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1.
Respir Care ; 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34584010

RESUMO

BACKGROUND: Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV. METHODS: This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality. RESULTS: Baseline characteristics and PaO2 /FIO2 ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31-1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35-0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17-0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38-1.04, P = .06). CONCLUSIONS: We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial.The study was registered at the Clinical Trials Registry of India (www.ctri.nic.in; reference number: CTRI/2020/07/026835) on July 27, 2020.

3.
Diabetes Metab Syndr ; 15(4): 102189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34217144

RESUMO

BACKGROUND: Vitamin-D is an immune-modulator which might be linked to disease severity by SARS-CoV-2. METHODS: Meta-analysis of RCTs and quasi-experimental studies, evaluating the role of vitamin-D supplementation in COVID patients was done. RESULTS: Total 5 studies (3 RCTs and 2 Quasi-experimental) including n = 467 patients were included. Vitamin D didn't reduce mortality (RR 0.55, 95%CI 0.22 to 1.39, p = 0.21), ICU admission rates (RR 0.20, 95% CI 0.01-4.26, p = 0.3) and need for invasive ventilation (RR 0.24, 95% CI 0.01-7.89, p = 0.42). CONCLUSION: No significant difference with vitamin-D supplementation on major health related outcomes in COVID-19. Well-designed RCTs are required addressing this topic.


Assuntos
COVID-19/tratamento farmacológico , Suplementos Nutricionais , Terapia Nutricional/métodos , SARS-CoV-2/efeitos dos fármacos , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , COVID-19/epidemiologia , COVID-19/virologia , Humanos , Prognóstico
4.
Indian J Crit Care Med ; 25(6): 660-667, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34316146

RESUMO

Background: Data are lacking on the role of cellular components of hematological system as biomarkers for prognosis of sepsis. We planned to identify if these parameters measured at admission to ICU and at 72 hours can be useful as prognostic marker in septic critically ill patients. Materials and methods: In this prospective observational study, 130 adult patients with sepsis were recruited. Various hematological study parameters (total, differential, and absolute leukocyte count, platelet count, platelet distribution width, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio) were noted at day 1 and day 3 of admission. Primary outcome was 28-day mortality, and secondary outcomes were duration of mechanical ventilation, vasopressor requirement, ICU length of stay, and requirement of renal replacement therapy. The variables were compared between two groups and using binary regression model and were evaluated as prognostic markers for 28-day mortality. Results: Data from n = 129 were analyzed. At day-28, n = 58 (44.96%) patients survived. Baseline and demographic parameters were comparable between survivors and nonsurvivors. Admission Sequential Organ Failure Assessment score was more in nonsurvivors than survivors [8 (6-8) vs 6 (4-8); p = 0.002]. In nonsurvivors, monocyte, lymphocyte, basophil, eosinophil, and platelet count were significantly less at day 1 and lymphocyte, eosinophil, basophil and platelet count were significantly less at day 3. NLR and PLR at day 3 were significantly more in nonsurvivors. On logistic regression analysis, age, thrombocytopenia on day 1, and low eosinophil count on day 3 predicted 28-day mortality (p = 0.006, p = 0.02, and p = 0.04, respectively). Conclusion: Thrombocytopenia on day 1 and eosinopenia on day 3 may predict 28-day mortality in sepsis. How to cite this article: Sinha H, Maitra S, Anand RK, Aggarwal R, Rewari V, Subramaniam R, et al. Epidemiology and Prognostic Utility of Cellular Components of Hematological System in Sepsis. Indian J Crit Care Med 2021;25(6):660-667.

