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PubMed1988

Contrast medium-induced adverse reactions: economic outcome.

Because the cost of managing an expected greater number of adverse reactions when high-osmolality contrast media (HOM) are used could offset the higher material cost of low-osmolality contrast media (LOM), a prospective study was done of 795 inpatients undergoing any of four procedures involving intravascular injection of HOM: cardiac catheterization, peripheral angiography, head computed tomography (CT), or body CT. The resources used in managing HOM-induced adverse reactions were measured, and the costs of these resources were estimated. Four hundred five patients (51%) had adverse reactions. Reactions were grouped into three classes according to their severity. Class 1 (mild) reactions occurred in 358 patients (45%), class 2 (moderate) reactions occurred in 44 patients (6%), and class 3 (severe) reactions occurred in three patients (0.4%). Ninety-nine patients (12%) consumed resources as a result of an adverse reaction. The average cost of these resources per patient undergoing examination was $1.07 to the radiology department, $5.83 to the hospital, and $12.93 to a charge-paying insurer. Mean (+/- standard deviation) cost to the hospital for managing class 1, class 2, and class 3 reactions were $2.52 +/- $5.33, $24 +/- $54, and $910 +/- $749, respectively. By comparison, the difference in material cost of HOM versus LOM ranged from $93 for body CT to $179 for cardiac catheterization. Even if LOM were to induce no adverse reactions, the increased material cost associated with universal substitution of LOM for HOM would be greater than the expected cost of managing adverse reactions when HOM are used.

Adult↗
PubMed1989

Hemodynamic monitoring in childhood.

Hemodynamic monitoring is indicated in children with impending or manifest cardiocirculatory failure. Since cardiocirculatory failure is characterized by an imbalance between oxygen delivery and oxygen demand due to perfusion failure, the parameters monitored should aid in the assessment of these oxygen variables. Oxygen delivery depends on oxygen content and cardiac output. Cardiac output is determined by heart rate and stroke volume; stroke volume by preload, afterload and contractility. Since the direct measurement of oxygen consumption routinely is almost impossible, global oxygen utilization represented by mixed venous oxygen saturation may be used to quantify the relationship between oxygen delivery and oxygen consumption. Justification of invasive hemodynamic monitoring depends among other things on an optimal balance between usefulness of information and complications associated with the techniques used. In future, the development of further noninvasive techniques and the scientific evaluation of recommended monitoring techniques are prospects in cardiovascular monitoring in childhood.

Cardiac Output↗
PubMed1991

Central venous pulsations associated with a falsely low oxygen saturation measured by pulse oximetry.

Venous pulsations are thought, but to our knowledge have never been demonstrated, to result in underestimation of oxygen saturation measured by pulse oximetry (SpO2); however, to our knowledge, this has never been demonstrated. A patient with ischemic cardiomyopathy requiring intra-aortic balloon counterpulsation (IABC) had to withstand a temporary cessation of IABC (period I), during which she had marked central venous pulsations and a pulse oximeter bias of -18%. After IABC was reinstituted (period II), the venous pulsations disappeared and the bias was reduced to 0%. Cardiac output, systemic vascular resistance, and temperature during both periods were comparable. Pulmonary vascular resistance, however, was much lower during period II. We postulate that the bias was caused by venous pulsations significantly contributing to the AC, or variable component, of light absorption.

Aged↗
PubMed1995

Evaluation of right ventricular function by assessment of cardiac efficiency: influence of induction of anaesthesia in coronary artery bypass grafting patients.

Considering the heart as a physical pump cardiac efficiency is calculated from the ratio of cardiac work performed to the maximum level of energy of the heart. The aim of the study was to compare cardiac efficiency with cardiac output and right ventricular ejection fraction. Nine patients scheduled for coronary artery bypass grafting were investigated. A femoral arterial and a right ventricular ejection fraction pulmonary artery catheter were placed in the awake state. Anaesthesia was induced with eltanolone and fentanyl. Cardiac output, pulmonary artery and central venous pressures, and right ventricular ejection fraction were measured in the awake state (baseline), 2 min after induction of anaesthesia and 1 and 5 min after intubation. Cardiac efficiency was calculated by dividing the stroke work by the maximum energy of the heart as calculated from the pressure volume diagram. An analysis of variance was carried out for cardiac efficiency, cardiac output and right ventricular ejection fraction. Cardiac efficiency was significantly (p < 0.05) reduced 1 min after intubation from 28 +/- 11 to 14 +/- 5%. In contrast the right ventricular ejection fraction (from 48 +/- 10 to 35 +/- 13%) and cardiac output (from 6.5 +/- 1.5 to 5.3 +/- 1.2 L/min) did not change significantly during the induction of anaesthesia. Cardiac efficiency was found to be a more sensitive parameter to describe changes in the right ventricular function than the ejection fraction and cardiac output during induction of anaesthesia with eltanolone and fentanyl which was used as a model to vary cardiac performance and afterload.

