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1.
PLoS One ; 15(1): e0227793, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31986168

RESUMO

Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective support modalities to treat critically ill patients. ECMO-associated hemolysis remains a serious complication. The aim was to disclose similarities and differences in VA- and VV ECMO-associated hemolysis. This is a retrospective single-center analysis (January 2012 to September 2018) including 1,063 adult consecutive patients (VA, n = 606; VV, n = 457). Severe hemolysis (free plasma hemoglobin, fHb > 500 mg/l) during therapy occurred in 4% (VA) and 2% (VV) (p≤0.001). VV ECMO showed significantly more hemolysis by pump head thrombosis (PHT) compared to VA ECMO (9% vs. 2%; p≤0.001). Pretreatments (ECPR, cardiac surgery) of patients who required VA ECMO caused high fHb pre levels which aggravates the proof of ECMO-induced hemolysis (median (interquartile range), VA: fHb pre: 225.0 (89.3-458.0); VV: fHb pre: 72.0 (42.0-138.0); p≤0.001). The survival rate to discharge from hospital differed depending on ECMO type (40% (VA) vs. 63% (VV); p≤0.001). Hemolysis was dominant in VA ECMO patients, mainly caused by different indications and not by the ECMO support itself. PHT was the most severe form of ECMO-induced hemolysis that occurs in both therapies with low frequency, but more commonly in VV ECMO due to prolonged support time.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemólise , Adulto , Idoso , Transfusão de Sangue , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Oxigenação por Membrana Extracorpórea/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
2.
Anaesthesia ; 75(3): 395-405, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31612480

RESUMO

There are numerous possible techniques for delivering local anaesthetic through peripheral nerve catheters. These include continuous infusions, patient-controlled boluses and programmed intermittent boluses. The optimal delivery regimen of local anaesthetic is yet to be conclusively established. In this review, we identified prospective trials of delivery regimens through peripheral nerve catheters. Our primary outcome was visual analogue scale scores for pain at 48 h. Secondary outcomes were: visual analogue scores at 24 h; patient satisfaction scores; rescue opioid use; local anaesthetic consumption; and nausea and vomiting. Network meta-analysis was used to compare these outcomes. Predefined sub-group analyses were performed. Thirty-three studies enrolling 1934 participants were included. In comparison with continuous infusion, programmed intermittent boluses improved visual analogue pain scores at both 48 and 24 h, the weighted mean difference (95%CI) being -0.63 (-1.12 to -0.14), p = 0.012 and -0.48 (-0.92 to -0.03), p = 0.034, respectively. Programmed intermittent boluses also improved satisfaction scores, the weighted mean difference (95%CI) being 0.70 (0.10-1.31), p = 0.023, and reduced rescue opioid use, the weighted mean difference (95%CI) in oral morphine equivalent at 24 h being -23.84 mg (-43.90 mg to -3.77 mg), p = 0.020. Sub-group analysis revealed that these findings were mostly confined to lower limb and truncal catheter studies; there were few studies of programmed intermittent boluses for upper limb catheters. Programmed intermittent boluses may provide optimal delivery of a local anaesthetic through peripheral nerve catheters. Further research is warranted, particularly to delineate the differences between upper and lower limb catheter locations, which will help clarify the clinical relevance of these findings.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Cateterismo/métodos , Nervos Periféricos , Analgesia Controlada pelo Paciente , Cateterismo/efeitos adversos , Cateteres , Humanos , Dor/prevenção & controle
4.
Nephrol Nurs J ; 46(4): 407-411, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490050

RESUMO

The arteriovenous fistula (AVF) is the recommended hemodialysis access for pediatric patients who weight more than 20 kg and who are not expected to receive a kidney transplant for one year or longer. Whereas buttonhole cannulation of the AVF has been discouraged in adults because of the associated risk of infection, the published pediatric experience with this technique is extremely limited. A retrospective chart review of all buttonhole cannulated AVFs in a single pediatric hemodialysis unit was performed. Approximately 5,600 cannulations were performed over 215.5 patient months with no infections of the AVF or adjacent skin in 13 of 14 (93%) patients. Results from this experience provide evidence that the buttonhole cannulation technique can be successfully performed in pediatric patients on hemodialysis without an associated increased risk of infection.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Cateterismo/métodos , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo/efeitos adversos , Criança , Humanos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
6.
BMC Cancer ; 19(1): 693, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307410

