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1.
J Vasc Access ; 21(1): 86-91, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31328625

RESUMEN

PURPOSE: In an effort to reduce catheter-related bloodstream infection's incidence rates in an intensive care unit, several evidence-based procedures recommended by the Centers for Disease Control and Prevention for centrally inserted central catheters were implemented. A failure to fully comply with the recommendation for prompt removal of the centrally inserted central catheters was attributed, mainly to the difficulties and inadequacies raised from establishing peripheral venous access. METHODS: The ultrasound-guided peripheral venous cannulation method as a supplementary intervention to the Centers for Disease Control and Prevention's recommendations was incorporated and examined during the subsequent year. RESULTS: A significant reduction on catheter-related bloodstream infection incidence rates out of the expected range was found. Centrally inserted central catheters utilization ratios were reduced by 10.7% (p < 0.05; 58%-47%) and the catheter-related bloodstream infection incidence rate was reduced by 11.7 per thousand device-days (15.9-4.16/1000 centrally inserted central catheters days (2015-2016 group, respectively)). CONCLUSION: The reduction of catheter-related bloodstream infection was higher than that described in the published literature. This probably shows that the combination of the five evidence-based procedures recommended by the Centers for Disease Control and Prevention together with that of ultrasound-guided peripheral venous cannulation method can increase the compliance with the Category IA recommendation for removal or avoidance of unnecessary placement of centrally inserted central catheters and decrease the catheter-related bloodstream infections in a more effective way, by affecting the patients' centrally inserted central catheter exposure.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Remoción de Dispositivos , Ultrasonografía Intervencional , Anciano , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/normas , Chipre/epidemiología , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/normas , Diseño de Equipo , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento , Ultrasonografía Intervencional/normas , Estados Unidos
2.
Ann R Coll Surg Engl ; 102(1): 43-48, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31865760

RESUMEN

INTRODUCTION: The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. MATERIALS AND METHODS: We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. RESULTS: A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. CONCLUSIONS: Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.


Asunto(s)
Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/métodos , Biopsia con Aguja Fina/normas , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/normas , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estudios Retrospectivos , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto Joven
3.
BMC Urol ; 19(1): 68, 2019 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-31340802

RESUMEN

BACKGROUND: To define a new coefficient to be used in the formula (Volume = L x H x W x Coefficient) that better estimates prostate volume using dimensions of fresh prostates from patients who had transrectal ultrasound (TRUS) imaging prior to prostatectomy. METHODS: The prostate was obtained from 153 patients, weighed and measured to obtain length (L), height (H), and width (W). The density was determined by water displacement to calculate volume. TRUS data were retrieved from patient charts. Linear regression analyses were performed to compare various prostate volume formulas, including the commonly used ellipsoid formula and newly introduced bullet-shaped formula. RESULTS: By relating measured prostate volumes from fresh prostates to TRUS-estimated prostate volumes, 0.66 was the best fitting coefficient in the (L x H x W x Coefficient) equation. This newfound coefficient combined with outlier removal yielded a linear equation with an R2 of 0.64, compared to 0.55 and 0.60, for the ellipsoid and bullet, respectively. By comparing each of the measured vs. estimated dimensions, we observed that the mean prostate height and length were overestimated by 11.1 and 10.8% using ultrasound (p < 0.05), respectively, while the mean width was similar (p > 0.05). Overall, the ellipsoid formula underestimates prostate volumes by 18%, compared to an overestimation of 4.6 and 5.7% for the bullet formula and the formula using our coefficient, respectively. CONCLUSIONS: This study defines, for the first time, a coefficient based on freshly resected prostates as a reference to estimate volumes by imaging. Our findings support a bullet rather than an ellipsoid prostate shape. Moreover, substituting the coefficient commonly used in the ellipsoid formula by our calculated coefficient in the equation estimating prostate volume by TRUS, provides a more accurate value of the true prostate volume.