Aged↗
PubMed2026

Safety and efficacy of distal versus conventional radial artery cannulation for invasive blood pressure monitoring: a systematic review and meta-analysis.

To compare the safety and effectiveness of distal radial artery (DRA) versus conventional radial artery (CRA) catheterization for invasive arterial blood pressure monitoring. This meta-analysis followed PRISMA guidelines. Randomized controlled trials published up to December 30, 2025 were systematically searched in PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, CNKI, Wanfang, VIP, and SinoMed. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Meta-analyses were conducted using Review Manager 5.4 and Stata 18.0, and evidence quality was evaluated with the GRADE system. 12 randomized controlled trials (RCTs) involving 1,790 participants were included. For the primary outcomes, compared with CRA, DRA was associated with lower incidences of haematoma (RR&#x2009;=&#x2009;0.42, 95% CI: 0.24-0.73), catheter blockage (RR&#x2009;=&#x2009;0.33, 95% CI: 0.14-0.81), and bleeding (RR&#x2009;=&#x2009;0.25, 95% CI: 0.11-0.59), but a longer catheter insertion time (MD&#x2009;=&#x2009;26.89, 95% CI: 5.28-48.50). For the secondary outcomes, DRA was associated with a shorter haemostasis time and reduced waveform instability, with no significant differences in first-attempt success rate or pain scores. Subgroup analysis showed a higher first-attempt success rate in patients aged&#x2009;&#x2264;&#x2009;65 years (RR&#x2009;=&#x2009;1.14, 95% CI: 1.02-1.28). DRA catheterization for invasive arterial blood pressure monitoring appears to be associated with fewer complications and more stable arterial waveform acquisition than CRA catheterization, despite a longer insertion time. DRA may represent a feasible alternative in surgical and intensive care settings; however, further high-quality studies are needed to confirm its long-term safety and generalizability.

Humans↗
PubMed1988

Infection related to intravascular pressure monitoring: effects of flush and tubing changes.

The optimal frequency for changing pressure monitoring tubing and flush solution that minimizes catheter-related infection and contains cost has not yet been established. We conducted a pilot study to examine the effects of three protocols on catheter-related infection: group I, change of flush solution and pressure monitoring tubing every 24 hours; group II, change of flush solution every 24 hours and change of pressure monitoring tubing every 48 hours; group III, change of flush solution and pressure monitoring tubing every 48 hours. Thirty critically ill patients were randomly assigned to one of the three protocols. Semiquantitative cultures of the solution from the flush bag and catheter tip were obtained. Intervening variables were documented: duration of cannulization, number of entries into the system, presence of other invasive devices, white cell count, patient's temperature, presence of preexisting infection, patient's age and diagnosis, use of steroids and antibiotics, and host risk factors for immunocompromise. All flush solution cultures were negative for growth. Incidence of catheter-related bacteremia was zero. The cultures of four catheter tips were positive for Staphylococcus epidermidis; none in group I, three in group II, and one in group III. The results of this pilot study suggest that there is no difference in the incidence of catheter-related infection whether the change interval for flush solution and pressure monitoring solution is 24 or 48 hours. However, further study with a larger sample is needed.

Adult↗
PubMed1992

Effects of smoking on survival and morbidity in patients randomized to medical or surgical therapy in the Coronary Artery Surgery Study (CASS): 10-year follow-up. CASS Investigators.