RESUMO

BACKGROUND: To evaluate the safety and efficacy of intra-arterial chemotherapy (IAC) for the primary or secondary treatment of infants diagnosed with advanced retinoblastoma before 3 months of age. METHODS: This single-center retrospective study included 39 infants (42 eyes) aged ≤3 months who were diagnosed with unilateral or bilateral advanced intraocular retinoblastoma (group D and E eyes) and received IAC as primary or secondary treatment between June 2012 and February 2017. Based on each patient's therapeutic history and response to chemotherapeutic drugs, melphalan, topotecan, and/or carboplatin were used for IAC. The main outcomes included the technical success rate for IAC, survival rates, and adverse events. RESULTS: In total, 29 and 13 eyes received IAC as primary and secondary treatments, respectively. Catheterization was successful in 136 of 137 procedures. All eyes in the secondary IAC group had previously received intravenous chemotherapy. The mean number of IAC sessions for each eye was 3 (range, 2-6). The 2-year ocular survival rates were 80.7% (95% confidence interval [CI], 58.9-91.7) in the primary IAC group and 91.7% (95% CI, 53.9-98.8) in the secondary IAC group. During the follow-up period, 1 patient with unilateral disease (group E) developed extraocular disease and died. The 2-year recurrence-free survival rates in the primary and secondary IAC groups were 71.9% (95% CI, 49.4-85.7) and 75.0% (95% CI, 40.8-91.2), respectively. During each catheterization procedure, the main complications included eyelid erythema (2.4%), fundus hemorrhage (11.9%), myelosuppression (7.7%), transient vomiting and hair loss (2.6%), and transient pancytopenia (2.6%). Prolonged complications included phthisis bulbi (19.0%), vision loss (19.0%), poor vision (9.5%), and cataract (2.4%). There was no case of stroke, neurological impairment, secondary malignant tumor, or metastasis. CONCLUSIONS: Our findings suggest that IAC, whether primary or secondary, is effective and fairly safe for the management of advanced retinoblastoma in infants aged < 3 months. However, adverse events related to intra-arterial injection and the visual outcomes cannot be neglected and require further investigation.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Carboplatina/uso terapêutico , Etoposídeo/uso terapêutico , Infusões Intra-Arteriais/efeitos adversos , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Vincristina/uso terapêutico , Antineoplásicos Fitogênicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/efeitos adversos , Cateterismo/efeitos adversos , Pré-Escolar , Etoposídeo/efeitos adversos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias da Retina/mortalidade , Retinoblastoma/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Vincristina/efeitos adversos
7.
PLoS One ; 14(7): e0218755, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291280

RESUMO

Catheter-associated asymptomatic bacteriuria (CAABU) is frequent in intensive care units (ICUs) and contributes to the routine use of antibiotics and to antibiotic-resistant infections. While nurses are responsible for the implementation of CAABU-prevention guidelines, variability in how individual nurses contribute to CAABU-free rates in ICUs has not been previously explored. This study's objective was to examine the variability in CAABU-free outcomes of individual ICU nurses. This observational cross-sectional study used shift-level nurse-patient data from the electronic health records from two ICUs in a tertiary medical center in the US between July 2015 and June 2016. We included all adult (18+) catheterized patients with no prior CAABU during the hospital encounter and nurses who provided their care. The CAABU-free outcome was defined as a 0/1 indicator identifying shifts where a previously CAABU-free patient remained CAABU-free (absence of a confirmed urine sample) 24-48 hours following end of shift. The analytical approach used Value-Added Modeling and a split-sample design to estimate and validate nurse-level CAABU-free rates while adjusting for patient characteristics, shift, and ICU type. The sample included 94 nurses, 2,150 patients with 256 confirmed CAABU cases, and 21,729 patient shifts. Patients were 55% male, average age was 60 years. CAABU-free rates of individual nurses varied between 94 and 100 per 100 shifts (Wald test: 227.88, P<0.001) and were robust in cross-validation analyses (correlation coefficient: 0.66, P<0.001). Learning and disseminating effective CAABU-avoidance strategies from top-performers throughout the nursing teams could improve quality of care in ICUs.