5.
Indian J Crit Care Med ; 25(3): 310-316, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33790513

RESUMO

Background: Transthoracic echocardiography is a reliable method to measure a dynamic change in left ventricular outflow tract velocity time integral (LVOTVTI) and stroke volume (SV) in response to passive leg raising (PLR) and can predict fluid responsiveness in critically ill patients. Measuring carotid artery velocity time integral (CAVTI) is easier, does not depend on adequate cardiac window, and requires less skill and expertise than LVOTVTI. The aim of this study is to identify the efficacy of ΔCAVTI and ΔLVOTVTI pre- and post-PLR in predicting fluid responsiveness in critically ill patients with sepsis and septic shock. Methods: After the institutional ethics committee's clearance and informed written consent, 60 critically ill mechanically ventilated patients aged 18-65 years were recruited in this prospective parallel-group study with 20 patients in each group: sepsis (group S), septic shock (group SS), and control (group C). Demographic parameters and baseline acute physiology, age and chronic health evaluation-II and sequential organ failure assessment scores were noted. LVOTVTI, SV, and CAVTI were measured before and after PLR along with other hemodynamic variables. Patients having a change in SV more than 15% following PLR were defined as "responders." Results: Twenty-three patients (38.33%) were responders. Area under receiver-operating characteristic curve for ΔCAVTI could predict responders in control and sepsis patients only. The correlation coefficients between pre- and post-PLR ΔCAVTI and ΔLVOTVTI were 0.530 (p = 0.016), 0.440 (p = 0.052), and 0.044 (p = 0.853) in control, sepsis, and septic shock patients, respectively. Conclusion: Following PLR, ΔCAVTI does not predict fluid responsiveness in septic shock patients and the correlation between ΔCAVTI and ΔLVOTVTI is weak in septic shock patients and only modest in sepsis patients. How to cite this article: Chowhan G, Kundu R, Maitra S, Arora MK, Batra RK, Subramaniam R, et al. Efficacy of Left Ventricular Outflow Tract and Carotid Artery Velocity Time Integral as Predictors of Fluid Responsiveness in Patients with Sepsis and Septic Shock. Indian J Crit Care Med 2021;25(3):310-316. CTRI/Trial Reg No: www.ctri.nic.in, CTRI/2017/11/010434.

6.
Indian J Crit Care Med ; 25(3): 349-350, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33790522

RESUMO

How to cite this article: Anand RK, Baidya DK, Maitra S, Ray BR. A Proposal for Dedicated "Prone Team" and "Prone Bundle of Care" in COVID-19 ICU. Indian J Crit Care Med 2021;25(3):349-350.

7.
Surgery ; 170(1): 277-283, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33771357

RESUMO

BACKGROUND: As respiratory system compliances are heterogenous, we hypothesized that individualized intraoperative positive end-expiratory pressure titration on the basis of lowest driving pressure can reduce postoperative atelectasis and improve intraoperative oxygenation and postoperative lung functions. METHODS: Eighty-two adult patients undergoing major abdominal surgery were recruited in this randomized trial. In the titrated positive end-expiratory pressure group, positive end-expiratory pressure was titrated incrementally until lowest driving pressure was achieved, and the same procedure was repeated in every 2 hours. In the fixed positive end-expiratory pressure group, a positive end-expiratory pressure of 5 cmH2O was used throughout the surgery. The primary objective of this study was lung ultrasound score noted at the completion of surgery and 5 minutes after extubation at 12 lung areas bilaterally. RESULTS: Mean (standard deviation) age of the recruited patients were 43.8 (17.3) years, and 50% of all patients (41 of 82) were women. Lung ultrasound aeration scores were significantly higher in the fixed positive end-expiratory pressure group both before and after extubation (median [interquartile range] 7 [5-8] vs 4 [2-6] before extubation and 8 [6-9] vs 5 [3-7] after extubation; P = .0004 and P = .0011, respectively). Incidence of postoperative pulmonary complications was significantly lower in the titrated positive end-expiratory pressure group (absolute risk difference [95% CI] 17.1% [32.5%-1.7%]; P = .034). The number of patients requiring postoperative supplemental oxygen therapy to maintain SpO2 >95%, the requirement of intraoperative rescue therapy, and the duration of hospital stay were similar in both of the groups. CONCLUSION: Intraoperative titrated positive end-expiratory pressure reduced postoperative lung atelectasis in adult patients undergoing major abdominal surgery. Further large clinical trials are required to know its effect on postoperative pulmonary complications.


