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1.
ObjectiveTo determine if following fluid resuscitation recommendations in the Surviving Sepsis Campaign guidelines affects hospital length of stay (LOS) in chronic kidney disease (CKD) patients who present to the emergency department with sepsis-induced hypotension or septic shock.DesignRetrospective, single center, cohort study.Setting433-bed community hospital with a 35-bed emergency department in central Kentucky.PatientsAdults (≥18 years of age) who presented to the emergency department with severe sepsis or septic shock, as defined by the Centers for Medicare and Medicaid Services (CMS), with documented CKD and at least one episode of hypotension within 6 h of presentation. A total of 106 patients were included in the study.Measurements and main resultsPatients were stratified into two groups based on the total volume of weight-based crystalloid fluid bolus initiated within the first three hours of hypotension onset (<27 mL/kg and ≥ 27 mL/kg). There was a statistically significant reduction in the primary outcome of median LOS among patients who received less than 27 mL/kg of a crystalloid fluid bolus (5.1 vs 7.7 days, p = .003). Likewise, there was a statistically significant reduction in the secondary outcome of total cost per case in the reduced fluid volume cohort (p = .019. No significant differences were found in other secondary outcomes, including vasopressor requirements, ICU admission rate, and normalization of MAP at 6 h.ConclusionThe results of this single-center, retrospective study indicate that CKD patients who receive guideline-directed fluid resuscitation (≥27 mL/kg) for sepsis-induced hypotension or septic shock experience a longer hospital LOS compared to those who receive a reduced initial fluid volume.  相似文献   

2.

Background

Nitroglycerin ointment is commonly used in the treatment of emergency department (ED) patients with suspected acute heart failure (AHF) or suspected acute coronary syndrome (ACS), but its hemodynamic effects in this population are not well described.

Objective

Our objective was to assess the effect of nitroglycerin ointment on mean arterial pressure (MAP) and systemic vascular resistance (SVR) in ED patients receiving nitroglycerin. We hypothesized that nitroglycerin ointment would result in a reduction of MAP and SVR in the acute treatment of patients.

Methods

We conducted a prospective, observational pilot study in a convenience sample of adult patients from a single ED who were treated with nitroglycerin ointment. Impedance cardiography was used to measure MAP, SVR, cardiac output (CO), stroke volume (SV), and thoracic fluid content (TFC) at baseline and at 30, 60, and 120 min after application of nitroglycerin ointment. Mixed effects regression models with random slope and random intercept were used to analyze changes in hemodynamic parameters from baseline to 30, 60, and 120 min after adjusting for age, sex, and final ED diagnosis of AHF.

Results

Sixty-four subjects with mean age of 55 years (interquartile range, 48–67 years) were enrolled; 59% were male. In the adjusted analysis, MAP and TFC decreased after application of nitroglycerin ointment (p = 0.001 and p = 0.043, respectively). Cardiac index, CO, SVR, and SV showed no change (p = 0.113, p = 0.085, p = 0.570, and p = 0.076, respectively) over time.

Conclusions

Among ED patients who are treated with nitroglycerin ointment, MAP and TFC decrease over time. However, other hemodynamic parameters do not change after application of nitroglycerin ointment in these patients.  相似文献   

3.
ObjectiveThe objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea.MethodsThis paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis.ResultsUsers of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006).ConclusionsThe use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.  相似文献   

