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Wang S, Ye Q. Association between blood pressure and the risk of biopsy-induced endobronchial hemorrhage during bronchoscopy. BMC Pulm Med 2022; 22:25. [PMID: 34991557 PMCID: PMC8740074 DOI: 10.1186/s12890-022-01822-5] [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: 10/22/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage. METHODS We conducted a retrospective cohort study of 643 consecutive adults with lung cancer over an approximately 4-year period (from January 2014 to February 2018) at a large tertiary care hospital. Patients were divided into the hemorrhage group and the non-hemorrhage group based on endobronchial biopsy (EBB) findings. The association between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), PP to DP ratio (PP/DP) and the risk of EBB-induced hemorrhage was evaluated using multivariate regression analysis and smooth curve fitting adjusted for potential confounding factors. RESULTS The EBB-induced bleeding incidence was 37.8% (243/643) in our cohort. An independent association was found between PP/PD and the EBB-induced hemorrhage risk (per 1 SD, adjusted odds ratio, 0.788; 95% confidence interval, 0.653-0.951). The multivariate regression analysis performed using quartiles of PP/DP revealed that lower level of PP/DP ratio was related to a higher risk of EBB-induced hemorrhage (P for trend <0.05) after adjustment for potential confounders. However, no association was observed between SP, DP, MAP, PP and EBB-induced hemorrhage. CONCLUSIONS Low PP/DP was the independent risk factor for biopsy-induced endobronchial hemorrhage during bronchoscopy in patients with lung cancer.
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Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Qian Ye
- Department of Medical Records Quality Management, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
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2
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Muehlestein MB, Steblaj B, Joerger FB, Briganti A, Kutter APN. Evaluation of the ability of haemodynamic variables obtained with minimally invasive techniques to assess fluid responsiveness in endotoxaemic Beagles. Vet Anaesth Analg 2021; 48:645-653. [PMID: 34334294 DOI: 10.1016/j.vaa.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/16/2020] [Accepted: 02/16/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the ability of different haemodynamic variables recorded by minimally invasive monitoring techniques to assess fluid responsiveness (FR) in endotoxaemic Beagles. STUDY DESIGN Prospective terminal experimental study. ANIMALS A group of six healthy, purpose-bred Beagle dogs (three intact females and males), age 5-9.8 years (range) and weighing 11.4-17.9 kg. METHODS Endotoxaemic shock was induced by injecting 1 mg kg-1Escherichia coli lipopolysaccharide (LPS) intravenously in six sevoflurane-anaesthetized mechanically ventilated Beagles for another project. After 10 minutes, three Ringer's acetate boluses (10 mL kg-1) were administered each over 10 minutes with collection of haemodynamic data immediately before and after each bolus. Thereafter, arterial hypotension was treated with noradrenaline ± dexmedetomidine until arterial pressures increased to a target value. After a wash-out period of 20 minutes another three boluses of fluid were administered and measurements were repeated equally. For each fluid bolus, FR was considered positive when change (Δ) in stroke volume measured by pulmonary artery thermodilution was ≥15%. To test predictive accuracy for FR, we recorded heart rate, invasive arterial, right atrial and pulmonary capillary wedge pressures, pulse wave transit time with haemodynamic monitors, calculated pulse pressure, shock index and rate over pressure evaluation (ROPE) and measured stroke distance and corrected flow time (FTc) with oesophageal Doppler monitoring. RESULTS A total of 35 measurements (19 positive and 16 negative responses) were evaluated. A FTc < 330 ms, Δ pulse pressure ≥20%, Δ shock index ≤-14% and ΔROPE ≤-17% were the most significant indicators of positive FR with an area under the receiver operating characteristics curve between 0.72 and 0.74. CONCLUSIONS AND CLINICAL RELEVANCE In endotoxaemic Beagles, none of the assessed haemodynamic variables could predict FR with high sensitivity and specificity.
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Affiliation(s)
- Melanie B Muehlestein
- Department of Clinical Diagnostics and Services, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
| | - Barbara Steblaj
- Department of Clinical Diagnostics and Services, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
| | - Fabiola B Joerger
- Department of Clinical Diagnostics and Services, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Annette P N Kutter
- Department of Clinical Diagnostics and Services, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland.