Asunto(s)
Próstata/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Próstata/patología
4.
Respir Res ; 20(1): 92, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31092254

RESUMEN

BACKGROUND: One of the known weaknesses of spirometry is its dependence on patients' cooperation, which can only partially be alleviated by educational efforts. Therefore, procedures less dependent on cooperation might be of value in clinical practice. We investigated the diagnostic accuracy of ultrasound-based capnovolumetry for the identification of airway obstruction. METHODS: Consecutive patients from a pulmonary outpatient clinic were included in the diagnostic study. As reference standard, the presence of airway obstruction was evaluated via spirometry and bodyplethysmography. Capnovolumetry was performed as index test with an ultrasound spirometer providing a surrogate measure of exhaled carbon dioxide. Receiver operating characteristic (ROC) analysis was performed using the ratio of slopes of expiratory phases 3 and 2 (s3/s2) ≥ 0.10 as primary capnovolumetric parameter for the recognition of airway obstruction. Logistic regression was performed as secondary analysis to identify further useful capnovolumetric parameters. The diagnostic potential of capnovolumetry to identify more severe degrees of airway obstruction was evaluated additionally. RESULTS: Of 1400 patients recruited, 1287 patients were included into the analysis. Airway obstruction was present in 29% of patients. The area under the ROC-curve (AUC) of s3/s2 was 0.678 (95% CI 0.645, 0.710); sensitivity of s3/s2 ≥ 0.10 was 47.7 (95% CI 42.7, 52.8)%, specificity 79.0 (95% CI 76.3, 81.6)%. When combining this parameter with three other parameters derived from regression analysis (ratio area/volume phase 3, slope phase 3, volume phase 2), an AUC of 0.772 (95% CI 0.743, 0.801) was obtained. For severe airway obstruction (FEV1 ≤ 50% predicted) sensitivity of s3/s2 ≥ 0.10 was 75.9 (95% CI 67.1, 83.0)%, specificity 75.8 (95% CI 73.3, 78.1)%; for very severe airway obstruction (FEV1 ≤ 30% predicted) sensitivity was 86.7 (95% CI 70.3, 94.7)%, specificity 72.8 (95% CI 70.3, 75.2)%. Sensitivities increased and specificities decreased considerably when the combined capnovolumetric score was used as index test. CONCLUSIONS: Capnovolumetry by way of an ultrasound spirometer had a statistically significant albeit moderate potential for the recognition of airway obstruction in a heterogeneous population of patients typically found in clinical practice. Diagnostic accuracy of the capnovolumetric device increased with the severity of airway obstruction. TRIAL REGISTRATION: The study is registered under DRKS00013935 at German Clinical Trials Register (DRKS).


Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico por imagen , Atención Ambulatoria/normas , Capnografía/normas , Volumen Espiratorio Forzado/fisiología , Pletismografía Total/normas , Espirometría/normas , Adulto , Anciano , Obstrucción de las Vías Aéreas/fisiopatología , Atención Ambulatoria/métodos , Capnografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pletismografía Total/métodos , Estudios Prospectivos , Espirometría/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas
6.
J Hepatobiliary Pancreat Sci ; 26(7): 249-269, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31025816

RESUMEN

Endoscopic ultrasound/ultrasonography-guided biliary drainage (EUS-BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its clinical utility, EUS-BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS-BD as well as safe introduction of the procedure to non-expert centers. The guidelines comprised patient-intervention-comparison-outcome-formatted clinical questions (CQs) and questions (Qs), which are background statements to facilitate understanding of the CQs. A literature search was performed using the PubMed and Cochrane Library databases. Statement, evidence level, and strength of recommendation were created according to the GRADE system. Four committees were organized: guideline creation, expert panelist, evaluation, and external evaluation committees. We developed 13 CQs (methods, device selection, supportive treatment, management of adverse events, education and ethics) and six Qs (definition, indication, outcomes and adverse events) with statements, evidence levels, and strengths of recommendation. The guidelines explain the technical aspects, management of adverse events, and ethics of EUS-BD and its introduction to non-expert institutions.


Asunto(s)
Colangitis/diagnóstico por imagen , Colangitis/cirugía , Drenaje/normas , Endosonografía/normas , Ictericia Obstructiva/diagnóstico por imagen , Ictericia Obstructiva/cirugía , Guías de Práctica Clínica como Asunto , Ultrasonografía Intervencional/normas , Humanos
7.
World Neurosurg ; 127: e1013-e1019, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30974273

