Difficult peripheral venous access: clinical evaluation of a catheter inserted with the Seldinger method under ultrasound guidance.

Purpose: A preliminary observational study was undertaken to evaluate the risk of failure of ultrasound-guided peripheral intravenous catheterization of a deep arm vein for a maximum of 7 days, after peripheral intravenous (PIV) cannulation failure.

Methods: This prospective study included patients referred to the intensive care unit for placement of a central line, a polyurethane cannula commercialized for arterial catheterization was used for peripheral venous cannulation. Catheter length and diameter were chosen based on preliminary ultrasound measurements of vein diameter and skin-vein distance.

Evaluation of blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage in critically ill patients with infectious pneumonia: a preliminary study.

Background: We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage (mini-BAL) to obtain respiratory secretion specimens from spontaneously breathing, non-intubated patients with infectious pneumonia in intensive care.

Methods: Patients suspected of having infectious pneumonia were included prospectively. Three samples were obtained: expectorated sputum, nasotracheal suctioning, and mini-BAL via a double telescopic catheter (Combicath).

Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient?

Objective: Transesophageal echocardiography (TEE) has proven its efficiency in assessing hemodynamics in patients by its ability to evaluate cardiac function and fluid responsiveness. Classically, it requires quantitative measurements, whereas in routine practice TEE is used in our unit especially as a qualitative procedure. We assessed the accuracy of this qualitative central hemodynamic evaluation obtained by TEE at the bedside.

Early veno-venous haemodiafiltration for sepsis-related multiple organ failure.

Introduction: We conducted a prospective observational study from January 1995 to December 2004 to evaluate the impact on recovery of a major advance in renal replacement therapy, namely continuous veno-venous haemodiafiltration (CVVHDF), in patients with refractory septic shock.

Method: CVVHDF was implemented after 6-12 hours of maximal haemodynamic support, and base excess monitoring was used to evaluate the improvement achieved. Of the 60 patients studied, 40 had improved metabolic acidosis after 12 hours of CVVHDF, with a progressive improvement in all failing organs; the final mortality rate in this subgroup was 30%.

Incidence, causes and prognosis of hypotension related to meprobamate poisoning.

Objective: Meprobamate self-poisoning has been reported as potentially inducing hypotension. We examined the incidence and causes of hypotension induced by this poisoning and its prognosis.

Design And Setting: Retrospective observational study conducted in a medical ICU between June 1997 and October 2003.

Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients.

Objective: In mechanically ventilated patients inspiratory increase in pleural pressure during lung inflation may produce complete or partial collapse of the superior vena cava. Occurrence of this collapse suggests that at this time external pressure exerted by the thoracic cavity on the superior vena cava is greater than the venous pressure required to maintain the vessel fully open. We tested the hypothesis that measurement of superior vena caval collapsibility would reveal the need for volume expansion in a given septic patient.

Early patterns of static pressure-volume loops in ARDS and their relations with PEEP-induced recruitment.

Objective: Evaluation of low-flow pressure-volume loop at the bedside in ARDS, as an aid to assess recruitment produced by PEEP.

Materials And Methods: Low-flow pressure-volume loop at the bedside were obtained on the first day of respiratory support in 54 successive pulmonary ARDS patients (49 of whom had pneumonia) treated between April 1999 and June 2002. From the loop obtained at ZEEP, we determined manually the lower inflexion point (LIP).

Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography.

It has long been known that there are cyclic changes in arterial pressure during mechanical ventilation. They are caused by cyclic changes in both the right and left ventricular stroke output, occurring in opposite phases. As a result, arterial pulse pressure is increased during inspiration and decreased during expiration.

Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS.

Objective: To assess the ability of a heated humidifier to improve CO(2) clearance in ARDS patients submitted to protective ventilation.

Design: Prospective clinical study.

Setting: University hospital intensive care unit.