Assuntos
Abdome/cirurgia , Procedimentos Cirúrgicos Eletivos , Respiração com Pressão Positiva/métodos , Atelectasia Pulmonar/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Cuidados Intraoperatórios , Tempo de Internação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia
8.
Indian J Crit Care Med ; 25(1): 85-87, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33603307

RESUMO

Background: Coronavirus disease 2019 (COVID-19) is a type of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 pneumonia has characteristic radiological features. Recent evidence indicates usefulness of chest X-ray and lung ultrasound (LUS) in detecting COVID-19 pneumonia. Materials and methods: In this prospective observational study, chest X-ray and LUS features of 50 adults with COVID-19 pneumonia at the time of presentation were described. Results: Chest X-ray findings were present in 96% of patients, whereas all patients have ultrasound finding. Proportion (95% CI) of patients having bilateral opacities in chest X-ray was 96% (86.5-98.9%), ground glass opacity 74% (60.5-84.1%), and consolidation 50% (36.7-63.4%). In LUS, shred sign and thickened pleura was present in all patients recruited in this study. Air bronchogram was present in at least one area in 80% of all patients and B-lines score of more than 2 was present in at least one lung area in 84% patients. Number of lung areas with "shred sign" were higher in hypoxemic (p = 0.005) and tachypneic (p = 0.006) patients and pleura line abnormalities were present in more lung areas in hypoxemic patients (p = 0.03). Conclusion: According to our study, LUS is a useful tool not only in diagnosing, but it also correlates with requirement of respiratory support in COVID-19 patients. How to cite this article: Behera S, Maitra S, Anand RK, Baidya DK, Subramaniam R, Kayina CA, et al. Thoracic Radiological Characteristics of COVID-19 Patients at the Time of Presentation: A Cross-sectional Study. Indian J Crit Care Med 2021;25(1):85-87.

10.
Surg J (N Y) ; 6(3): e167-e170, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33102699

RESUMO

Introduction The ongoing coronavirus disease-2019 (COVID-19) pandemic has disrupted health services throughout the world. It has brought in several new challenges to deal with surgical emergencies. Herein, we report two suspected cases of COVID-19 that were operated during this "lockdown" period and highlight the protocols we followed and lessons we learned from this situation. Result Two patients from "red zones" for COVID-19 pandemic presented with acute abdomen, one a 64-year male, who presented with perforation peritonitis and another, a 57-year male with acute intestinal obstruction due to sigmoid volvulus. They also had associated COVID-19 symptoms. COVID-19 test could not be done at the time of their presentation to the hospital. Patients underwent emergency exploratory laparotomy assuming them to be positive for the infection. Surgical team was donned with full coverall personal protective equipment. Sudden and uncontrolled egression intraperitoneal free gas was avoided, Echelon flex 60 staplers were used to resect the volvulus without allowing the gas from the volvulus to escape; mesocolon was divided using vascular reload of the stapler, no electrosurgical devices were used to avoid the aerosolization of viral particles. Colostomy was done in both the patients. Both the patients turned out to be negative for COVID-19 subsequently and discharged from hospital in stable condition. Conclusion Surgeons need to adapt to safely execute emergency surgical procedures during this period of COVID-19 pandemic. Preparedness is of paramount importance. Full precautionary measures should be taken when dealing with any suspected case.

11.
Indian J Med Res ; 152(1 & 2): 100-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32811801

RESUMO

Background & objectives: In this study we describe the epidemiological data, comorbidities, clinical symptoms, severity of illness and early outcome of patients with coronavirus disease 2019 (COVID-19) from a tertiary care teaching hospital in New Delhi, India. Methods: In this preliminary analysis of a prospective observational study, all adult patients admitted to the screening intensive care unit (ICU) of the institute who fulfilled the WHO case definition of COVID-19 and confirmed to have SARS-CoV-2 infection by reverse transcription-polymerase chain reaction were included. Demographics, clinical data and 24 h outcome were assessed. Results: The preliminary analysis of 235 patients revealed that the mean age was 50.7±15.1 yr and 68.1 per cent were male. Fever (68.1%), cough (59.6%) and shortness of breath (71.9%) were the most common presenting symptoms. Hypertension (28.1%) and diabetes mellitus (23.3%) were the most common associated comorbid illnesses. Patients with mild, moderate, severe and critical illness were 18.3, 32.3, 31.1 and 18.3 per cent, respectively, at the time of ICU admission. The proportions (95% confidence interval) of patients requiring any form of oxygen therapy, oxygen therapy by high-flow nasal cannula and invasive mechanical ventilation were 77, 21.7 and 25.5 per cent, respectively, within 24 h of hospital admission. The 24 h ICU mortality was 8.5 per cent, and non-survivors had higher respiratory rate (P <0.01, n=198) and lower baseline oxyhaemoglobin saturation (P <0.001, n=198) at presentation and higher baseline serum lactate (P <0.01, n=122), total leucocyte count (P <0.001, n=186), absolute neutrophil count (P <0.001, n=132), prothrombin time (P <0.05, n=54) and INR (P <0.05, n=54) compared to survivors. Interpretation & conclusions: Nearly half of the patients presented with severe and critical disease and required high-flow nasal oxygen or invasive mechanical ventilation at admission. Severity of the presenting respiratory illness, haematological parameters and lactate rather than age or presence of comorbidity predicted early death within 24 h.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária , Atenção Terciária à Saúde , Adulto , COVID-19 , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Hospitalização , Hospitais de Ensino , Humanos , Índia/epidemiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Respiração Artificial/métodos , SARS-CoV-2 , Resultado do Tratamento
12.
Indian J Anaesth ; 64(6): 507-512, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32792716