OBJECTIVES: The goal of this study was to ascertain how continued cigarette smoking or smoking cessation related to long-term survival and morbidity in patients with established coronary artery disease managed with medical therapy or coronary bypass surgery. BACKGROUND: Although the association of cigarette smoking with coronary artery disease is well established, the morbidity and mortality associated with smoking behavior in patients with such disease receiving medical or surgical therapy are less well established. METHODS: The 780 patients randomized to medical therapy or coronary bypass surgery in the Coronary Artery Surgery Study (CASS) were subgrouped according to smoking behavior during a mean 11.2-year follow-up interval. Comparisons between smokers and nonsmokers were accomplished by univariate and Cox time-dependent multivariate analyses. RESULTS: Survival at 10 years after entry into the study was 82% among 468 patients who reported no smoking during follow-up (nonsmokers) compared with 77% among the 312 smokers (p = 0.025). Survival was 80% among those who smoked at entry but stopped (quitters) versus 69% among those who continued smoking (p = 0.025). For patients who smoked at baseline and were randomized to bypass surgery, survival at 10 years was 84% among quitters and 68% among nonquitters (p = 0.018); the difference in survival between quitters (75%) and nonquitters (71%) was less among those randomized to medical therapy (p = NS). Among those who smoked at baseline, continued smoking increased the relative risk of death by 1.73. After 10 years, smokers, in comparison with nonsmokers, were less likely to be angina free and more likely to be unemployed and had more activity limitation and more hospital admissions (primarily for chest pain, heart attack, cardiac catheterization, peripheral vascular surgery and stroke). CONCLUSIONS: Thus, among patients with documented coronary artery disease, continued cigarette smoking may result in decreased survival--especially among those undergoing bypass surgery. Moreover, smokers have more angina, more unemployment, a greater limitation of physical activity and more hospital admissions.

Coronary Artery Bypass↗
PubMed1993

The relationship between the arteriovenous carbon dioxide gradient and cardiac index.

It has been reported that under normal conditions, mixed venous blood gases have approximated arterial samples; however, during cardiac arrest or severe cardiogenic shock, marked differences between arterial and venous blood gases have been noted. To further assess the relationships between arterial and mixed venous blood gases and cardiac index, a study population was chosen consisting of patients with less severe states of cardiac impairment. The differences between arterial and mixed venous PCO2s and pHs were compared with cardiac indexes (CI) of 44 patients in an intensive care unit with arterial lines and Swan-Ganz catheters in place. Twenty-six patients with normal CIs (2.6 to 4.1 L/min/m2) had a mean difference in mixed venous-arterial PCO2 (delta PCO2) of 4.88 +/- 0.40 mm Hg. In patients with low CIs (< 2.6), the delta PCO2 was 7.44 +/- 0.63 mm Hg (P = .001). The difference of mixed venous and arterial pH (delta pH) was 0.027 +/- 0.004 pH units for patients with normal CIs and 0.04 +/- 0.003 pH units for those with low CIs (P < .002). When the CIs of all patients were plotted against the delta PCO2s, there was an inverse linear relationship wherein delta PCO2 increased as CI decreased (r = -.47, P = .0011). There is an inverse relationship between delta PCO2 and CI that has not been previously described. An elevated delta PCO2 may be a marker of a low cardiac index.

Aged↗
PubMed1992

Thermodilution cardiac output: comparison between automated and manual injection of indicator.

In clinical practice, cardiac output (CO) is usually reported as the average of thermodilution determinations with injection of the thermal indicator performed at end-exhalation. However, an average of multiple determinations with injections equally dispersed throughout the respiratory cycle has been shown to provide the best estimate of mean CO. This study sought to determine the reproducibility of CO determinations obtained with manual injections of indicator solution performed at end-exhalation, compared with those determined by computer-controlled injections equally dispersed throughout the breathing cycle of 27 patients undergoing cardiac operations. Mean CO was calculated by averaging the four determinations obtained with each technique before induction of anesthesia, after induction of anesthesia, after sternotomy, after cardiopulmonary bypass, and after sternal closure. A total of 130 pairs of mean CO estimations were obtained with manual and automated injections. Mean CO values obtained with manual injections were significantly lower than those obtained with the dispersed injection technique (5.0 +/- 1.4 L/min vs 5.3 +/- 1.6 L/min, P = 0.002). The bias between CO values measured with the manual technique was -0.25 +/- 0.47 L/min lower than those obtained with the dispersed technique. The mean relative bias for the group was 7 +/- 18% with 95% confidence intervals of +/- 26%. During mechanical ventilation, the thermodilution technique with manual injection of indicator solution significantly underestimated CO. Variability in the manual injection technique and inappropriate representation of the mean CO by injections timed to occur at end-exhalation contributed to the disparity. These results indicate that the manual technique of determining CO at end-exhalation may not accurately reflect the average CO.