RESUMEN

OBJECTIVE: To evaluate the feasibility of transcranial sonography in patients harboring polymethylmethacrylate cranioplasties (PMMA-CP) and explore whether this material is a valid sonic window to explore intracerebral structures. METHODS: In 6 patients, we performed transcranial sonography (TCS), using the PMMA-CP as sonic window. To test the reliability of ultrasound images, we collected several quantitative and qualitative measurements of intracranial structures and compared these sonographic images with standard computed tomography (CT) scan images. RESULTS: We found that PMMA-CP is a very good sonic window and allowed us to obtain very good quality echographic images of intracranial structures, as shown by the comparison of measurements with CT scan, which were very reliable. The main drawback was related to the shape (i.e., the curvature) of the cranial flap, which hindered the ultrasound probe from correctly adhering to the scalp. CONCLUSIONS: Although limited by the restricted number of cases, this preliminary experience represents the first available data about the serial use of TCS using PMMA-CP as window. These results open the path to the routine use of TCS to longitudinally control patients already harboring PMMA-CP. More, we here discuss its potential role in globally reducing the number of follow-up CT and magnetic resonance imaging scans required in different type of patients and pathologies.


Asunto(s)
Metilmetacrilato/administración & dosificación , Polimetil Metacrilato/administración & dosificación , Procedimientos Quirúrgicos Reconstructivos/métodos , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Encefalopatías/diagnóstico por imagen , Encefalopatías/cirugía , Craneotomía/métodos , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/normas , Ultrasonografía Intervencional/normas , Adulto Joven
8.
Respir Res ; 20(1): 68, 2019 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-30953529

RESUMEN

The study by Kiranantawat et al. "Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation" highlights how "pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy". Even if we agree about the role of CT guidance, we would like to point out how Thoracic Ultrasound could be better than CT for biopsy of subpleural lesions that could easily be detected and reached with this "real-time" and quicker technique.


Asunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/normas , Ultrasonografía Intervencional/normas , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/normas , Humanos , Enfermedades Pulmonares/patología , Neumotórax/etiología , Neumotórax/prevención & control , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/instrumentación , Ultrasonografía Intervencional/efectos adversos , Ultrasonografía Intervencional/instrumentación
9.
Eur Radiol ; 29(11): 6129-6139, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31028446

RESUMEN

OBJECTIVES: We sought to evaluate the accuracy of standardized total plaque volume (TPV) measurement and low-density non-calcified plaque (LDNCP) assessment from coronary CT angiography (CTA) in comparison with intravascular ultrasound (IVUS). METHODS: We analyzed 118 plaques without extensive calcifications from 77 consecutive patients who underwent CTA prior to IVUS. CTA TPV was measured with semi-automated software comparing both scan-specific (automatically derived from scan) and fixed attenuation thresholds. From CTA, %LDNCP was calculated voxels below multiple LDNCP thresholds (30, 45, 60, 75, and 90 Hounsfield units [HU]) within the plaque. On IVUS, the lipid-rich component was identified by echo attenuation, and its size was measured using attenuation score (summed score ∕ analysis length) based on attenuation arc (1 = < 90°; 2 = 90-180°; 3 = 180-270°; 4 = 270-360°) every 1 mm. RESULTS: TPV was highly correlated between CTA using scan-specific thresholds and IVUS (r = 0.943, p < 0.001), with no significant difference (2.6 mm3, p = 0.270). These relationships persisted for calcification patterns (maximal IVUS calcium arc of 0°, < 90°, or ≥ 90°). The fixed thresholds underestimated TPV (- 22.0 mm3, p < 0.001) and had an inferior correlation with IVUS (p < 0.001) compared with scan-specific thresholds. A 45-HU cutoff yielded the best diagnostic performance for identification of lipid-rich component, with an area under the curve of 0.878 vs. 0.840 for < 30 HU (p = 0.023), and corresponding %LDNCP resulted in the strongest correlation with the lipid-rich component size (r = 0.691, p < 0.001). CONCLUSIONS: Standardized noninvasive plaque quantification from CTA using scan-specific thresholds correlates highly with IVUS. Use of a < 45-HU threshold for LDNCP quantification improves lipid-rich plaque assessment from CTA. KEY POINTS: • Standardized scan-specific threshold-based plaque quantification from coronary CT angiography provides an accurate total plaque volume measurement compared with intravascular ultrasound. • Attenuation histogram-based low-density non-calcified plaque quantification can improve lipid-rich plaque assessment from coronary CT angiography.