4.
BackgroundSocioeconomic disparities are engrained in the US healthcare system and may extend to the prehospital cardiac arrest setting where mortality is high.MethodsUsing the National Emergency Medical Services Information System (NEMSIS) database, 150,003 cases were analyzed comparing socioeconomic status and cardiac arrest outcomes. Cardiac arrest outcomes were measured by the percent of cases that achieved return of spontaneous circulation (ROSC) and the percent of cases in which ROSC occurred in the Emergency Department (ED) as opposed to a prehospital setting which was a proxy for the length of time spent in cardiac arrest. Chi-square tests checked for statistical significance and effect size was measured using Pearson's r values and linear regression coefficients.ResultsComparing neighborhood poverty level and the percent of cardiac arrest cases that achieved ROSC resulted in a Pearson's r value of 0.9424 (R2 = 0.8881, p < 0.005) and a linear regression coefficient of 2.088 (p < 0.05, R2 = 0.8881, 95% CI [1.059, 3.117]) meaning for every interval increase in poverty, the chance of an individual in cardiac arrest achieving ROSC decreases 2.09%. Comparing neighborhood poverty level and the percent of ROSC cases that occurred in the ED yielded a Pearson's r value of 0.9005 (R2 = 0.8109, p < 0.05) and a linear regression coefficient of 0.7701 (p < 0.05, R2 = 0.8109, 95% CI [0.254, 1.286]) meaning for every interval increase in poverty, the chance that ROSC is delayed increases 0.77%.ConclusionsLow income individuals in cardiac arrest have a statistically significant lower probability of achieving ROSC and a higher chance of delayed ROSC.  相似文献   

5.
BackgroundDegradation of the endothelial glycocalyx is recognized as a major part of the pathophysiology of sepsis. Previous clinical studies, mostly conducted in intensive care settings, showed associations between glycocalyx shedding and clinical outcomes. We aimed to explore the association of plasma syndecan-1, a marker of glycocalyx degradation, with the subsequent fluid requirements and clinical outcomes of emergency department patients with sepsis.MethodsThis was a post hoc analysis of a randomized trial of fluid resuscitation in the emergency department. The study was conducted in the emergency department of an urban 1500-bed tertiary care center. The data of 95 adults who were diagnosed with sepsis-induced hypoperfusion and had undergone baseline syndecan-1 measurement were included. The syndecan-1 levels at baseline (T0) and hour 6 (T6) were studied to characterize their association with clinical outcomes, including subsequent fluid administration, organ failure outcomes and mortality.ResultsThe median syndecan-1 levels at T0 and T6 were 207 (IQR 135–438) and 207 (IQR 128–490) ng/ml, respectively. Syndecan-1 levels at T0 were correlated with baseline sequential organ failure assessment (SOFA) score (ρ = 0.35, p < 0.001). Syndecan-1 levels at both T0 and T6 were correlated with subsequent fluid administration over 24 and 72 h and associated with the diagnosis of septic shock, the maximum dose of vasopressors and the need for renal replacement therapy (p < 0.05). Higher syndecan-1 levels at T6 were associated with higher 90-day mortality (p = 0.03).ConclusionsIn the emergency department, syndecan-1 levels were associated with fluid requirements, sepsis severity, organ dysfunction, and mortality.  相似文献   

6.
Instability in carotid vulnerable plaque can generate cerebral micro-emboli, which may be related to both stroke and eventual cognitive abnormality. Strain imaging to detect plaque vulnerability based on regions with large strain fluctuations, with arterial pulsation, may be able to determine the risk of cognitive impairment. Plaque instability may be characterized by increased strain variations over a cardiac cycle. Radiofrequency signals for ultrasound strain imaging were acquired from the carotid arteries of 24 human patients using a Siemens Antares with a VFX 13-5 linear array transducer. These patients underwent standardized cognitive assessment (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]). Plaque regions were segmented by a radiologist at end-diastole using the Medical Imaging Interaction Toolkit. A hierarchical block-matching motion tracking algorithm was used to estimate the cumulated axial, lateral and shear strains within the imaging plane. The maximum, minimum and peak-to-peak strain indices in the plaque computed from the mean cumulated strain over a small region of interest in the plaque with large deformations were obtained. The maximum and peak-to-peak mean cumulated strain indices over the entire plaque region were also computed. All strain indices were then correlated with RBANS Total performance. Overall cognitive performance (RBANS Total) was negatively associated with values of the maximum strain and the peak-to-peak for axial and lateral strains, respectively. There was no significant correlation between the RBANS Total score and shear strain and strain indices averaged over the entire identified plaque for this group of patients. However, correlation of maximum lateral strain was higher for symptomatic patients (r = −0.650, p = 0.006) than for asymptomatic patients (r = −0.115, p = 0.803). On the other hand, correlation of maximum axial strain averaged over the entire plaque region was significantly higher for asymptomatic patients (r = −0.817, p = 0.016) than for symptomatic patients (r = −0.224, p = 0.402). The results reveal a direct relationship between the maximum axial and lateral strain indices in carotid plaque and cognitive impairment.  相似文献   