Assuntos
Bacteriúria/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Cateterismo/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Idoso , Doenças Assintomáticas , Bacteriúria/etiologia , Bacteriúria/microbiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo/efeitos adversos , Estudos Transversais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Carga de Trabalho/estatística & dados numéricos
8.
J Med Microbiol ; 68(9): 1306-1313, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31274401

RESUMO

Introduction. Umbilical catheterization offers unique vascular access that is only possible in the neonatal setting due to unobstructed umbilical vessels from foetal circulation. With the cut of the umbilical cord, two arteries and a vein are dissected, allowing quick and painless catheterization of the neonate. Unfortunately, keeping the umbilical access sterile is challenging due to its mobility and necrosis of the umbilical stump, which makes it a perfect model for vessel catheter colonization analysis.Aim. The aim of this study was to evaluate bacterial colonization of the umbilical catheter, with a focus on the difference between various sections of the catheter, the duration of catheterization, patient status and gestational age.Methodology. We performed bacterial cultures for 44 umbilical catheters, analysing the superficial and deep parts of the catheter separately, and revealed colonization in one-third of cases.Results. One hundred per cent of the colonization occurred in preterm infants, with a shift towards extreme prematurity. The catheters were mainly colonized by coagulase-negative staphylococci. The majority of catheters presented with superficial colonization dominance, and there were no cases of deep colonization. The bacterial strains and their resistance were consistent between the catheter's proximal and distal parts, as well as positive blood cultures. The patients with the most intense bacterial catheter colonization presented with sepsis around removal time or a couple of days later, especially if they were extremely premature and exhibited very low birth weight. Catheterization time did not play a major role.Conclusion. Umbilical catheters are vectors for skin microflora transmission to the bloodstream via biofilm formation, regardless of antibiotic use and the duration of catheterization, especially in preterm neonates.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Cateterismo/métodos , Cateteres/microbiologia , Uso de Medicamentos , Contaminação de Equipamentos , Recém-Nascido Prematuro , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/patologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Técnicas Bacteriológicas , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Cateterismo/efeitos adversos , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
9.
Medicine (Baltimore) ; 98(30): e16529, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348269

RESUMO

Although endoscopic papillary balloon dilation (EPBD) seems to cause fewer instances of bleeding, there are insufficient data to determine the optimal methods for decreasing the risk of bleeding in cirrhotic patients.In this study, we compared the bleeding risks following endoscopic biliary sphincterotomy (EST) vs EPBD in cirrhotic patients and identified clinical factors associated with bleeding and 30-day mortality.Taiwan's National Health Insurance Database was used to identify 3201 cirrhotic patients who underwent EST or EPBD between January 1, 2010, and December 31, 2013.We enrolled 2620 patients receiving EST and 581 patients receiving EPBD. The mean age was 63.1 ±â€Š13.9 years, and 70.4% (2252/3201) were men. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding was higher among patients treated with EST than those treated with EPBD (EST vs EPBD: 3.5% vs 1.9%). Independent predisposing factors for bleeding included EST, renal function impairment, and antiplatelet or anticoagulant therapy. The overall 30-day mortality was 4.0% (127/3201). Older age, renal function impairment, hepatic encephalopathy, bleeding esophageal varices, ascites, hepatocellular carcinoma, biliary malignancy, and pancreatic malignancy were associated with higher risks for 30-day mortality.To decrease post-ERCP hemorrhage, EPBD is the preferred method in patients with cirrhosis, especially for those who have renal function impairment or are receiving antiplatelet or anticoagulant therapy.


