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Luo W, Jin D, Huang J, Zhang J, Xu Y, Gu J, Sun C, Yu J, Xu P, Liu L, Zhang Z, Guo C, Liu H, Miao C, Zhong J. Low Pneumoperitoneum Pressure Reduces Gas Embolism During Laparoscopic Liver Resection: A Randomized Controlled Trial. Ann Surg 2024; 279:588-597. [PMID: 38456278 PMCID: PMC10922664 DOI: 10.1097/sla.0000000000006130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To compare the effect of low and standard pneumoperitoneal pressure (PP) on the occurrence of gas embolism during laparoscopic liver resection (LLR). BACKGROUND LLR has an increased risk of gas embolism. Although animal studies have shown that low PP reduces the occurrence of gas embolism, clinical evidence is lacking. METHODS This parallel, dual-arm, double-blind, randomized controlled trial included 141 patients undergoing elective LLR. Patients were randomized into standard ("S," 15 mm Hg; n = 70) or low ("L," 10 mm Hg; n = 71) PP groups. Severe gas embolism (≥ grade 3, based on the Schmandra microbubble method) was detected using transesophageal echocardiography and recorded as the primary outcome. Intraoperative vital signs and postoperative recovery profiles were also evaluated. RESULTS Fewer severe gas embolism cases (n = 29, 40.8% vs n = 47, 67.1%, P = 0.003), fewer abrupt decreases in end-tidal carbon dioxide partial pressure, shorter severe gas embolism duration, less peripheral oxygen saturation reduction, and fewer increases in heart rate and lactate during gas embolization episodes was found in group L than in group S. Moreover, a higher arterial partial pressure of oxygen and peripheral oxygen saturation were observed, and fewer fluids and vasoactive drugs were administered in group L than in group S. In both groups, the distensibility index of the inferior vena cava negatively correlated with central venous pressure throughout LLR, and a comparable quality of recovery was observed. CONCLUSIONS Low PP reduced the incidence and duration of severe gas embolism and achieved steadier hemodynamics and vital signs during LLR. Therefore, a low PP strategy can be considered a valuable choice for the future LLR.
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Affiliation(s)
- Wenchen Luo
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Anesthesiology, Zhongshan Wusong Hospital Affiliated to Fudan University, Shanghai, China
| | - Danfeng Jin
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jian Huang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jinlin Zhang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongfeng Xu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Jiahui Gu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Caihong Sun
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jian Yu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Peiyao Xu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Luping Liu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhenyu Zhang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chenyue Guo
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hongjin Liu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Jing Zhong
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Anesthesiology, Zhongshan Wusong Hospital Affiliated to Fudan University, Shanghai, China
- Fudan Zhangjiang Institute, Shanghai, China
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Hakim DDL, Meilyana F, Peryoga SU, Arniawati I, Wijaya EA, Martiano MR. Usefulness of Non-Invasive Parameters (Inferior Vena Cava Diameter, Inferior Vena Cava Collapsibility, Inferior Vena Cava-Aortic Ratio) for Hemodynamic Monitoring in Critically Ill Children: A Systematic Review. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:123-133. [PMID: 38525306 PMCID: PMC10959115 DOI: 10.2147/mder.s454849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose Volume measurement in critically ill children can be conducted using invasive procedure such as Central Venous Pressure (CVP), or non-invasive procedure such as measurement of Inferior Vena Cava (IVC) indices using ultrasonography. However, their accuracy and efficacy are still under scrutiny. We aim to compare CVP and IVC indices as non-invasive parameters in assessing volume status in critically ill children. Methods We conducted a systematic review based on literature searching from four electronic databases which were PubMed, Cochrane, ScienceDirect, SpringerLink with keywords: "CENTRAL VENOUS PRESSURE", "INFERIOR VENA CAVA DIAMETER", "INFERIOR VENA CAVA COLLAPSIBILITY", "INFERIOR VENA CAVA AORTIC-RATIO", "VOLUME STATUS", "FLUID STATUS", "CRITICAL ILL", "CHILDREN", and "PEDIATRICS". We included relevant studies in English published from 2000 to 2023 on critically ill children aged 0-18 years. Comparison between CVP and IVC indices was resumed. Results Eight articles were included in this study. Majority of the studies showed a consistent correlation between CVP and IVC indices. IVC-CI was the most common parameter evaluated in the included studies. There was moderate to strong correlations using IVC-CI and IVC-DI, and moderate correlation using IVC-Ao ratio. Conclusion We found that non-invasive tools might have a potential role to measure volume in critically ill children equals to CVP. Further high-quality and longitudinal studies are needed to validate these findings and to establish a clear guideline for the non-invasive tool to be used in daily clinical practice.
