Study of the accuracy of a radial arterial pressure waveform cardiac output measurement device after cardiac surgery.

BACKGROUND: Less invasive monitoring, such as radial arterial pulse contour analysis (ProAQT® sensor), represents an alternative when hemodynamic monitoring is necessary to guide postoperative management and invasive monitoring is not technically feasible. The aim of the study is to evaluate the accuracy of the ProAQT® sensor cardiac output measurements in comparison with Pulmonary Artery Catheter (PAC) during the postoperative course of patients who underwent cardiac surgery with cardiopulmonary bypass. CASE PRESENTATION: Prospective observational study in a Surgical Intensive Care Unit of a tertiary university hospital. Ten patients with a mean age of 73.5 years were included. The main comorbidities were hypertension, diabetes, dyslipidemia and the preoperative left ejection fraction was 43.8 ± 14.5%. Regarding the type of surgery, six patients underwent valve surgery, two underwent coronary artery bypass grafting and two underwent aortic surgery. The cardiac index measured simultaneously by the ProAQT® sensor was compared with the PAC. The parameters were evaluated at predefined time points during the early postoperative courses (6 h, 12 h, 24 h, 48 h and 72 h). The degree of agreement with the cardiac index between the PAC and the ProAQT® sensor along the time points was measured using the concordance correlation coefficient, Bland-Altman analysis, and four-quadrant plot. Sixty-three pairs of measurements were analyzed. We showed that measurements of cardiac index were slightly higher with PAC (ß Ì‚ = - 0.146, p-value = 0.094). The concordance correlation coefficient for the additive model of cardiac index was 0.64 (95% Confidence Interval: 0.36, 0.82), indicating a high concordance between both sensors. Bland-Altmann analysis showed a mean bias of 0.45 L·min-1·m-2, limits of agreement from - 1.65 to 2.3 L·min-1·m-2, and percentage of error was 82.5%. Four-quadrant plot of changes in cardiac index showed a good concordance rate (75%), which increases after applying the exclusion zone (87%). CONCLUSIONS: In patients undergoing cardiac surgery, the ProAQT® sensor may be useful to monitor cardiac index during the postoperative period, especially when more invasive monitoring is not possible.

Impacto del programa de prevención de infección del catéter venoso central en Unidades de Cuidados Intensivos / Impact of infecion prevention program central venous catheter in Intensive Care Units

Introducción. La canalización de vías venosas centrales (CVC) es una técnica utilizada en unidades de cuidados intensivos (UCI) no exenta de riesgo de infección en la colocación y en su posterior manipulación. Objetivo. Evaluar la efectividad de un programa de prevención e infección tras la incorporación de nuevas estrategias multifactoriales, en el programa de prevención de la bacteriemia relacionada con catéter (BRC) en UCI. Metodología. Estudio descriptivo comparativo en dos periodos. Incluidos todos los pacientes ingresados en dos UCI polivalentes de un hospital de tercer nivel el año 2014. Se analizaron los datos de 2014 en comparación con los de 2013 para comprobar el impacto de las nuevas medidas del programa de prevención de BRC. Variables: n.º de catéteres, n.º infecciones/1000 días de catéter y vía de acceso. Las actuaciones realizadas han sido: vigilancia prospectiva de la tasa de incidencia, programa de prevención multifactorial secuencial con implantación de diferentes medidas, lista de comprobación de la inserción de nuevos catéteres, introducción de monitorización semanal, notificación de episodios al equipo asistencial, formación continuada al personal sanitario e implantación de los apósitos transparentes semipermeables con gel de clorhexidina. Resultados. La tasa de incidencia descendió de 3.1 episodios/ 1000 días de catéter en 2013 a 2.3 episodios/1000 días de catéter en 2014, lo que supone una mejora en las diferentes unidades. La ratio de utilización de los diferentes accesos fue: 35 % humeral; 33 % yugular; 25 % subclavia; 10 % femoral, y 13 % Shaldon. Conclusiones: Las nuevas medidas aplicadas para reducir la bacteriemia han permitido una disminución en la tasa de infección, lo que nos acerca al objetivo del programa Bacteriemia Zero (AU)

Introduction. The channeling of central venous catheters (CVC) is a technique used in intensive care units (ICUs ) but it doesn’t come without the risk of infection in the placement and subsequent handling. Objective. Evaluate the effectiveness of a prevention of infection following the introduction of new multifactorial strategies in the prevention program Central line-associated bloodstream infection (CLABSI) at ICU. Methodology. Comparative descriptive study in two periods, including all patients admitted in multipurpose ICUs of a tertiary hospital 2014. Were analyzed 2014 data comparated with 2013, to test the impact of new measures CRB prevention program. Variables: number of catheters, number of infections/1000 catheter days and path. Actions carried out were: prospective surveillance of the incidence rate, sequential program multifactorial prevention implementation of different measures, checklist for insertion of new catheters, introduction of weekly monitoring compliance, reporting episodes team care, continuing education for sanitary personal and implementation of the semipermeable transparent dressings with chlorhexidine gel. Results. The overall incidence density rate decreased from 3.1 episodes/1000 catheter days in 2013 to 2.3 episodes/1000 catheter days in 2014, improving in different units. The utilization ratio of the different accesses was: 35 % humeral; 33 % jugular; 25 % subclavian; 10 % femoral, and 13 % hemodialysis catheter. Conclusions. The new measures applied to reduce the bacteremia have allowed a decrease in the rate of infection, what brings closer to the objective of the Bacteremia Zero program (AU)

[Impact of Infection Prevention Program Central Venous Catheter in Intensive Care Units]. / Impacto del programa de prevención de infección del catéter venoso central en unidades de cuidados intensivos.

Introduction: The channeling of central venous catheters (CVC) is a technique used in intensive care units (ICUs) but it doesn't come without the risk of infection in the placement and subsequent handling. Objective: Evaluate the effectiveness of a prevention of infection following the introduction of new multifactorial strategies in the prevention program Central line-associated bloodstream infection (CLABSI) at ICU. Methodology: Comparative descriptive study in two periods, including all patients admitted in multipurpose ICUs of a tertiary hospital 2014. We analyzed 2014 data compared with 2013, to test the impact of new measures CRB prevention program. Variables: number of catheters, number of infections/1000 catheter days and path. Actions carried out were: prospective surveillance of the incidence rate, sequential program multifactorial prevention implementation of different measures, checklist for insertion of new catheters, introduction of weekly monitoring compliance, reporting episodes team are, continuing education for sanitary personal and implementation of the semipermeable transparent dressings with chlorhexidine gel. Results: The overall incidence density rate decreased from 3.1 episodes/1000 catheter days in 2013 to 2.3 episodes/1000 catheter days in 2014, improving in different units. The utilization ratio of the different accesses was: 35% humeral; 33% jugular; 25% subclavian; 10% femoral, and 13% hemodialysis catheter. Conclusions: The new measures applied to reduce the bacteremia have allowed a decrease in the rate of infection, what brings closer to the objective of the Bacteremia Zero program.