RESUMO

Background and Aims: Postoperative pain following laparoscopic donor nephrectomy (LDN) is significant and no suitable analgesic technique is described. Opioid analgesia in standard doses is often suboptimal and associated with numerous adverse effects. Transversus abdominis plane (TAP) block has been evaluated in various laparoscopic procedures. Intrathecal morphine (ITM) has been seen to provide long-lasting analgesia of superior quality in laparoscopic colorectal procedures. Methods: The present study was undertaken to evaluate the analgesic efficacy of single-dose ITM 5 µg/kg for LDN. After ethics approval, 60 adult patients scheduled for LDN were randomised to receive intravenous fentanyl, ultrasound-guided TAP block or ITM for postoperative analgesia. Postoperative 24-h patient-controlled analgesia (PCA) fentanyl consumption, visual analogue scale (VAS) score and intraoperative fentanyl and muscle relaxant requirements were compared. Statistical analysis was performed using appropriate statistical tests by using Stata 11.1 software. Results: Haemodynamic stability at pneumoperitoneum and in the post anaesthesia care unit was significantly better in patients receiving ITM. Intraoperative rescue fentanyl requirement (P = 0.01) and postoperative fentanyl requirement until 24 h (P = 0.000) were significantly lower in the morphine group. Postoperative VAS at rest and on movement was significantly lower in the morphine group at all points of assessment (P = 0.000). Conclusion: ITM 5 µg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl.

14.
J Anesth ; 34(6): 865-875, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32719939

RESUMO

PURPOSE: A few randomized controlled trials (RCTs) have compared crystalloid-based goal-directed fluid therapy (GDFT) with starch-based GDFT in patients undergoing major surgical procedures with conflicting results. In this meta-analysis, colloid-based GDFT was compared with crystalloid-based GDFT. METHODS: In this meta-analysis, RCTs comparing colloid- and crystalloid-based GDFT in patients undergoing non-cardiac surgery were included. Binary outcomes were reported as risk ratio (RR) and continuous outcomes were reported as mean difference (MD) with 95% confidence interval (95% CI). PubMed, PubMed central, The Cochrane Library database and EMBASE were searched for potentially eligible trials from inception to 28 February 2020. RESULTS: Data of 2392 patients from nine RCTs were included in this meta-analysis. Mortality at the longest available follow-up [RR (95% CI) 1.44 (0.88, 2.34); p = 0.15], postoperative kidney dysfunction [RR (95% CI) 1.07 (0.72, 1.60); p = 0.73], postoperative length of hospital stay [MD (95% CI) - 0.29 ( - 1.25, 0.66) d; p = 0.55], cardiovascular complications [RR (95% CI) 1.20 (0.50, 2.88); p = 0.68], wound complications [RR (95% CI) 1.08 (0.76, 1.54); p = 0.66], pulmonary complications [RR (95% CI) 0.90 (0.71, 1.140); p = 0.40] and bleeding [RR (95% CI) 1.24 (0.77, 1.99); p = 0.37] were similar in both the groups. Postoperative major complications were also similar between patients who received colloid and crystalloid [RR (95% CI) 0.79 (0.48, 1.29); p = 0.34]. CONCLUSION: Colloids in goal-directed fluid therapy protocol does not offer any benefit over crystalloid-based goal-directed fluid therapy protocol in patients undergoing major non-cardiac surgical procedure.


