshoy Nabil,&nbsp;Ahmed Samir","doi":"10.1155/2020/8156801","DOIUrl":"https://doi.org/10.1155/2020/8156801","url":null,"abstract":"Introduction Currently, there is no method to assess the performance while inserting a central venous catheter. We suggest a new scoring system for evaluation of both the technique as well as the operator, and then we applied it for the comparison between the landmark and ultrasound techniques to assess its validity. Methods. Four hundred patients were divided into two equal groups: group (A): internal jugular vein (IJV) and group (B): subclavian vein (SV). The landmark technique and the ultrasound guidance were used equally (100 patients for each) in both groups. Results In group (A), 20% of patients in the landmark group achieved score 4, while 82% of patients in the ultrasound group achieved the same score. This suggests that the ultrasound technique for catheterization of IJV decreased overall complications and improved the success rate. In group (B), there were 70% of patients in the landmark group who achieved score 5, while 49% of patients in the ultrasound group achieved the same score which proposes that the landmark technique might be deceptively better than the ultrasound technique for catheterization of SV. This could be because the time required for catheterization of SV by the ultrasound technique was longer than that in the landmark technique. Overall complications of 15% with the landmark technique vs. 2% with ultrasound guidance in this group of patients are not only statistically significant but also increase morbidity and mortality with a highly invasive procedure. Complications and their incidences are by far more significant than seconds of time. Our results suggest that the ultrasound technique could decrease the incidence of overall complications, but it is time-consuming in group (B). These results support the validity of our new scoring system. Conclusion We suggest a new scoring system for CVC insertion that can be used for evaluation of both the technique and the operator. It can evaluate the performance of junior staff and follow their progress. It can be applied in the medical and critical care practice as well as the quality management privileges and protocols.","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"8156801"},"PeriodicalIF":1.7,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8156801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38613992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}