Journal of intensive care medicine
-
J Intensive Care Med · May 2008
Case ReportsParadoxical air embolism successfully treated with hyperbaric oxygen.
The use of the central venous catheter may be complicated by air embolism when central venous pressure is subatmospheric and the catheter is open to the surrounding air. Paradoxical air embolus occurs when the gas bubbles are able to traverse a right to left shunt, gaining access to the systemic arterial circulation causing ischemic symptoms in end organs. In this article, a case of a patient with an unknown patent foramen ovale through which air entered the arterial circulation resulting in obtundation and stroke after inadvertent manipulation of a Hickman catheter is presented. The physiology, clinical manifestations, and management strategies are also discussed.
-
Transfusion-related acute lung injury (TRALI) refers to a clinical syndrome of acute lung injury that occurs in a temporal relationship with the transfusion of blood products. Because of the difficulty in making its diagnosis, TRALI is often underreported. Three not necessarily mutually exclusive hypotheses have been described to explain its etiogenesis: antibody mediated, non-antibody mediated, and two hit mechanisms. ⋯ Diuretics are generally not indicated, as hypovolemia should be avoided. Compared with many other forms of acute lung injury, including the acute respiratory distress syndrome, TRALI is generally transient, reverses spontaneously, and carries a better prognosis. A variety of prevention strategies have been proposed, ranging from restrictive transfusion strategies to using plasma derived only from males.
-
J Intensive Care Med · Mar 2008
Anion gap, anion gap corrected for albumin, and base deficit fail to accurately diagnose clinically significant hyperlactatemia in critically ill patients.
Anion gap, anion gap corrected for serum albumin, and base deficit are often used as surrogates for measuring serum lactate. None of these surrogates is postulated to predict hyperlactatemia in the critically ill. We prospectively collected data from September 2004 through August 2005 for 1381 consecutive admissions. ⋯ The receiver-operating characteristic area under the curve for the prediction of hyperlactatemia for anion gap, anion gap corrected for albumin, and base deficit were 0.55, 0.57, and 0.64, respectively. Anion gap, anion gap corrected for albumin, and base deficit do not predict the presence or absence of clinically significant hyperlactatemia. Serum lactate should be measured in all critically ill adults in whom hypoperfusion is suspected.
-
J Intensive Care Med · Mar 2008
Clinical TrialMeasurement of central venous pressure from a peripheral intravenous catheter following cardiopulmonary bypass in infants and children with congenital heart disease.
The current study evaluates the feasibility and accuracy of measuring central venous pressure from a peripheral intravenous catheter following cardiopulmonary bypass in infants and children. Central venous pressure was simultaneously measured from a right atrial catheter and from a peripheral intravenous cannula. The continuity of the peripheral intravenous cannula with the central venous system was evaluated by noting the change in the pressure during a sustained inspiratory effort and during occlusion of the vessel above (proximal to) the catheter. ⋯ The difference between peripheral venous pressure and central venous pressure in these patients was 11 +/- 3 mm Hg versus 2 +/- 1 mm Hg in the patients in whom the peripheral venous pressure increased with these maneuvers (P < .0001). No clinically significant variation in the accuracy of the technique was noted based on the actual CVP value, size of the PIV, its location, or the patient's weight. Provided that the peripheral venous pressure increases to a sustained inspiratory breath and occlusion above the intravenous site, there is a clinically useful correlation between the peripheral venous pressure and the central venous pressure following cardiopulmonary bypass in infants and children with congenital heart disease.