Assuntos
Cateterismo/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Dilatação/efeitos adversos , Cirrose Hepática/cirurgia , Hemorragia Pós-Operatória/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Idoso , Cateterismo/instrumentação , Cateterismo/métodos , Bases de Dados Factuais , Dilatação/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Esfinterotomia Endoscópica/métodos , Taiwan/epidemiologia , Resultado do Tratamento
10.
A A Pract ; 13(8): 313-315, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31343432

RESUMO

We report the rare complication of a retained peripheral nerve block catheter (PNBC). A 45-year-old man with intractable postamputation phantom limb pain was treated with continuous infusions via femoral and sciatic peripheral nerve catheters. The catheters were removed by an emergency department physician 2 days after placement. Five months later, the patient presented with a discharging sinus from the sciatic nerve catheter site. Magnetic resonance imaging (MRI) was inconclusive. Surgical exploration showed 15 cm of retained peripheral nerve catheter, which was removed.


Assuntos
Cateterismo/efeitos adversos , Cateteres/efeitos adversos , Bloqueio Nervoso , Amputação , Cotos de Amputação , Cateterismo/instrumentação , Falha de Equipamento , Nervo Femoral , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/terapia , Membro Fantasma/terapia , Nervo Isquiático
11.
Ann Vasc Surg ; 60: 203-210, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200049

RESUMO

BACKGROUND: The annual cost of care associated with end-stage renal disease (ESRD) per patient on hemodialysis is approaching $100,000, with nearly $42 billion in national spend per year. Early cannulation arteriovenous grafts (ECAVGs) help decrease the use of central venous catheters (CVCs), thus potentially decreasing the cost of care. However, a formal financial analysis that also includes the cost of CVC-related complications and secondary interventions has not been completed. The purpose of this project is to evaluate the overall financial costs associated with ECAVGs on patients with ESRD during a one-year period. METHODS: Access modality, complications, secondary interventions, hospital outcomes, and cost of care were determined for 397 sequential patients who underwent access creation between July 2014 and October 2018. A detailed financial analysis was completed, including an evaluation of implant, supplies, medications, laboratories, labor, and other direct costs. All variables were measured at the time of the index procedure, 30 days, 90 days, 180 days, 270 days, and one year. RESULTS: There were 131 patients who underwent arteriovenous fistula (AVF) and 266 who underwent ECAVG for dialysis access. The average cost of care was $17,523 for AVF and $5,894 for ECAVG at one year (P < 0.01). Fewer CVC-related complications and secondary interventions associated with ECAVGs saved $11,630 per patient with ESRD, primarily in the form of supply costs. Fewer CVCs in the patients receiving ECAVGs led to an additional $1,083 decrease in cost associated with sepsis reduction at one year. A subsequent decrease in length of stay and ICU utilization led to an additional $2.0 million decrease in annual cost of care for patients with ESRD. CONCLUSIONS: The use of ECAVGs has significant cost savings over using an AVF and CVC for urgent-start dialysis in patients with ESRD. This cost savings is secondary to decreased CVC-related complications and fewer secondary interventions. Significant national savings are possible with appropriate use of ECAVGs in patients with ESRD.


Assuntos
Derivação Arteriovenosa Cirúrgica/economia , Implante de Prótese Vascular/economia , Prótese Vascular/economia , Cateterismo/economia , Custos de Cuidados de Saúde , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Indicadores de Qualidade em Assistência à Saúde/economia , Diálise Renal/economia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Cateterismo/efeitos adversos , Redução de Custos , Análise Custo-Benefício , Humanos , Desenho de Prótese , Diálise Renal/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
12.
Ren Fail ; 41(1): 434-438, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31162993