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Affiliation(s)
- Dzulfikar Djalil Lukman Hakim
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Fina Meilyana
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Stanza Uga Peryoga
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Irma Arniawati
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Elrika Anastasia Wijaya
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Muhamad Rinaldhi Martiano
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Ruscica A, Chen C, Ng L. Updates in pediatric ultrasound. Curr Opin Pediatr 2023; 35:324-330. [PMID: 36974449 DOI: 10.1097/mop.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW Point-of-care ultrasound (POCUS) has various diagnostic and therapeutic applications in the pediatric acute care setting that have an impact on clinical outcomes. RECENT FINDINGS POCUS can improve diagnostic efficiency and expedite management in pediatric patients who present to the emergency department with common complaints such as respiratory distress, abdominal pain, shock, and pain. SUMMARY Rapid advancements in POCUS have allowed it to become a powerful tool in pediatric care. As the clinical applications of ultrasound diversify, research is needed to evaluate impacts on healthcare outcomes, delivery, and costs.
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Affiliation(s)
- Alice Ruscica
- Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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Zhang H, Gao H, Xiang Y, Li J. Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study. Front Cardiovasc Med 2022; 9:958259. [PMID: 36267641 PMCID: PMC9576846 DOI: 10.3389/fcvm.2022.958259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Inferior vena cava (IVC) ultrasonography is a reliable variable that predicts post-induction hypotension (PIH) in patients undergoing surgery under general anesthesia. However, in patients with hypertension, the predictive performance of ultrasound IVC measurements needs further exploration. Methods This is a prospective cohort study. Adult patients with existing hypertension scheduled to undergo non-cardiac surgery under general anesthesia were eligible. An abdominal ultrasound examination was conducted immediately prior to anesthesia induction (0.03 mg kg–1 midazolam, 0.3 mg kg–1 etomidate, 0.4 μg kg–1 sufentanil, and 0.6 mg kg–1 rocuronium). IVC collapsibility index (IVC-CI) was calculated as (dIVCmax–dIVCmin)/dIVCmax, where dIVCmax and dIVCmin represent the maximum and minimum IVC diameters at the end of expiration and inspiration, respectively. PIH was defined as a reduction of mean arterial pressure (MAP) by >30% of the baseline or to <60 mmHg within 10 min after endotracheal intubation. The diagnostic performance of IVC-CI, dIVCmax, and dIVCmin in predicting PIH was also examined in a group of normotensive patients receiving non-cardiac surgery under the same anesthesia protocol. Results A total of 51 hypertensive patients (61 ± 13 years of age, 31 women) and 52 normotensive patients (42 ± 13 years of age, 35 women) were included in the final analysis. PIH occurred in 33 (64.7%) hypertensive patients and 19 (36.5%) normotensive patients. In normotensive patients, the area under the receiver operating curve (AUC) in predicting PIH was 0.896 (95% confidence interval [CI]: 0.804–0.987) for IVC-CI, 0.770 (95% CI: 0.633–0.908) for dIVCmax, and 0.868 (95% CI: 0.773–0.963) for dIVCmin. In hypertensive patients, the AUC in predicting PIH was 0.523 (95% CI: 0.354–0.691) for IVC-CI, 0.752 (95% CI: 0.621–0.883) for dIVCmax, and 0.715 (95% CI: 0.571–0.858) for dIVCmin. At the optimal cutoff (1.24 cm), dIVCmax had 54.5% (18/33) sensitivity and 94.4% (17/18) specificity. Conclusion In hypertensive patients, IVC-CI is unsuitable for predicting PIH, and dIVCmax is an alternative measure with promising performance. Clinical trial registration [http://www.chictr.org.cn/], identifier [ChiCTR2000034853].
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Kim SW, Lee KH, Eom DW, Kim TH, Park SY. Monitoring of hemodynamic changes during huge cystic lymphangioma resection in a 91-day-old infant. Clin Case Rep 2021; 9:e05060. [PMID: 34795896 PMCID: PMC8581326 DOI: 10.1002/ccr3.5060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022] Open
Abstract
Cystic lymphangioma (CL) is a rare benign lesion that can be treated with surgical resection. We describe the monitoring of hemodynamic changes in a 91-day-old girl undergoing resection of a huge CL. Monitoring was managed through continuous central venous pressure monitoring using a central catheter in the inferior vena cava.
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Affiliation(s)
- Sung Wan Kim
- Department of Anesthesiology and Pain MedicineDong‐A University College of MedicineBusanKorea
| | - Kyung Hyun Lee
- Department of Anesthesiology and Pain MedicineDong‐A University College of MedicineBusanKorea
| | - Deuk Won Eom
- Department of Anesthesiology and Pain MedicineDong‐A University College of MedicineBusanKorea
| | - Tae Hyung Kim
- Department of Anesthesiology and Pain MedicineDong‐A University College of MedicineBusanKorea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain MedicineDong‐A University College of MedicineBusanKorea
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