7.
Background and purposeTriggering receptors expressed on myeloid cells 1 and 2 (TREM-1 and TREM-2) are cell surface receptors important for modulation of microglia immune response. In this study, we evaluate serum levels of TREM-1 and TREM-2 as potential biomarkers in acute ischemic stroke (AIS).Material and methodsProspective cohort study of 50 patients with AIS admitted at our hospital. Serum TREM-1 and TREM-2 was evaluated within 24 h of the acute event and on the third and fifth days after the stroke. Neurological stroke severity and global disability were determined with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at the same three times and at the time of hospital discharge.ResultsTREM-1 and TREM-2 levels were elevated in stroke. TREM-1, but not TREM-2, exhibited correlations with NIHSS and mRS within 24 h (NIHSS and TREM-1: rS = 0.31, p = 0.029; mRS and TREM-1: rS = 0.32, p = 0.023). The serum level of TREM-1 within 24 h correlated with the neurological outcomes at hospital discharge (NIHSS and TREM-1: p = 0.021; mRS and TREM-1: p = 0.049). The serum concentrations of TREM-1 protein within 24 h after stroke was significantly higher in patients with poor outcome (mRS > 2) at hospital discharge (p = 0.021). After Exact Logistic Regression, large segmental stroke (O.R. = 4.14; 95CI = 1.07–16.09; p = 0.040) and initial sTREM levels (O.R. = 1.02; 95CI 1.00–1.04; p = 0.045) remained independent prognostic factors for AIS poor outcome (mRS > 2).ConclusionIn our study, TREM-1 and TREM-2 were significantly increased in AIS. Early elevation of TREM-1 correlated with stroke severity and it was an independent prognostic factor for stroke outcome.  相似文献   

8.
IntroductionLactate is an easily measurable laboratory parameter that is considered a potentially useful prognostic marker for determining risk in emergency department patients. The aim of this study was to investigate the role of serum lactate in the patients who were admitted to the emergency department at the time of admission.MethodsPatients who were admitted to the emergency department for various reasons between June 2017 and January 2018 were included in the study. Demographic data, laboratory findings, mortality and hospitalization rates of the patients were analyzed. The primary endpoint was determined as the role of serum lactate in predicting mortality, and the secondary endpoint in predicting hospitalization.ResultsOf the 1382 patients, 47.4% (n = 655) were female and 52.6% (n = 727) were male. The mean age of the patients was 60.99 ± 20.04 (18–100) years. In 59.6% (n = 824) of the patients, the most common hypertension (36%) was an additional disease. Mortality was found in 43 (3.1%) patients. It was observed that 20.5% (n = 284) of the patients were hospitalized. The ages of patients with hospitalization and mortality were found to be statistically significant higher than those without hospitalization and without mortality (p = 0.001; p < 0.01). There was no statistically significant difference between the serum lactate measurements of the patients according to hospitalization (p > 0.05). The serum lactate levels of the patients with mortality were found to be statistically significant higher than those without mortality (p = 0.001; p < 0.01). The cut off point for serum lactate level in predicting mortality was found to be ≥3.6 mmol/L. The mortality rate was found to be statistically significant higher in patients with serum lactate level 3,6 mmol/L and above (p = 0,001; p < 0,01).ConclusionIn conclusion, we believe in the light of the findings of our study that the serum lactate level is effective and reliable in the prediction of mortality in patients who present to emergency department for any reason. However, prospective studies with broader patient groups are required in this subject.  相似文献   