RESUMO

Objectives: The successful implantation of peritoneal dialysis (PD) catheters is a critical skill procedure with the potential to impact both the short- and long-term success of renal replacement therapy and the patients' survival. Methods: We retrospectively reviewed our single-center experience with nephrologist-placed minimally invasive, double-cuffed PD catheters (PDCs). Results: The recruitment period was March 2014 through December 2015. The follow-up period lasted until 2016. The mean age of the subjects was 60 ± 18 years and indications for the PD were diuretic resistant acutely decompensated chronic heart failure in seven patients (47%) and end-stage renal disease in eight (53%) patients. Comorbid conditions included diabetes (27%), ischemic heart disease (47%), advanced liver failure (27%), and a history of hypertension (73%). The cohort had a high mortality with five subjects only in severe heart failure group (33%) passing away during the index hospitalization; of the rest, two (13%) had heart transplantation, three (20%) changed modality to hemodialysis, and only five (33%) continued with maintenance PD beyond 1 month. Acute technical complications within the first month were infrequent: one catheter (6%) had drainage problems and one (6%) was lost due to extrusion. There were no serious complications (e.g., organ damage, peritonitis, etc.). Conclusions: In selected cases, particularly in severe diuretic refractory heart failure, PDC placement placed by a nephrologist is feasible with a low rate of complications even in a low-volume center setting. The catheters we placed were all functioning with only minor complications and PD could be started immediately.


Assuntos
Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Insuficiência Cardíaca/terapia , Falência Renal Crônica/terapia , Diálise Peritoneal/instrumentação , Idoso , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Hungria , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Nefrologistas , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
13.
PLoS One ; 14(6): e0218677, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220171

RESUMO

INTRODUCTION: Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. METHODS: Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. RESULTS: Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54-0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. CONCLUSION: Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study.


Assuntos
Cateterismo/efeitos adversos , Cateterismo/estatística & dados numéricos , Diálise Peritoneal , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Cateteres de Demora/estatística & dados numéricos , Estudos de Coortes , Falha de Equipamento/estatística & dados numéricos , Análise de Falha de Equipamento , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/instrumentação , Diálise Peritoneal/métodos , Diálise Peritoneal/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Falha de Tratamento
14.
J Hosp Infect ; 103(3): 321-327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31226271

RESUMO

BACKGROUND: Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing. AIM: To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy. METHODS: We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance. FINDINGS: Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected. CONCLUSION: Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo/efeitos adversos , Infecção Hospitalar/prevenção & controle , Desinfecção das Mãos/métodos , Controle de Infecções/métodos , Transplante de Células-Tronco/efeitos adversos , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Farmacorresistência Bacteriana Múltipla , Feminino , Fidelidade a Diretrizes , Humanos , Incidência , Masculino
15.
J Vasc Interv Radiol ; 30(6): 801-806, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31040058

RESUMO

PURPOSE: To evaluate changes in the use of catheter-directed therapy (CDT) for pulmonary embolism (PE) treatment with attention to primary operator specialty in the Medicare population. METHODS: Using a 5% national sample of Medicare claims data from 2004 to 2016, all claims associated with PE were identified. The annual volume of 2 billable CDT services-arterial mechanical thrombectomy and transcatheter arterial infusion for thrombolysis-were determined to evaluate changes in CDT use and primary CDT operator specialty over time. RESULTS: The total number of CDT procedures increased over the course of the study period, representing 0.457 and 5.057 service counts per 100,000 Medicare beneficiaries in 2004 and 2016, respectively. The proportion of PEs treated with CDT increased 10-fold from 2004 to 2016, increasing from 0.1% to 1.0%. Interventional radiologists performed most CDT therapies each year, with the exception of 2010 when vascular surgeons performed more. In 2016, interventional radiologists performed 3.54 CDT services for PE per 100,000 Medicare beneficiaries, which was 70% of total CDT for PE procedures, followed by interventional cardiologists and vascular surgeons performing 0.92 services (18%) and 0.60 services (12%), respectively. CONCLUSIONS: CDT is an increasingly used treatment for PE, with a 10-fold increase from 2004 to 2016. Interventional radiologists are the dominant providers of these services, followed by interventional cardiologists and vascular surgeons.


