Early association between respiratory mechanics and radiological changes in mechanically ventilated critically ill patients with COVID-19.

The chest X-ray (CXR) Brixia scoring system was developed exclusively for COVID-19 severity assessment. However, no association between the score and respiratory mechanics during mechanical ventilation has been examined. Our aim was to evaluate the association between the CXR Brixia score and respiratory mechanics on the first day of mechanical ventilation in critically ill COVID-19 patients. A total of 77 COVID-19 patients who underwent mechanical ventilation and CXR in the ICU setting were retrospectively included. The CXR Brixia scoring system was applied, and respiratory mechanics data were recorded on the first day of invasive mechanical ventilation. Median Simplified Acute Physiologic Score II (SAPSII) and Sequential Organ Failure Assessment (SOFA) scores were 40 (31-54) and 6 (4-8), respectively. The median Brixia score was 14 (11-16). The correlation between the Brixia score and static compliance or driving pressure was significant, at r = -0.38, p < 0.001 and r = 0.33, p = 0.003, respectively. Using multivariable linear regression, the model with the B zone was significantly better associated with static compliance (F = 11.5, R2 = 0.14, p = 0.001) and driving pressure (F = 11.3, R2 = 0.13, p = 0.001). In logistic regression analysis, the Brixia score (OR 1.24; 95% CI 1.07, 1.45; p = 0.005), B zone (OR 2.60; 95% CI 1.30, 5.20; p = 0.007), C zone (OR 2.50; 95% CI 1.23, 5.11; p = 0.012), A zone (OR 2.01; 95% CI 1.16, 3.44; p = 0.012), and D zone (OR 1.84; 95% CI 1.07, 3.17; p = 0.027) significantly predicted a driving pressure > 14 cmH2O. There is a relationship between changes in Brixia-scored chest X-ray images and compliance and driving pressure on the first day of invasive mechanical ventilation. We identified some CXR areas using the Brixia score, and evaluation of the Brixia score may provide additional information for predicting respiratory mechanics.

Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania.

BACKGROUND Ultrasound-guided procedures have become more reliable and efficient in daily anesthesiology practice, with increased patient comfort, better antimicrobial pattern, and easer care, and can be used in routine central vein catheterization practice. The infraclavicular subclavian vein approach provides all these advandages and in some clinical scenarios ensures the only appropriate route to central vein access. Therefore, this study of 105 patients aimed to implement and evaluate the use of ultrasound-guided infraclavicular subclavian venous catheterization. MATERIAL AND METHODS We enrolled 108 patients who were scheduled for elective major abdominal surgery and had an indication for central venous access. Catheterization was done according to the developed protocol. Anesthesiologists with at least 1 year of experience in regional ultrasound-guided anesthesia participated in this study. Data were collected and compared with the existing literature. RESULTS Out of 108 patients enrolled, 3 were excluded due to unfulfilled protocol. The successful catheterization rate was 98.1%. A significant relationship with deeper and narrower vein and failure was noted. On average, the distance between the vein entry point and acoustic shadow of the clavicle was 10.45 mm, at this point the depth was 22.01 mm and the diameter of the vein was 10.74 mm. The length of catheter intratissue passage was 42.06 mm. The angle between the skin and catheter passage was 31.58°. The malposition rate was 8.7%, and no predictive factors were identified. Equations to predict vein diameter and depth were generated. Patient weight more than 119.5 kg predicted procedure failure. There were no complications. CONCLUSIONS Ultrasound-guided infraclavicular subclavian vein catheterization can be easily and safely integrated into daily clinical practice, with high success rates and low complication rates.

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.