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Campos-Serra A, Montmany-Vioque S, Rebasa-Cladera P, Llaquet-Bayo H, Gràcia-Roman R, Colom-Gordillo A, Navarro-Soto S. The use of the Shock Index as a predictor of active bleeding in trauma patients. Cir Esp 2018; 96:494-500. [PMID: 29778416 DOI: 10.1016/j.ciresp.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vital signs indicate the presence of bleeding only after large amounts of blood have been lost, with high morbidity and mortality. The Shock Index (SI) is a hemorrhage indicator with a cut-off point for the risk of bleeding at 0.9. The aim of this study is to assess whether a cut-off of≥0.8 is more sensitive for detecting occult bleeding, providing for early initiation of therapeutic maneuvers. METHODS SI analytical validation study of severe trauma patients older than 16 years of age. Vital signs were recorded, and scales for predicting bleeding included: SI, Assessment of Blood Consumption score, and Pulse Rate Over Pressure score. The relationship between the SI and 5 markers for bleeding was analyzed: need for massive transfusion, angiographic embolization, surgical bleeding control, death due to hypovolemic shock, and the overall predictor «active bleeding» (defined as the presence of at least one of the 4 markers above). RESULTS Data from 1.402 trauma patients were collected prospectively over a period of 10 years. The mean Injury Severity Score was 20.9 (SD 15.8). The mortality rate was 10%. The mean SI was 0.73 (SD 0.29). «Active bleeding» was present in 18.7% of patients. The SI area under the ROC curve for «active bleeding» was 0.749. CONCLUSIONS An SI cut-off point≥0.8 is more sensitive than≥0.9 and allows for earlier initiation of resuscitation maneuvers in patients with occult active bleeding.
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Affiliation(s)
- Andrea Campos-Serra
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España.
| | - Sandra Montmany-Vioque
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Pere Rebasa-Cladera
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Heura Llaquet-Bayo
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Raquel Gràcia-Roman
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Anna Colom-Gordillo
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Salvador Navarro-Soto
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
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Andreason CL, Pohlman TH. Damage Control Resuscitation for Catastrophic Bleeding. Oral Maxillofac Surg Clin North Am 2017; 28:553-568. [PMID: 27745621 DOI: 10.1016/j.coms.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The timely recognition of shock secondary to hemorrhage from severe facial trauma or as a complication of complex oral and maxillofacial surgery presents formidable challenges. Specific hemostatic disorders are induced by hemorrhage and several extreme homeostatic imbalances may appear during or after resuscitation. Damage control resuscitation has evolved from massive transfusion to a more complex therapeutic paradigm that includes hemodynamic resuscitation, hemostatic resuscitation, and homeostatic resuscitation. Definitive control of bleeding is the principal objective of any comprehensive resuscitation scheme for hemorrhagic shock.
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Affiliation(s)
- Chase L Andreason
- Department of Oral Surgery and Hospital Dentistry, Indiana University School of Dentistry, 1121 West Michigan Street, Indianapolis, IN 46202, USA
| | - Timothy H Pohlman
- Trauma Services, Division of General Surgery, Department of Surgery, Methodist Hospital, Indiana University Health, Suite B238, 1701 North Senate Boulevard, Indianapolis, IN 46202, USA.