Asunto(s)
Algoritmos , Angiografía por Tomografía Computarizada/normas , Angiografía Coronaria/normas , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Placa Aterosclerótica/diagnóstico , Ultrasonografía Intervencional/normas , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados
11.
Value Health ; 22(3): 284-292, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30832966

RESUMEN

BACKGROUND: For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression. OBJECTIVES: To evaluate whether the trend of image guidance for RFA is moving toward the more expensive computed tomography (CT) technology and to determine the clinical benefits of CT guidance over the ultrasound (US) guidance. METHODS: A cohort of 463 patients was identified from the Surveillance, Epidemiology, and End Results and Medicare-linked database. The temporal trends in use of image guidance were assessed using the Cochrane-Armitage test. The associations between modality of image guidance and survival, complications, and costs were assessed using the Cox regression model, the logistic regression model, and the generalized linear model, respectively. RESULTS: The use of CT-guided RFA increased sharply, from 20.7% in 2002 to 75.9% in 2011. Compared with CT-guided RFA, those who received US-guided RFA had comparable risk of periprocedural and delayed postprocedural complications. Stratified analyses by tumor size also showed no statistically significant difference. In adjusted survival analysis, no statistically significant difference was observed in overall and cancer-specific survival. Nevertheless, the cost of CT-guided RFA ($2847) was higher than that of US-guided RFA ($1862). CONCLUSIONS: Despite its rapid adoption over time, CT-guided RFA incurred higher procedural costs than US-guided RFA but did not significantly improve postprocedural complications and survival. Echoing the American Board of Internal Medicine's Choosing Wisely campaign and the American Society of Clinical Oncology's Value of Cancer Care initiative, findings from our study call for critical evaluation of whether CT-guided RFA provides high-value care for patients with HCC.


Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Medicare/normas , Ablación por Radiofrecuencia/normas , Tomografía Computarizada por Rayos X/normas , Ultrasonografía Intervencional/normas , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/cirugía , Estudios de Cohortes , Femenino , Humanos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/cirugía , Masculino , Puntaje de Propensión , Ablación por Radiofrecuencia/métodos , Estudios Retrospectivos , Programa de VERF/normas , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía Intervencional/métodos , Estados Unidos/epidemiología
12.
Eur Radiol ; 29(9): 4889-4896, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30783787

RESUMEN

OBJECTIVE: To evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice. METHODS: Our institutional review board approved this retrospective study. We reviewed all CNB performed in our center over a period of 11 years. Ultrasound-guided CNBs were performed using a spring-loaded 18-gauge biopsy needle. We used a classification with four diagnostic categories for CNB results: insufficient, benign, follicular lesion (indeterminate), and malignant. Final diagnosis was based on surgical diagnosis or follow-up of at least 2 years in non-operated patients. RESULTS: The study included 4412 CNB in 4112 nodules of 3768 patients, 300 of them repeated biopsies. Results were 148 insufficient (3.4%), 3706 benign (84%), 278 follicular lesions (6.3%), and 280 malignant (6.3%). Considering follicular lesion and malignancy CNB results as positive (both lead to the recommendation of surgery) sensitivity was 96% (CI 93.2-97.8) and specificity 93.7% (CI 92.9-94.5). Predictive positive value for a follicular lesion diagnosis was 12.2% and for a malignancy diagnosis, 98.6%. CNB likelihood ratio for malignancy of a malignant diagnosis was 841.9 (CI 315.8-2313.3), of a malignant/follicular lesion diagnosis was 23.4 (CI 20.1-27.3), and of a benign diagnosis was 0.04 (CI 0.02-0.07). Repeated CNB in 53 insufficient biopsies obtained 50 diagnostic results. Minor complications occurred in 2.2% of CNB, and major in four procedures (0.09%). CONCLUSIONS: CNB in thyroid nodules is accurate and has few complications and a low rate of non-diagnostic and indeterminate diagnoses. It can be an alternative method when FNAC has poor performance. Repeating biopsy is useful after non-diagnostic biopsies. KEY POINTS: • Core-needle biopsy of thyroid has a low ratio non-diagnostic and indeterminate results. • Core-needle biopsy results are highly reliable, especially benign results. • Complication rate of core-needle biopsy of thyroid is low.