9.
Objectives In septic patients, reliable non-invasive predictors of fluid responsiveness are needed. We hypothesised that the respiratory changes in the amplitude of the plethysmographic pulse wave (ΔPPLET) would allow the prediction of changes in cardiac index following volume administration in mechanically ventilated septic patients. Design Prospective clinical investigation. Setting An 11-bed hospital medical intensive care unit. Patients Twenty-three deeply sedated septic patients mechanically ventilated with tidal volume ≥ 8 ml/kg and equipped with an arterial catheter and a pulse oximetry plethysmographic sensor. Interventions Respiratory changes in pulse pressure (ΔPP), ΔPPLET and cardiac index (transthoracic Doppler echocardiography) were determined before and after volume infusion of colloids (8 ml/kg). Measurements and main results Twenty-eight volume challenges were performed in 23 patients. Before volume expansion, ΔPP correlated with ΔPPLET (r 2 = 0.71, p < 0.001). Changes in cardiac index after volume expansion significantly (p < 0.001) correlated with baseline ΔPP (r 2 = 0.76) and ΔPPLET (r 2 = 0.50). The patients were defined as responders to fluid challenge when cardiac index increased by at least 15% after the fluid challenge. Such an event occurred 18 times. Before volume challenge, a ΔPP value of 12% and a ΔPPLET value of 14% allowed discrimination between responders and non-responders with sensitivity of 100% and 94% respectively and specificity of 70% and 80% respectively. Comparison of areas under the receiver operator characteristic curves showed that ΔPP and ΔPPLET predicted similarly fluid responsiveness. Conclusion The present study found ΔPPLET to be as accurate as ΔPP for predicting fluid responsiveness in mechanically ventilated septic patients. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. This work was performed in the Medical Intensive Care Unit, Centre Hospitalier, Belfort, France. Funding: No external funding  相似文献   

10.

Purpose

Point-of-care ultrasound evaluates inferior vena cava (IVC) and internal jugular vein (IJV) measurements to estimate intravascular volume status. The reliability of the IVC and IJV collapsibility index during increased thoracic or intra-abdominal pressure remains unclear.

Methods

Three phases of sonographic scanning were performed: spontaneous breathing phase, increased thoracic pressure phase via positive pressure ventilation (PPV) phase, and increased intra-abdominal pressure (IAP) phase via laparoscopic insufflation to 15 mmHg. IVC measurements were done at 1–2 cm below the diaphragm and IJV measurements were done at the level of the cricoid cartilage during a complete respiratory cycle. Collapsibility index was calculated by (max diameter − min diameter)/max diameter × 100 %. Chi square, t test, correlation procedure (CORR) and Fisher’s exact analyses were completed.

Results

A total of 144 scans of the IVC and IJV were completed in 16 patients who underwent laparoscopic surgery. Mean age was 46 ± 15 years, with 75 % female and 69 % African-American. IVC and IJV collapsibility correlated in the setting of spontaneous breathing (r2 = 0.86, p < 0.01). IVC collapsibility had no correlation with the IJV in the setting of PPV (r2 = 0.21, p = 0.52) or IAP (r2 = 0.26, p = 0.42). Maximal IVC diameter was significantly smaller during increased IAP (16.5 mm ± 4.9) compared to spontaneous breathing (20.6 mm ± 4.8, p = 0.04) and PPV (21.8 mm ± 5.6, p = 0.01).

Conclusion

IJV and IVC collapsibility correlated during spontaneous breathing but there was no statistically significant correlation during increased thoracic or intra-abdominal pressure. Increased intra-abdominal pressure was associated with a significant smaller maximal IVC diameter and cautions the reliability of IVC diameter in clinical settings that are associated with intra-abdominal hypertension or abdominal compartment syndrome.  相似文献   