Assuntos
Cateterismo/tendências , Procedimentos Endovasculares/tendências , Medicare/tendências , Padrões de Prática Médica/tendências , Embolia Pulmonar/terapia , Radiologistas/tendências , Trombectomia/tendências , Terapia Trombolítica/tendências , Demandas Administrativas em Assistência à Saúde , Cardiologistas/tendências , Cateterismo/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Humanos , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Cirurgiões/tendências , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
16.
QJM ; 112(8): 599-604, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31120124

RESUMO

BACKGROUND: Indwelling pleural catheters (IPCs) are most frequently used in those with malignant pleural effusions, although their use is expanding to patients with non-malignant diseases. AIM: To provide an overview of IPCs and highlight how, when and why they can be used including our own real-life experience. DESIGN: Data were collected retrospectively from a large tertiary centre for all individuals who received an IPC between June 2010 and February 2018 inclusive. The data collected included gender, age, origin of malignancy, number of drains prior to IPC, whether they had received pleurodesis prior to IPC, presence of a trapped lung, date of insertion, documented complications, overall outcome and date of death. RESULTS: A total of 68 patients received an IPC, the majority were female (n = 38, 57%) with an overall median age of 68 years (range 40-90 years). The most common site of cancer origin was lung (n = 33, 49%) followed by pleura (n = 10, 15%) and breast (n = 9, 13%). The median survival of all patients was 141 days (IQR 26-181). Sixteen percent (n = 11) of patients underwent a spontaneous pleurodesis resulting in their IPC being removed. Only three individuals had a complication (4.4%). CONCLUSIONS: IPC insertion is a safe procedure and represents an exciting and expanding field in the management of pleural disease. Further longitudinal studies are required to fully delineate their place in the management of both malignant and benign effusions.


Assuntos
Cateterismo/instrumentação , Cateteres de Demora , Drenagem/instrumentação , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Cateterismo/efeitos adversos , Drenagem/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/complicações , Estudos Retrospectivos , Taxa de Sobrevida
17.
Medicine (Baltimore) ; 98(20): e15742, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096538

RESUMO

BACKGROUND AND AIMS: The before-procedure or after-procedure rectal indomethacin administration was shown to be useful in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. We designed this prospective randomized study to compare the efficacy of single-dose and double-dose rectal indomethacin administration in preventing post-ERCP pancreatitis (PEP). METHODS: We enrolled patients who underwent the ERCP in Taipei Mackay Memorial Hospital from 2016 June to 2017 November. Patients were randomly assigned to 2 groups: single and double-dose groups. The primary endpoint was the frequency of post-ERCP pancreatitis. RESULTS: A total 162 patients participated in this study, and there were 87 patients randomly assigned to the single-dose group, and 75 patients were assigned to the double-dose group. In the high-risk patients, the incidence of PEP was lower in double-dose patients (4.8%) than the single-dose patients (9.5%), but there was no significant difference (P =.24). Difficult cannulation was the only 1 risk factor for PEP after rectal indomethacin treatment. CONCLUSIONS: Single-dose rectal indomethacin administration immediately after ERCP in general population is good enough to prevent PEP, but difficult cannulation could induce the PEP frequency up to 15.4% even under rectal indomethacin use.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Indometacina/administração & dosagem , Pancreatite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Administração Retal , Adulto , Idoso , Cateterismo/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Incidência , Indometacina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Pancreatite/etiologia , Complicações Pós-Operatórias/epidemiologia , Distribuição Aleatória
18.
World Neurosurg ; 128: e787-e795, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078808

RESUMO

BACKGROUND: Conventional craniotomy (CC) is generally favored for treating large intracerebral hemorrhage (ICH), but the feasibility of minimally invasive stereotactic aspiration for large ICH is controversial. We investigated the efficacy and safety of stereotactic aspiration with multicatheter insertion (SAMCI) for large ICH (≥50 mL). METHODS: In January 2014, we implemented SAMCI for large ICH. The inclusion criteria for SAMCI were as follows: 1) spontaneous supratentorial ICH, 2) ICH volume ≥50 mL, 3) Glasgow Coma Scale score ≥5, and 4) no bilateral fixed dilated pupils. Forty-seven patients who underwent SAMCI from January 2014 to July 2018 composed the SAMCI group, and 34 patients who underwent CC between January 2010 and December 2013 and retrospectively met the inclusion criteria for SAMCI composed the control group (CC group). RESULTS: The mean preoperative ICH volume in the SAMCI and CC groups was 73.1 ± 22.8 and 72.4 ± 21.5 mL, respectively. There were no significant differences between the groups in baseline characteristics except for ICH location. The deep portion of the ICH was higher in the SAMCI group than in the CC group. Postoperative mortality and rebleeding rates were significantly lower in the SAMCI group than in the CC group (4.3% vs. 26.5% and 0% vs. 14.7%, respectively; P < 0.05). Logistic regression analysis showed that SAMCI contributed to a decrease in the mortality rate (odds ratio, 0.04; P = 0.008). CONCLUSIONS: SAMCI is a feasible therapeutic option for large ICH and has low complication rates.


