Efficacy of Infrared Vein Visualization versus Standard Technique for Peripheral Venous Cannulation in Infant and Toddler Populations: A Randomized Study.

Establishing intravenous (IV) access in younger patient populations via the traditional cannulation technique for procedures requiring anesthesia is often challenging. Infrared (IR) vein visualization is a modality that aids venous cannulation; however, few reports of this technique exist in the infant and toddler population. The primary aim of this study was to compare the efficacy of IR vein visualization to the standard cannulation technique for obtaining peripheral IV access in infant and toddler populations. Following Institutional Review Board (IRB) approval and written informed consent, children were randomly assigned to either a standard cannulation technique group or an IR vein visualization device group for venous cannulation. The primary outcome variable was the success rate of IV cannulation, and the secondary variables were the total number of attempts and the time to successful cannulation. No difference was noted between either group for first-attempt success rate (standard versus IR: 61.25% vs. 54.4%; p = 0.4) or time to establish IV cannulation (standard versus IR: median [interquartile range], 40 s [24-120] vs. 53 s [26-106]; p = 0.55). The anesthesiologist's grading of the anticipated difficulty of IV cannulation was a significant predictor of cannulation success (p = 0.0016). Our study demonstrated no significant benefit in utilizing the IR vein visualization device in terms of the overall success rate, number of attempts, and time to establish successful IV cannulation when compared to the standard technique. However, in difficult IV access situations, this device proved to be a valuable rescue adjunct.

Increased Ileostomy Output as an Indicator of Thyroid Storm in a Patient without an Established History of Underlying Thyroid Disease.

BACKGROUND Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening endocrine emergency that presents with multisystem involvement. Patients present with pronounced signs of hyperthyroidism, fever, tachycardia, and differing severities of multisystem dysfunction and decompensation. Early recognition and prompt initiation of treatment are important. The development of thyroid storm in patients with no established history of underlying hyperthyroidism is rare. CASE REPORT In this case report, we describe the occurrence of thyroid storm in a 27-year-old man without an established history of underlying thyroid disease, who was admitted to the Intensive Care Unit (ICU) with a high ileostomy output and fever. Although initially treated for possible sepsis, the diagnosis of thyroid storm was made only after a thorough workup was initiated and he was found to have underlying Graves' disease. Prompt treatment resulted in the resolution of symptoms and avoided potential morbidity and mortality. CONCLUSIONS This case highlights the potential difficulty in diagnosing thyroid storm in a patient admitted to the ICU without an established history of hyperthyroidism. Upgrade in care, timely diagnosis, and initiation of appropriate therapy led to a favorable outcome. Clinicians should consider hyperthyroidism as a possible cause of high ileostomy output, especially when it does not resolve with traditional treatment and no obvious cause can be identified. This case demonstrates the challenges presented when the patient's history and clinical signs are ambiguous and stresses the importance of "outside the box" thinking.

Increased whole blood FFA2/GPR43 receptor expression is associated with increased 30-day survival in patients with sepsis.

OBJECTIVE: Sepsis is a condition associated with a dysregulated inflammatory response to infection with significant morbidity. Recent advances have elucidated the vital role that the short chain fatty acid glycoprotein receptor 43 (FFA2/GPR43) plays in inflammatory and immunomodulatory pathways. We hypothesized that elevated whole blood GPR43 RNA expression would be associated with increased 30-day survival in patients admitted with sepsis. Patients (n = 93) admitted to the intensive care unit with the diagnosis of sepsis underwent quantitative real time PCR within 48 h of intensive care unit admission. Clinical and demographical parameters were retrospectively extracted from the chart and compared to quantitative measurements of GPR43 RNA expression. RESULTS: Utilizing logistic regression, we found that the odds of mortality decreased for every one-unit increase in GPR43 RNA expression for patients that survived to 30 days [OR = 0.71; 95% CI (0.50, 0.99) p = 0.049]. Using linear regression, we determined that the increase in whole blood GPR43 expression was not associated with whole blood white cell count [r = 0.04; 95% CI (-0.16, 0.24); p = 0.70] or body mass index [r = - 0.07; 95% CI (- 0.23, 0.18); p = 0.81]. We conclude that the GPR43 receptor plays an integral role in survival during and after sepsis.