11.
Objective  To evaluate whether arterial pressure response during a Valsalva maneuver could predict fluid responsiveness in spontaneously breathing patients. Design and setting  Prospective clinical study in a 17-bed multidisciplinary intensive care unit. Patients  Thirty patients without mechanical ventilation and equipped with a radial arterial catheter for whom the decision to give fluids was taken due to suspected hypovolemia. Intervention  A 10-s Valsalva maneuver was performed before and after volume expansion (VE). Patients were classified as responders if stroke volume index (SVi) increased ≥15% after VE. Measurements and results  Pulse pressure changes during the Valsalva maneuver (∆VPP) were calculated as the difference between maximal pulse pressure during phase 1 and minimal pulse pressure during phase 2 of the Valsalva maneuver divided by the mean of the two values and expressed as a percentage. Valsalva changes in systolic pressure (∆VSP) were calculated in similar way. SVi changes induced by VE was correlated with baseline values of ∆VPP and ∆VSP (r 2 = 0.71 and r 2 = 0.60; P < 0.0001, respectively), and with VE-induced changes in ∆VPP and ∆VSP (r 2 = 0.56 and r 2 = 0.44; < 0.0001 and < 0.001, respectively). A ∆VPP value of 52% and ∆VSP of 30% predicted fluid responsiveness with a sensitivity of 91% and 73% and a specificity of 95 and 90%, respectively. Conclusions  Arterial response during the Valsalva maneuver is a feasible tool for predicting fluid responsiveness in patients without mechanical ventilatory support. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. This article is discussed in the editorial available at: doi:.  相似文献   

12.
AimRefractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution.MethodThis is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared.ResultsThe overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0. 0998) at 1 year after discharge.ConclusionsThe management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR.  相似文献   

13.
Objective: To assess whether the change in cardiac output after volume replacement is due to elevation of stroke volume or heart rate and to determine the effect of mechanical ventilation on the hemodynamic situation. Design: Prospective study. Setting: A ten-bed neonatal intensive care unit (level III) at a university hospital. Patients: 15 consecutive newborns with blood pressure below the 10th percentile related to age and weight. Interventions: Volume replacement with Ringer's lactate 20 ml/kg body weight. Measurements and results. Before and after volume replacement, arterial pressure recordings, blood gas analysis, and an echocardiographic study were carried out. Left ventricular and aortic diameters were measured by the two-dimensional M-mode technique and velocity time integral of aortic flow by the pulsed color Doppler technique. From these data, stroke volume and cardiac output were calculated. Cardiac output (703 ± 204 vs 826 ± 166 ml/min, p < 0.005) and cardiac index (267 ± 69 vs 302 ± 55 ml/min per kg body weight, p < 0.01) changed significantly due to an appreciable elevation in stroke volume (5.2 ± 1.7 vs 5.8 ± 1.7 ml, p < 0.05), whereas heart rate was unaltered (140 ± 12 vs 142 ± 20 beats/min; NS). The change in blood pressure (32 ± 5 vs 38 ± 8 mm Hg, p < 0.01) was also significant. Cardiac index before and after volume replacement showed a significant inverse correlation with the severity of respiratory disease expressed as alveolar-arterial oxygen difference (A-aDO2) (A-aDO2 vs cardiac index before volume replacement: r = − 0.77, p < 0.001; after volume replacement: r = − 0.73, p < 0.005) or oxygenation index (oxygenation index vs cardiac index before volume replacement: r = − 0.73, p < 0.005; after volume replacement: r = − 0.73, p < 0.005). Changes in left ventricular diastolic diameter, left ventricular systolic diameter, and fractional shortening were not significant. Conclusions: These results indicate that the major regulator of left ventricular output in newborns with hypovolemic or cardiogenic shock is stroke volume and not heart rate and that cardiac output depends on the severity of the respiratory disease. Received: 21 March 1997 Accepted: 8 July 1997  相似文献   

14.
Violence against healthcare employees is a profound problem in the emergency department worldwide. One strategy to reduce the risk of violence is prevention focused education. The purpose of this paper was to report the learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees. A quasi-experimental design was used to determine the knowledge retention of program content following a hybrid (online and classroom) educational intervention. One hundred twenty emergency department employees that completed the workplace violence prevention program participated in the study. A repeated-measures analysis of variance was conducted to determine if individual test scores increased significantly between baseline, posttest, and six month posttest periods. The results indicated a significant time effect, Wilk's Λ = .390, F (2, 118) = 26.554, p < .001, η2 = .310. Follow-up polynomial contrasts indicated a significant linear effect with means increasing over time, F (1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly higher over time. It was concluded that the use of a hybrid modality increases the probability that significant learning outcomes and retention will be achieved.  相似文献   