Assuntos
Cateterismo/métodos , Hemorragia Cerebral/cirurgia , Hemorragia Cerebral/terapia , Craniotomia/métodos , Técnicas Estereotáxicas , Sucção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Hemorragia Cerebral/mortalidade , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/cirurgia , Sucção/efeitos adversos , Resultado do Tratamento
19.
Cardiol Young ; 29(5): 660-666, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31142394

RESUMO

INTRODUCTION: Interstage mortality causes are often unknown in infants with shunt-dependent univentricular defects. For 2 years, screening catheterisation was encouraged before neonatal discharge to determine if routine evaluation improved interstage outcomes. METHODS: Retrospective single-centre review of home monitoring programme from December, 2010 to June, 2012. Composite scores were created for physical examination/echocardiography risk factors; catheterisation risk factors; and interstage adverse events. Composite scores were compared between usual care and screening catheterisation groups. The ability of each risk factor composite to predict interstage adverse events, individually and in combination, was assessed with sensitivity, specificity, and receiver operating characteristic curves. RESULTS: There were 27 usual care and 32 screening catheterisation patients. There were no significant differences between groups except rates of catheterisation before discharge (29.6 versus 100%, p < 0.001). Usual care patients who underwent catheterisation for clinical indications had higher intervention rates (37.5 versus 3.1%, p = 0.004). Physical examination/echocardiography risk factor frequency was similar, but usual care patients with catheterisation had a higher catheterisation risk factor frequency. Interstage adverse event frequency was similar (48.2 versus 53.1%, p = 0.7). For interstage adverse event prediction, sensitivity for the physical examination/echocardiography, catheterisation, and either risk factor composites was 53.3, 72, and 80%, respectively; specificity was 59, 60, and 48%. The area under the receiver operating characteristic curve was 0.56, 0.66, and 0.64. CONCLUSION: Screening catheterisation evaluation offered slightly increased sensitivity and specificity, but no difference in interstage adverse event frequency. Given this small advantage versus known risks, screening catheterisations are no longer encouraged.


Assuntos
Cateterismo/efeitos adversos , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood , Alta do Paciente , Ecocardiografia , Feminino , Ventrículos do Coração/anormalidades , Ventrículos do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Monitorização Ambulatorial/métodos , Cuidados Paliativos/métodos , Philadelphia , Complicações Pós-Operatórias/etiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
J Int Med Res ; 47(6): 2702-2708, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006299

RESUMO

Central vein perforation associated with a mediastinal lesion is a rare complication of catheterization. A 50-year-old woman was diagnosed with chronic kidney disease and required hemodialysis treatment. The patient developed central vein injury during attempted placement of a double-channel catheter. A computed tomographic scan and venography showed that the catheter had punctured the mediastinum from the central vein. After comprehensive assessment and multidisciplinary consultation, percutaneous catheter thrombin injection with follow-up balloon dilatation under fluoroscopy guidance successfully fixed the perforation. We summarize the therapeutic strategy of this complication and other treatment options, and discuss the related literature of central vein injury.


Assuntos
Cateterismo/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Mediastino/patologia , Insuficiência Renal Crônica/terapia , Lesões do Sistema Vascular/terapia , Feminino , Humanos , Mediastino/irrigação sanguínea , Pessoa de Meia-Idade , Prognóstico , Diálise Renal , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia
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