Assuntos
Hidratação , Objetivos , Coloides , Soluções Cristaloides , Humanos , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Cardiovasc Eng Technol ; 11(2): 128-133, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31950349

RESUMO

PURPOSE: Carotid artery corrected flow time (cFT) derived from Doppler USG is a known predictor of volume responsiveness. However, it can't be obtained continuously, and is operator dependent. In this prospective study, correlation between Doppler derived carotid artery cFT and pressure transducer derived radial artery cFT was evaluated in adult patients undergoing surgery under general anaesthesia. METHODS: Doppler derived carotid artery cFT were obtained from n = 51 adult patients at n = 125 time points. Simultaneously, pressure transducer waveforms were saved at the time of measurement of carotid artery cFT. Later, images were analyzed by an image processing computer software; both pulse pressure variation and cFT were estimated from pressure transducer waveform. RESULTS: Radial artery flow times measured by two independent observers, were significantly correlated (r2 = 0.99, p < 0.00001). Bland-Altman analysis found limits of agreement - 8.3 to 6.3 ms [mean difference (95% CI) - 0.98 (- 1.63, - 0.32)]. Doppler derived carotid artery cFT & pressure transducer derived radial artery cFT were also significantly correlated [r2 = 0.78, p < 0.0001]. However, radial artery cFT was significantly higher than carotid artery cFT [p < 0.0001, paired sample t test]. Radial artery cFT > 404.4 ms had an sensitivity and specificity of 87.34% and 85% respectively with a grey zone was between 393.7 and 417 ms to predict PPV ≥ 12%. CONCLUSION: Pressure transducer derived radial artery cFT correlated with Doppler derived carotid artery cFT and may be a reasonable predictor of volume responsiveness. Further studies are required to confirm its role in various clinical scenario for prediction of volume responsiveness.


Assuntos
Pressão Arterial , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiologia , Monitorização Hemodinâmica/instrumentação , Artéria Radial/fisiologia , Transdutores de Pressão , Ultrassonografia Doppler , Adulto , Anestesia Geral , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Respiração Artificial , Fatores de Tempo
17.
Aliment Pharmacol Ther ; 51(5): 490-504, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31943236

RESUMO

BACKGROUND: The effect of baseline resistance-associated substitutions (RAS) on the sustained virologic response at 12 weeks (SVR12) among chronic hepatitis C (CHC) patients receiving the second generation, pan-genotypic glecaprevir/pibrentasvir (G/P) regimen is unclear. AIM: To assess the effect of RAS on the SVR12 in CHC patients treated with G/P regimen. METHODS: The EMBASE, MEDLINE and Cochrane central register of controlled trials databases were searched for relevant studies published before 1 March 2019. The principal outcome was to compare the SVR12 in CHC patients with and without baseline RAS, particularly in genotype-1, genotype-3 and direct-acting anti-virals (DAAs) failure patients. The outcomes were pooled using a random-effects model and odds ratio (OR) was calculated. The risk of bias was assessed using the Cochrane risk of bias tools for randomised and nonrandomised interventional studies. RESULTS: After initially identifying 410 studies, 3302 patients from 17 studies were included. Among 50 cases of virologic failures, 48% had genotype-3 infection, 44% genotype-1 infection and 36% DAA-failure patients. Baseline RAS were present in 44(88%) patients. The most common NS5a and NS3 mutations were Y93H and A166S respectively. The odds of SVR12 were significantly reduced in patients with any baseline RAS (NS3 and/or NS5a) (OR 0.32, 95%C I[0.15, 0.65], I2  = 0%) and NS5a substitutions (OR 0.36, 95%CI [0.18,0.73]). The impact of RAS on SVR12 was significant among genotype-3 patients, but not among genotype-1 or DAA-failure cases. The presence of Y93H and A30K mutations significantly impacted SVR12 rates in genotype-3 patients. CONCLUSION: Baseline NS3 or NS5a RAS, especially the NS5a substitutions-A30K, Y93H, decrease the odds of achieving SVR12 in genotype-3 CHC patients.