Anesthesia, General↗
PubMed1997

Specific problems of arterial, Swan-Ganz, and hemodialysis catheters.

In our experience, the incidence and pathogenesis of colonization may vary in different types of catheters. Arterial, Swan-Ganz, and hemodialysis catheters are good examples of this problem. This observation has implications for diagnosis, and the best method for each type of catheter may not be the same. In our opinion, laboratory diagnosis in daily practice should be limited to external surface cultures of the tip of intravascular catheters. Intraluminal cultures should be limited to research purposes, except in catheters used for parenteral nutrition or hemodialysis. In this case, the intradermal segment gives more sensitive information. Sensitivity in diagnosing pulmonary artery colonization can be improved by evaluating both the tip and intradermal segments. In presence of an indwelling introducer the intradermal segment should be replaced by the introducer tip.

Catheterization, Peripheral↗
PubMed2002

Transpulmonary thermodilution cardiac output measurement using the axillary artery in critically ill patients.

STUDY OBJECTIVE: To compare cardiac output (CO) as measured by the arterial thermodilution technique using only a central venous catheter and an arterial catheter inserted into the axillary artery, with conventional CO measurement with thermodilution using a pulmonary artery (PA) catheter (PAC). DESIGN: Prospective clinical study in which each patient served as his/her own control. SETTING: General ICU of a large tertiary-care teaching hospital. PATIENTS: 22 patients who required invasive hemodynamic monitoring in the ICU. INTERVENTIONS AND MEASUREMENTS: CO measurements made using the PAC (COpa) were compared to bolus arterial thermodilution measurements (COax). The significance of acute changes in the continuous CO measurements during acute hemodynamic episodes was observed. MAIN RESULTS: The correlation between the two techniques (COpa and COax) was R(2) = 0.82. There was a tendency for 5% overestimation of COpa by the COax. The SEM% (SEM/average CO) for COax and COpa was 2.6% and 3.2%, respectively. The bias between measurements was 0.27 +/- 0.67 L/min, and the limits of agreement (mean difference +/- 2 SD) from minus 1.07 L/min to 1.63 L/min. CONCLUSIONS: In critically ill patients, in whom the measurement of CO is required, arterial thermodilution, using a central vein and the axillary artery is accurate and reproducible.

Adult↗
PubMed1995

Maternal and fetal effects of laparoscopic insufflation in the gravid baboon.

STUDY OBJECTIVE: To test the hypothesis that intraabdominal pressures (IAP) associated with abdominal insufflation for laparoscopic procedures can alter pulmonary and hemodynamic values in the pregnant baboon and hemodynamic values in the fetus. DESIGN: A descriptive physiologic study. SETTING: Animal research facility at Scott and White Memorial Hospital, Temple, TX. PARTICIPANTS: Four pregnant baboons at 120 +/- 7 days' gestation. INTERVENTIONS: The baboons underwent general anesthesia, Swan-Ganz and arterial catheter placement, and abdominal insufflation at 10 and 20 mm Hg IAP for 20-minute intervals at each pressure. The following end points were measured: maternal heart rate (MHR), mean arterial pressure (MAP), cardiac output (CO), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressures (PAP), central venous pressure (CVP), systemic vascular resistance (SVR), ventilator rate (VR), oxygen saturation, and end-tidal carbon dioxide (CO2). Fetal heart rate and fetal growth values were measured, and umbilical artery Doppler flow studies were performed. MEASUREMENTS AND MAIN RESULTS: The PCWP (p <0.026), CVP (p <0.0012), and PAP (p <0.046) were significantly increased at 20 mm Hg IAP; CO decreased as IP increased. The MAP, MHR, and SVR did not change significantly with increased IAP. The only significant change in pulmonary values was the increase in peak airway pressure (p <0.001). The VR was increased from an average of 18 to 41 breaths/minute in an attempt to maintain adequate oxygen saturation and to normalize end-tidal CO2 when IAP was increased to 20 mm Hg. Respiratory acidosis (pH <7. 35, partial pressure of carbon dioxide >50 torr) was demonstrated in three of four animals within 20 minutes at an IAP of 20 mm Hg. Results of Doppler flow studies on the effects of the fetuses were unaltered immediately after this procedure compared with baseline measurements. Normal interval growth was demonstrated 2 weeks after the procedure. CONCLUSION: The baboon mothers and fetuses had no adverse effects at an IAP of 10 mm Hg, but may have significant cardiovascular and respiratory alterations associated with IAP of 20 mm Hg.