15.
This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps  0.05) of variance in measures of pain (partial r2 [pr2] = 0.10), psychological disability (pr2 = 0.20), physical disability (pr2 = 0.11), and gait velocity at normal (pr2 = 0.04), fast (pr2 = 0.04), and intermediate speeds (pr2 = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr2 = 0.07) and walking at a fast speed (pr2 = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.  相似文献   

16.
PurposeThis study investigated which commonly used right ventricular (RV) echocardiographic parameter correlates best with stroke volume (SV) estimated by Doppler echocardiography in ischemic cardiogenic shock (CS).Materials and methodsWe retrospectively reviewed the records of 100 patients admitted to the ICU over 34 months with CS. Tricuspid annular plane systolic excursion (TAPSE), Tricuspid annulus systolic velocity (RV S′), Tricuspid regurgitation maximum velocity (TR Vmax), and RV outflow tract velocity time integral (RVOT VTI) were correlated to SV.ResultsMean age was 62.6 ± 12.7 years and 78% were male. The mean SV, TAPSE, RV S′, TR Vmax, and RVOT VTI were 47 ± 16 ml, 16 ± 5 mm, 11 ± 4 mm/s, 1.97 ± 0.73 m/s, and 12.7 ± 5 cm, respectively. RVOT VTI correlated best to SV (r = 0.39 p = 0.01) compared to TAPSE, RV S′, and TR Vmax (r = 0.26 p = 0.01, r = 0.15 p = 0.21, r = 0.03 p = 0.78). RVOT VTI independently predicted SV. Univariate analysis demonstrated that only RVOT VTI predicted SV (OD = 1.18 p = 0.04) and had the best area under the curve (0.70, p = 0.03).ConclusionRVOT VTI correlated better (albeit weakly) to and best predicted SV compared to TAPSE, RV S′, and TR Vmax in patients admitted to intensive care with CS. This study suggests that RVOT VTI has the potential as a therapeutic target to optimize SV in CS.  相似文献   

17.
BackgroundIn some patients securing the peripheral intravenous cannula (PIVC) with a standard adhesive dressing can be difficult because of sweat or other body fluids. The aim of our study was to evaluate the use of tissue adhesives alone as a means to secure PIVCs inserted in the emergency department.MethodsWe performed a prospective interventional pilot study from November 2019 to May 2020 in a medical emergency department of an urban tertiary hospital. Patients were randomized to two groups: tissue adhesives (TA) or adhesive dressing (AD) group. After randomization we followed them until day 4.ResultsThere were no significant differences between TA and AD groups in the rate of unplanned removal of PIVCs in the first 72 h (57.1% vs. 45.8%, p = 0.29), the rate of unplanned removal of PIVCs in the ED (0% vs. 2.1%, p = 1.00), the rate of unplanned removal of PIVC in the first 24 h (42.8% vs. 35.4%, p = 0.52), as well as in the rate of phlebitis (7.1% vs. 14.6%, p = 0.34) and the rate of any blood-stream infection (0% vs. 0%, p = 1.00).ConclusionWe did not observe any significant differences when PIVCs inserted in the emergency department were secured with tissue adhesives alone, compared to standard adhesive dressings. We observed a high rate of unplanned removal of PIVCs, necessitating further research to determine more reliable ways of securing PIVCs.  相似文献   