Assuntos
Antivirais/administração & dosagem , Benzimidazóis/administração & dosagem , Farmacorresistência Viral/genética , Hepatite C Crônica/tratamento farmacológico , Quinoxalinas/administração & dosagem , Sulfonamidas/administração & dosagem , Proteínas não Estruturais Virais/genética , Substituição de Aminoácidos/genética , Farmacorresistência Viral/fisiologia , Quimioterapia Combinada , Genótipo , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/patologia , Hepatite C Crônica/virologia , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Resposta Viral Sustentada , Resultado do Tratamento
19.
J Vasc Access ; 21(2): 204-209, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31423893

RESUMO

BACKGROUND: Comparison between various approaches of ultrasound (USG)-guided internal jugular vein cannulation, that is, short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach, is sparse. In this network meta-analysis of randomized controlled trials, all three approaches were evaluated to identify the best technique for USG-guided internal jugular vein cannulation. METHODS: Randomized controlled trials comparing short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach in any combination (i.e. comparison of any two or all three) for USG-guided internal jugular vein cannulation were included in this meta-analysis. Bayesian network meta-analysis was conducted with a non-informative prior effect size and heterogeneity, and all results were reported as posterior median odds ratio with 95% credible interval. RESULTS: Data of 658 patients from five randomized controlled trials were included in this meta-analysis. No difference was obtained in first attempt success rate of cannulation in three approaches (posterior median odds ratio between long-axis and short-axis view, oblique-axis and short-axis view, and long-axis and oblique-axis view were 0.67 (0.20, 2.08), 0.92 (0.09, 4.790), and 1.3420 (0.1680, 6.7820), respectively). No difference was seen in the incidence of carotid artery puncture and overall success rate of cannulation. CONCLUSION: All three commonly used approaches for USG-guided internal jugular vein cannulation, that is, short axis, long axis, and oblique axis, are comparable in terms of clinical utility and safety. There is insufficient evidence to recommend one approach over another for this purpose.


Assuntos
Cateterismo Venoso Central , Veias Jugulares/diagnóstico por imagem , Ultrassonografia de Intervenção , Cateterismo Venoso Central/efeitos adversos , Humanos , Metanálise em Rede , Punções , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Ultrassonografia de Intervenção/efeitos adversos
20.
J Ultrasound Med ; 39(4): 721-730, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31647132

RESUMO

OBJECTIVES: Hypotension is common after induction of general anesthesia, and intraoperative hypotension is associated with postoperative end-organ injury such as acute kidney injury and myocardial ischemia. This study was designed to determine the utility of the carotid corrected flow time (cFT) and carotid artery peak blood flow velocity variation (ðVpeak ) for prediction of hypotension after induction of general anesthesia. METHODS: Adult patients (n = 112) undergoing any elective surgery under general anesthesia who fasted for at least 6 to 8 hours were recruited in this prospective observational study. The common carotid artery cFT and ðVpeak were measured with ultrasound 10 minutes before induction of general anesthesia. After that, general anesthesia with propofol was used, and hemodynamic data were collected until 3 minutes after induction of anesthesia. RESULTS: The carotid cFT was significantly correlated with percentages of the fall in the systolic blood pressure at 2 minutes (P < .0001) and 3 minutes (P < .0001) and percentages of the fall in the mean arterial pressure at 1 minute (P = .0006), 2 minutes (P < .0001), and 3 minutes (P < .0001). The cFT was a predictor of hypotension after induction of general anesthesia, with an area under the receiver operating characteristic curve of 0.91. The best cutoff value obtained from this study was 330.2 milliseconds or less, which predicted postinduction hypotension with sensitivity and specificity of 85.7% and 96.8%, respectively. The ðVpeak was an inferior predictor of postinduction hypotension, with an area under the receiver operating characteristic curve of 0.68. The optimum cutoff value was 18.8%, with sensitivity and specificity of 61.9% and 67.4%. CONCLUSIONS: The cFT measured in the common carotid artery is a reasonable predictor of hypotension after induction of general anesthesia in American Society of Anesthesiologists physical status I and II patients. Further studies are required to identify its role in high-risk patients such as older groups and patients with cardiovascular diseases and also to identify interobserver and intraobserver variability of cFT and ðVpeak measurements.


Assuntos
Anestesia Geral/efeitos adversos , Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/fisiopatologia , Procedimentos Cirúrgicos Eletivos , Hipotensão/induzido quimicamente , Adulto , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Feminino , Humanos , Hipotensão/fisiopatologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Respiração , Sensibilidade e Especificidade
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