摘要:

ObjectiveTo compare the conventional method for cannulation of the internal jugular vein with the ultrasound-aided technique.DesignProspective, randomized trial.SettingMedical and surgical patients requiring central cannulation in a university hospital.PatientsConsecutive medical and surgical patients in whom central venous cannulation was indicated.InterventionsCannulation of the internal jugular vein was performed by one anesthesiologist. During the first 6 months, the ultrasound-aided technique (n = 29) was used, and during the second 6 months, the conventional technique (n = 27) was applied.Measurements and Main ResultsThe venous lumen was reached with fewer punctures (1.2 ± 0.5 vs. 3.3 ± 3.0 punctures per patient) and the cannulation time was shorter (35 ± 19 vs. 198 ± 211 sees) while using the ultrasound-aided technique. The ultrasound-aided method showed that the large-bore (diameter >2.0 mm) needles invariably perforated the medial wall of the internal jugular vein, increasing the risk of perforating the adjacent carotid artery.ConclusionsUltrasound guidance reduces both the duration of time and the number of punctures required to cannulate the internal jugular vein. The Seldinger technique appears safer for catheterization of the internal jugular vein.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Positive end-expiratory pressure is thought to improve oxygenation in patients with adult respiratory distress syndrome (ARDS) by recruiting alveoli to augment a decreased functional residual capacity. At high levels, typically >10 cm H2O, positive end-expiratory pressure may have deleterious hemodynamic effects. Positive end-expiratory pressure may decrease cardiac output, and therefore oxygen delivery, by reducing right and left ventricular preload, decreasing ventricular compliance, and increasing right ventricular afterload (1). Positive end-expiratory pressure can increase right ventricular afterload by increasing the pulmonary vascular resistance (2–5). As lung volume increases, the alveoli become more distended, compress the alveolar capillary bed, and increase the pulmonary vascular resistance. A decrease in Pao2with an increase of positive end-expiratory pressure has been described in the setting of unilateral lung disease, where positive end-expiratory pressure overdistends the more compliant lung and redirects blood flow to the diseased lung (6, 7).

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We present a new and successful method of carotid artery cannulation without ligation of the carotid artery for extracorporeal membrane oxygenation (ECMO) in two neonates with severe respiratory failure caused by meconium aspiration and sepsis. ECMO was carried out for 4 and 17 days, respectively. Both neonates showed normal neurologic findings and normal transcranial Doppler scans during and after ECMO.ECMO has been used successfully to treat severe respiratory failure in neonates (1). Survival rates are 90% in neonates with an expected mortality rate of 80%, using conventional respiratory support (2). However, ECMO usually requires ligation of the carotid artery, because of the risk of cerebral embolization. This adverse consequence of ECMO (i.e., carotid artery ligation) might be one of the causes for the high occurrence of right hemispheric brain lesions in ECMO-treated children (3). Recently, Crombleholme et al. (4) described a technique for the reconstruction of the carotid artery after ECMO and speculated that carotid artery reconstruction may decrease the occurrence, or limit the extent of right-side brain injury and obviate the long-term consequences of compromised right hemispheric perfusion. We used a different technique of carotid artery cannulation and reconstruction in two neonates with severe respiratory failure.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID