Safety of intravenous application of second-generation ultrasound contrast agent in children: prospective analysis.

The goal of the work described here was to assess the safety profile of intravenous second-generation ultrasound contrast agents (UCAs) containing sulfur hexafluoride in pediatric contrast-enhanced ultrasound. Between 2010 and 2013, a total of 167 examinations were performed in 137 children referred by the Oncology Department. Approval by an Independent Ethical Review Board on Scientific Research for the intravenous use of an UCA containing sulfur hexafluoride in children with oncologic diseases was obtained. Consent for UCA administration was acquired from the parents or legal guardians. Severe anaphylactic reaction was observed in 0.6% (n = 1). No other adverse events during or after intravenous administration of contrast were observed in the examined group (no changes in heart rate and rhythm, blood pressure, oxygen saturation or respiratory rate). There were no reports of subjective flushing, nausea, transient headaches or altered taste. Although second-generation ultrasound contrast agents are considered potentially safe, all investigators should be prepared for the development of adverse reactions and have provisions in place for all pediatric intravenous contrast-enhanced ultrasound examinations. More multicenter studies are essential to determination of an accurate UCA safety profile.

[Does the time of admission to ITU affect mortality?]. / Czy na smiertelnosc w oddziale intensywnej terapii ma wplyw czas przyjecia chorych do oddzialu?

BACKGROUND: Among many factors that may affect mortality among ITU patients, the time of admission has been reported to play some, but ill-defined role. In the retrospective study, we analysed the time of admission, severity of the underlying disease, clinical status on admission and mortality among adult patients treated in a single ITU over a six-year period. METHODS: We compared the mortality of patients who were admitted during daytime (7 a.m. to 6:59 p.m.) and at night (7 p.m. to 6:59 a.m.). We also compared those admitted on weekdays (Monday 7 p.m. to Friday 6:59 a.m.) to those admitted during weekends (Friday 7 p.m. to Monday 7 a.m.). The patients condition was assessed using the APACHE II scale. Brain dead organ donors and readmissions were excluded from the analysis. RESULTS: The retrospective study involved the data of 1789 patients. Mortality was higher in patients who were admitted during the night and during weekends, when compared to daytime and weekdays, respectively. Mortality was also higher in patients admitted directly from the operating theatre after emergency surgery, but only during nights and weekends. The following independent factors in ITU mortality have been identified: length of ITU stay (OR 1.015; % CI 1.005-1.024), admission from a hospital ward (OR 1.39; 95% CI 1.04-1.86) and APACHE II score (OR 1.177; 95% CI 1.156-1.198). CONCLUSION: Time of admission has not been identified as a single independent factor of ITU mortality, but admissions at night and during weekends were associated with higher mortality, probably because of emergency conditions.

[Selected factors affecting long-term outcomes of in-hospital resuscitation]. / Analiza wybranych czynników wplywajacych na odlegle wyniki resuscytacji po wewngtrzszpitalnych zatrzymaniach krazenia.

BACKGROUND: Results of resuscitation attempts and subsequent survival rates can now be analysed, based on the Utstein templates. Few such reports have been published so far in Poland. METHODS: We have retrospectively analysed the outcomes of in-hospital resuscitation attempts, performed during 30 months in a large university hospital.The buildings were spread over 5.72 hectares, with the longest distance between buildings being 500 m. The resuscitation team consisted of an anaesthesiologist and a specialized nurse equipped with a basic set containing airway equipment, intravenous cannulas and drugs. Resuscitation protocols were analysed according to the Utstein templates. RESULTS: There were 198 resuscitation attempts registered. In 47% of the cases, the circulation returned, but 28% of the patients died within 24 hours. 11% were discharged home, however 9 patients died within the next 6 months. 6% of the resuscitated patients survived over 12 months and were rated grade 1 or 2 on the CPC (Cerebral Performance Category) scale.The 12-month survival rate correlated only with the time from cardiac arrest to the first adrenaline injection. The in-hospital survival rate (possibility of discharge) correlated with the duration of hospitalization before cardiac arrest, the first registered cardiac rhythm (defibrillation-susceptible), and the time to first defibrillation. DISCUSSION: The most pronounced difference between the results of in-hospital and pre-hospital CPR was the primary cardiac rhythm associated with the cardiac arrest. Defibrillation-susceptible rhythm was observed in only 15% of cases, and was associated with immediate survival and hospital discharge, but not with 12-month survival. The time to administration of the first dose of adrenaline was a sole factor associated with 12 month survival.