18.
ObjectiveFever is one of the frequent reasons for admission to the emergency department. Studies comparing oral forms of non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol with intravenous (IV) forms for fever are common in the literature. Our study is the first emergency department study comparing IV forms of ibuprofen and paracetamol in the treatment of febrile patients.MethodsA randomized, double-blind study was conducted in a tertiary university emergency department for a six-month period. Patients aged 18–65 years who had a fever of ≥38.0 °C were included. Patients were administered 400 mg of IV ibuprofen and 1000 mg of IV paracetamol. The primary aim of the study was to determine whether there was a difference in the effect of the two drugs on fever. The secondary aim was to investigate whether there was a difference in terms of numeric rating scale (NRS) measurements and the need for additional antipyretic therapy.ResultsA total of 200 people, 100 of whom were female, were included in the study. The mean age was 30.77 ± 10.61 years. The mean initial temperature for ibuprofen and paracetamol was 38.79 ± 0.470 °C and 38.70 ± 0.520 °C, respectively, with no difference noted between the groups (p = 0.380). It was found that both drugs significantly provided fever control in the first 30 min (p < 0.001), with no difference between them in terms of fever reduction (p = 0.980). Both drugs significantly improved in accompanying symptoms, although both drugs did not show superiority to each other (p = 0.0226). When evaluated in terms of a need for rescue medication, no significant difference was found between the two drugs (p = 0.404). No side effects were encountered during the study.ConclusionIn adult age group patients admitted to the emergency department with high fever, the IV forms of 1000 mg paracetamol and 400 mg ibuprofen effectively and equally reduce complaints, such as fever and accompanying pain. They can be effectively used as each other's rescue medicine and as an alternative to each other in patients with comorbid diseases.  相似文献   

19.
BackgroundOutpatient referrals constitute a critical component of emergency medical care. However, barriers to care after emergency department (ED) visits have not been investigated thoroughly.ObjectiveThe purpose of this study was to determine the impact of sociodemographic variables on referral attendance after ED visits.MethodsA retrospective cohort study was designed. Patients aged 0–17 years who visited the C.S. Mott Children's Hospital ED in 2016 and received a referral were included. Multiple referrals for 1 patient were counted as independent encounters for statistical analysis.ResultsChart review was performed on 6120 pediatric ED encounters, producing a total of 822 referrals to University of Michigan Health System outpatient clinics. Referral attendance did not differ by race, ethnicity, language, or religion. Older age was associated with decreased attendance at referrals (p = 0.043). Patients who were black and female (p = 0.019), patients with public health insurance (p = 0.004), and patients residing in areas with either high rates of unemployment (p = 0.003), or lower high school education rates (p = 0.006) demonstrated decreased attendance. Patients referred to pediatric neurology had lower attendance rates (p < 0.001), and those referred to pediatric orthopedic surgery attended referrals more often (p = 0.006).ConclusionsThis study provides an overview of the impact of sociodemographic and departmental factors on attendance at outpatient follow-up referrals. Significant disparities exist with respect to referral attendance after emergency medical care. Informed resource allocation may be utilized to improve care for these at-risk patient populations.  相似文献   

20.

Purpose

To assess whether invasive and non-invasive blood pressure (BP) monitoring allows the identification of patients who have responded to a fluid challenge, i.e., who have increased their cardiac output (CO).

Methods

Patients with signs of circulatory failure were prospectively included. Before and after a fluid challenge, CO and the mean of four intra-arterial and oscillometric brachial cuff BP measurements were collected. Fluid responsiveness was defined by an increase in CO ≥10 or ≥15 % in case of regular rhythm or arrhythmia, respectively.

Results

In 130 patients, the correlation between a fluid-induced increase in pulse pressure (Δ500mlPP) and fluid-induced increase in CO was weak and was similar for invasive and non-invasive measurements of BP: r² = 0.31 and r² = 0.29, respectively (both p < 0.001). For the identification of responders, invasive Δ500mlPP was associated with an area under the receiver-operating curve (AUC) of 0.82 (0.74–0.88), similar (p = 0.80) to that of non-invasive Δ500mlPP [AUC of 0.81 (0.73–0.87)]. Outside large gray zones of inconclusive values (5–23 % for invasive Δ500mlPP and 4–35 % for non-invasive Δ500mlPP, involving 35 and 48 % of patients, respectively), the detection of responsiveness or unresponsiveness to fluid was reliable. Cardiac arrhythmia did not impair the performance of invasive or non-invasive Δ500mlPP. Other BP-derived indices did not outperform Δ500mlPP.

Conclusions

As evidenced by large gray zones, BP-derived indices poorly reflected fluid responsiveness. However, in our deeply sedated population, a high increase in invasive pulse pressure (>23 %) or even in non-invasive pulse pressure (>35 %) reliably detected a response to fluid. In the absence of a marked increase in pulse pressure (<4–5 %), a response to fluid was unlikely.  相似文献   

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