Association Between The First Central Venous Pressure Time Acquisition And Mortality In Patients With Severe Sepsis And Septic Shock

Kashiouris, Markos; Kashyap, Rahul; Paturi, Anil; Sathick, Insara Jaffer; Dong, Yue; Gajic, Ognjen; Cartin‐Ceba, Rodrigo

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a1123

Cited by 3 publications

(3 citation statements)

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“…Finally, POCUS has advantages over chest radiography including avoidance of ionizing radiation exposure, optimized resource utilization, and decreased time to diagnosis (13). Immediate confirmation of CVC positioning allows for earlier clinical management that could affect patient outcomes, particularly in critically ill patients (14)(15)(16). A recent meta-analysis found that POCUS detected all pneumothoraces and most catheter malpositions following CVC placement while much faster than chest radiography (17).…”

Section: Introductionmentioning

confidence: 99%

Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters

Ablordeppey

Drewry

Theodoro

et al. 2019

Shock

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Section: Introductionmentioning

confidence: 99%

Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters

Ablordeppey

Drewry

Theodoro

et al. 2019

Shock

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“…Bedside ultrasound has advantages over chest radiography including lack of ionizing radiation exposure, decreased resource utilization and decreased diagnostic time (15–18). This earlier confirmation of CVC positioning allows for earlier clinical management which could potentially affect patient outcomes (19). The bedside ultrasound CVC confirmation approach is demonstrated in Supplemental Digital Content 1–2 (digital videos and legend) and consists of a focused exam of the vascular structures and the right atrium to identify catheter position and examination of the anterior chest wall to assess for pneumothorax (20–22).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

Ablordeppey

Drewry

Beyer

et al. 2017

Critical Care Medicine

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Objective We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared to chest radiography. Data Sources PubMed, EMBASE, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov Study Selection Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2×2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, inter-rater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Data Extraction Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Data Synthesis 15 studies with 1553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 [0.77, 0.86] and 0.98 [0.97, 0.99] respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 [14.72, 65.78] and 0.25 [0.13, 0.47]. The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Conclusions Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than chest radiography.

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“…One small study found organ function worsened with each hour of CVC delay. 18 In a large population-based study, Walkey et. al.…”

Section: Discussionmentioning

confidence: 99%

Rates and Timing of Central Venous Cannulation Among Patients With Sepsis and Respiratory Arrest Admitted by the Emergency Department*

Theodoro

Owens

Olsen

et al. 2014

Critical Care Medicine

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Objective Clinical guidelines for the acute management of emergency department (ED) patients with severe sepsis encourage the placement of central venous catheters (CVC). Data examining the timing of CVC insertion among critically ill patients admitted from the ED are limited. We examined the hypothesis that prompt CVC insertion during hospitalization among patients admitted from the ED acts as a surrogate marker for early aggressive care in the management of critically ill patients. Design Retrospective cross sectional analysis of ED visits using 2003-2006 discharge data from California, State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Setting General medical or general surgical hospitals (n=310). Patients Patient hospitalizations beginning in the ED with the two most common diagnoses associated with CVC (sepsis and respiratory arrest.) Interventions None. Measurements and Main Results We identified the occurrence and timing of CVC using International Classification of Diseases, Clinical Modifications, 9th Revision procedure codes. The primary outcomes measured were annual CVCs per 1000 hospitalizations that began in the ED occurring emergently (procedure day 0), urgently (procedure day 1-2), or late (procedure day 3 or later). A total of 129,288 hospital discharges had evidence of CVC. In 2003 5,759 CVCs were placed emergently compared to 10,469 in 2006. The rate of emergent CVC/1000 increased annually from 228 in 2003, 239 in 2004, 257 in 2005, up to 269 in 2006. Urgent and late CVC rates trended down (p<.001). In a multilevel model the odds of undergoing emergent CVC relative to 2003 increased annually: 1.08 (95%CI, 1.03 to 1.12) in 2004, 1.19 (95%CI, 1.14 to 1.23) in 2005, and 1.28 (95%CI, 1.23 to 1.33) in 2006. Conclusions CVCs are inserted earlier and more frequently among critically ill patients admitted from the ED. Earlier CVC insertion may require systematic changes to meet increasing utilization and enhanced mechanisms to measure CVC outcomes.

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Association Between The First Central Venous Pressure Time Acquisition And Mortality In Patients With Severe Sepsis And Septic Shock

Cited by 3 publications

References 0 publications

Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters

Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

Rates and Timing of Central Venous Cannulation Among Patients With Sepsis and Respiratory Arrest Admitted by the Emergency Department*

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