Asunto(s)
Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Gruesa/efectos adversos , Biopsia con Aguja Gruesa/métodos , Biopsia con Aguja Gruesa/normas , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/normas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patología , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto Joven
13.
Int J Cardiol ; 281: 62-68, 2019 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-30718133

RESUMEN

AIMS: The current algorithm in transthoracic echocardiography (TTE) proposed in the 2016 ASE/EACVI recommendation for the estimation of left ventricular filling pressure (LVFP) is quite complex and time-consuming. B-lines, in lung ultrasonography (LUS), could constitute an interesting tool for LVFP evaluation in clinical practice, although data regarding their association with invasive haemodynamics are lacking. The purpose of this study was to explore the diagnostic accuracy of B-lines in identifying elevated left ventricular end-diastolic pressure (LVEDP). METHOD AND RESULTS: 81 adults with significant dyspnoea (NYHA ≥ 2) were prospectively analyzed by LUS in four areas in each hemithorax and a complete TTE within four hours prior to coronary angiography. Twenty-eight patients had elevated LVEDP. Clinical variables yielded a C-index of 79% to identify elevated LVEDP. The number of total B-lines was higher in the elevated LVEDP group (1.0vs17.0, p < 0.0001) and significantly increased the diagnostic accuracy (C-index increase = 10.5%, p = 0.002) and net reclassification index (NRI = 145.4, 113.0-177.9, p < 0.0001) on top of clinical variables. CONCLUSION: This study demonstrates the substantial diagnostic capacity of B-lines to identify elevated LVEDP, which appears superior to that of classical echocardiographic strategies. This tool should be considered in a multi-parametric approach in patients with heart failure.


Asunto(s)
Pulmón/diagnóstico por imagen , Ultrasonografía Intervencional/normas , Función Ventricular Izquierda/fisiología , Presión Ventricular/fisiología , Anciano , Anciano de 80 o más Años , Disnea/diagnóstico por imagen , Disnea/fisiopatología , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos
16.
J Cardiothorac Vasc Anesth ; 33(4): 1029-1034, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30269888

RESUMEN

OBJECTIVE: Visualizing the needle tip using the short-axis out-of-plane (SA-OOP) ultrasound-guided central venous catheterization approach is difficult and results in posterior wall puncture (PWP). To improve needle tip visualization in the long-axis view, combining the SA-OOP and the long-axis in-plane approaches has been suggested. The authors, who previously reported on the utility of this technique using a manikin model, examined the feasibility of this novel method (referred to as the combined short-axis and long-axis [CSLA] approach) and compared the CSLA approach with the SA-OOP approach in humans for the present study. DESIGN: Prospective observational study. SETTING: Single institution, Rakuwakai Otowa Hospital. PARTICIPANTS: Patients undergoing cardiac or vascular surgeries. INTERVENTIONS: The CSLA and SA-OOP approaches were used for ultrasound-guided right jugular venous puncture. The puncturing procedures were determined arbitrarily preoperatively without consideration of the patient's neck anatomy and were based on the operator's preference without randomization. MEASUREMENTS AND MAIN RESULTS: The study comprised 100 patients. Successful guidewire insertion without PWP was performed in 48 patients (96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach group; the rate was significantly higher in the CSLA approach group (p = 0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP approach group (p = 0.19). CONCLUSIONS: This study showed that the CSLA approach to ultrasound-guided central venous catheterization might help prevent PWP.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Agujas/normas , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía Intervencional/instrumentación
17.
J Vasc Access ; 20(3): 239-249, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30286688

RESUMEN

Ultrasound technology has revolutionized the practice of safer vascular access, for both venous and arterial cannulation. The ability to visualize underlying structures of the chest, neck, and upper/lower extremities provides for greater success, speed, and safety with all vascular access procedures. Ultrasound not only yields superior procedural advantages but also provides a platform to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency, including the location of other important and best avoided anatomical structures-prior to performing any procedures. Such assessment is best performed using a systematic and standardized approach, as the Rapid Central Vein Assessment, described in this study.


Asunto(s)
Cateterismo Venoso Central/normas , Ultrasonografía Intervencional/normas , Venas/diagnóstico por imagen , Puntos Anatómicos de Referencia , Cateterismo Venoso Central/efectos adversos , Toma de Decisiones Clínicas , Humanos , Guías de Práctica Clínica como Asunto/normas , Valor Predictivo de las Pruebas , Punciones
18.
Int J Cardiol ; 278: 295-299, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30545621

RESUMEN

BACKGROUND: Coronary Artery Disease (CAD) is the leading cause of death worldwide. Ultrasound-detected carotid plaque has been previously shown to predict significant CAD. Despite this evidence, carotid plaque assessment has not been implemented in cardiac risk screening, likely due to the cost associated with a formal carotid ultrasound examination. This study sought to determine whether a handheld vascular ultrasound device could be used as an accurate point-of-care imaging tool for the assessment of carotid artery plaque. METHODS: We performed a focused vascular ultrasound of the carotid arteries of 200 patients referred for coronary angiography using a handheld ultrasound device as well as a full-size conventional ultrasound system. For each participant, the maximum plaque height (MPH) and total plaque area (TPA) of the carotid artery bulbs were measured. RESULTS: Carotid plaque assessment using the handheld device was comparable to that of the conventional ultrasound system. We found a good correlation and no relevant bias between handheld and conventional ultrasound systems in measuring MPH (r = 0.84, p < 0.0001) and TPA (r = 0.94, p < 0.0001). Furthermore, there was good inter-rater reliability for online and offline measurements of MPH and offline measurements of TPA by handheld ultrasound (0.79, 0.76 and 0.85, respectively). CONCLUSIONS: This study demonstrates that a focused ultrasound of the carotid artery using a handheld device can be used to accurately measure MPH and TPA. This protocol has the potential to provide an expedited point-of-care assessment of carotid plaque.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Computadoras de Mano/normas , Sistemas de Atención de Punto/normas , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/normas , Anciano , Estenosis Carotídea/terapia , Angiografía Coronaria/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía Intervencional/métodos
19.
Eur J Anaesthesiol ; 36(3): 200-205, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30431501

RESUMEN

BACKGROUND: The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation. OBJECTIVE: We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants. DESIGN: A randomised, controlled and patient-blinded study. SETTING: Single-centre trial, study period from June 2016 to February 2017. PATIENTS: Seventy-four infants undergoing elective cardiac surgery. INTERVENTION: Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video. MAIN OUTCOME MEASURES: The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed. RESULTS: The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION: The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required. TRIAL REGISTRATION: ClinicalTrials.gov NCT02795468.


Asunto(s)
Cateterismo Periférico/métodos , Palpación/métodos , Arteria Radial/diagnóstico por imagen , Arteria Radial/cirugía , Ultrasonografía Intervencional/métodos , Factores de Edad , Cateterismo Periférico/normas , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Palpación/normas , Método Simple Ciego , Ultrasonografía Intervencional/normas
20.
Catheter Cardiovasc Interv ; 93(2): 233-238, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30260080

RESUMEN

BACKGROUND: Angiographic assessment of left main coronary artery (LMCA) lesions remains challenging and limited data is available on reference diameters and length of nonobstructive LMCA dimensions. Our aim was to provide insights in the dimensions of nonobstructive LMCA and to find a possible correlation with gender and patient habitus. METHODS: This retrospective single center study was performed in a consecutive cohort of patients who underwent Intravascular Ultrasound (IVUS) guided percutaneous coronary interventions of the left coronary system including complete pullbacks of a non-obstructive LMCA (n = 254). RESULTS: Mean LMCA length as measured with IVUS was 7.37 ± 4.2 mm and mean lumen area (LA) was 15.63 ± 4.76 mm2 corresponding to a mean lumen diameter (LD) of 4.41 ± 0.67 mm. An IVUS derived mean LD of >4 mm was present in 71.7%, >4.5 mm in 43% and > 5 mm in 19% of patients. LMCA mean LA was significantly smaller in women as compared to men (14.1 ± 4.1 mm2 and 16.2 ± 4.8 mm2 , P < 0.01). Multivariable analysis identified weight of the patient as the sole significant predictor for LMCA length while height of the patient and LMCA length were predictors of LMCA mean LA. Correlation coefficients of determination for all independent predictors were low (R2 < 0.1 for all). CONCLUSION: This study demonstrated that the mean LD of a non-obstructive LMCA is 4 mm or greater in the majority of patients, with a mean LMCA length of 7.4 mm. Women have smaller luminal dimension than men. No clinically relevant predictors were found for both LMCA length and mean LA.


Asunto(s)
Vasos Coronarios/diagnóstico por imagen , Ultrasonografía Intervencional , Anciano , Estatura , Peso Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Valores de Referencia , Estudios Retrospectivos , Factores Sexuales , Ultrasonografía Intervencional/normas
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