Acidosis, Respiratory↗
PubMed1999

Signs of massive intraoperative pulmonary embolism with extensive invasive monitoring.

A 71-year-old patient suffered a massive pulmonary tumor embolism during removal of a renal carcinoma. He had extensive invasive monitoring, and the data were stored for later analysis. This shows that most of the known signs of pulmonary embolism were present in the tracings. It is discussed how none of them alone was sufficient for clinical diagnosis, but the comparison of several simultaneous variables together may be of great help. This report shows also the importance of the data-storing devices in the anesthesia monitors to make these comparisons possible in quickly changing emergency situations.

Aged↗
PubMed2001

The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications.

In a prospective multi-centre study involving 1132 peripheral venous catheters in three hospitals, the relationship between various measures of hand hygiene before insertion of peripheral venous catheters and the frequency of infectious complications', such as local reddening, swelling, pain, purulence and fever of unknown origin, were analysed. For documentation of the relevant data, special protocol forms, one for each catheter, were filled in at the time of insertion and removal of catheters. In comparison with simple hand washing, disinfection of hands before the insertion or wearing of gloves resulted in significantly fewer complications (relative risk 0.59 and 0.66, respectively). Normal hand washing was no better than no hand hygiene (relative risk 1.13), with regard to reduction of complications. This underlines the necessity of employing more effective measures of hand hygiene. The frequency of complications was dependent on the duration of peripheral venous catheterization. Catheters inserted in the operating room had a significantly lower risk of complications than catheters inserted on the ward or in the outpatient unit.

Aged↗
PubMed2001

Transvenous catheter embolectomy.

Transvenous pulmonary embolectomy was first described in 1969 by Greenfield and associates who designed a special catheter for the aspiration of thrombi in the pulmonary circulatory system. This technique was applied in 64 patients with massive pulmonary embolism (PE) with a 70 to 72% survival rate. However, it is difficult to implement and has not gained widespread acceptance. More recently, several other catheter devices have been used in patients with PE. The total number of patients reported does not exceed 100. Relative angiographic improvement varies between 10 and 49%, but hemodynamic improvement is not observed or not measured in most patients and mortality varies between 9 and 30%. Fibrinolysis was associated with mechanical thrombectomy in 54% of the patients, making the results difficult to interpret. Transvenous pulmonary embolectomy remains an experimental procedure and should been attempted only in the very few patients with PE, uncontrolled cardiogenic shock, and absolute contraindication to fibrinolytic treatment. Animal models are required to compare the different devices available.

Catheterization, Central Venous↗
PubMed2003

Successful thrombolysis by prolonged low-dose alteplase in catheter-directed infusion.

UNLABELLED: Catheter-directed thrombolysis is a sophisticated method in the treatment of thromboembolism with maximum effect on the thrombus and minimal systemic effect. The consequences are enhanced local thrombolysis and a reduction in general bleeding tendency, compared with systemic thrombolysis. At our institution, two children had successful thrombolysis by prolonged continuous catheter-directed low-dose alteplase. The first patient, a boy with Fontan physiology, was successfully treated for a massive pulmonary thromboembolism by catheter-directed very low-dose alteplase for five days. The second patient, who suffered from relapsing nephrotic syndrome, achieved satisfactory thrombolysis of an arterial leg thrombosis after four days of continuous catheter-directed low-dose alteplase. CONCLUSION: Although catheter-directed thrombolysis seems to be a valuable method in thrombolytic therapy, there is a lack of evidence-based recommendations concerning dosage, effect of bolus, simultaneous anticoagulation and duration of treatment for children.

Catheterization, Peripheral↗