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Olaussen A, Thaveenthiran P, Fitzgerald MC, Jennings PA, Hocking J, Mitra B. Prediction of critical haemorrhage following trauma: A narrative review. JOURNAL OF EMERGENCY MEDICINE, TRAUMA AND ACUTE CARE 2016. [DOI: 10.5339/jemtac.2016.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction: Traumatic haemorrhagic shock can be difficult to diagnose. Models for predicting critical bleeding and massive transfusion have been developed to aid clinicians. The aim of this review is to outline the various available models and report on their performance and validation. Methods: A review of the English and non-English literature in Medline, PubMed and Google Scholar was conducted from 1990 to September 2015. We combined several terms for i) haemorrhage AND ii) prediction, in the setting of iii) trauma. We included models that had at least two data points. We extracted information about the models, their developments, performance and validation. Results: There were 36 different models identified that diagnose critical bleeding, which included a total of 36 unique variables. All models were developed retrospectively. The models performed with variable predictive abilities–the most superior with an area under the receiver operating characteristics curve of 0.985, but included detailed findings on imaging and was based on a small cohort. The most commonly included variable was systolic blood pressure, featuring in all but five models. Pattern or mechanism of injury were used by 16 models. Pathology results were used by 15 models, of which nine included base deficit and eight models included haemoglobin. Imaging was utilised in eight models. Thirteen models were known to be validated, with only one being prospectively validated. Conclusions: Several models for predicting critical bleeding exist, however none were deemed accurate enough to dictate treatment. Potential areas of improvement identified include measures of variability in vital signs and point of care imaging and pathology testing.
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Affiliation(s)
- Alexander Olaussen
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 5Monash School of Medicine, Monash University, Australia
- 3Trauma Service, The Alfred Hospital, Melbourne, Australia
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 1Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Prasanthan Thaveenthiran
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 5Monash School of Medicine, Monash University, Australia
| | - Mark C. Fitzgerald
- 3Trauma Service, The Alfred Hospital, Melbourne, Australia
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Paul A. Jennings
- 1Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 6College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Jessica Hocking
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Biswadev Mitra
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 7Department of Epidemiology & Preventive Medicine, Monash University, Australia
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Kaczynski J. Prevention of tissue hypoperfusion in the trauma patient: initial management. Br J Hosp Med (Lond) 2014; 74:81-4. [PMID: 23411976 DOI: 10.12968/hmed.2013.74.2.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article outlines the challenges of identification and management of tissue hypoperfusion as a consequence of haemorrhagic shock in civilian polytrauma cases. It also describes damage resuscitation, but does not cover specific trauma cases such as pregnancy, burns, head injuries, children and elderly trauma.
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Affiliation(s)
- Jakub Kaczynski
- Department of General Surgery, Morriston Hospital, Swansea SA6 6NL.
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Recent advances of hemorrhage management in severe trauma. Emerg Med Int 2014; 2014:638956. [PMID: 24627809 PMCID: PMC3929186 DOI: 10.1155/2014/638956] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/14/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022] Open
Abstract
Trauma is one of the most common causes of mortality worldwide with a substantial percentage of deaths resulting secondary to haemorrhages, which are preventable and treatable when adequately managed. This paper offers a review of the current literature on how to successfully resuscitate patients with major haemorrhage.
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The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality. J Trauma Acute Care Surg 2013; 74:1432-7. [DOI: 10.1097/ta.0b013e31829246c7] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Validation of the pulse rate over pressure evaluation index as a detector of early occult hemorrhage. J Trauma Acute Care Surg 2012; 73:286-8. [DOI: 10.1097/ta.0b013e318253b52e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Tachycardia, often defined as heart rate >100 bpm, has been utilized as a physical sign of hypovolemic shock among the injured for decades without evidence to support its use as a predictor of injury or significant hypovolemia. We sought to determine whether admission heart rate is a valid predictor of hemodynamically significant injuries. METHODS Trauma registry data from 1998 to 2004 were analyzed with logistic regression to determine whether heart rate was associated with need for emergent intervention for bleeding (laparotomy, thoracotomy, or angiography), need for packed red blood cell (pRBC) transfusion in the first 24 hours, or severe injury (ISS >25) after blunt or penetrating trauma. RESULTS Records of 10,825 patients were analyzed. Overall, heart rate was neither sensitive nor specific in determining the need for emergent intervention, pRBCs in the first 24 hours or severe injury. This was not altered by the presence of hypotension (systolic blood pressure <90 mm Hg) or age in the blunt cohort. CONCLUSIONS Heart rate alone is not sufficient to determine the need for emergent interventions for hemorrhage. Although tachycardia may still indicate need for emergent intervention in the trauma patient, its absence should not allay such concern.
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Affiliation(s)
- Karen J Brasel
- Department of Surgery, Medical College of Wisconsin, Wisconsin 53226, USA.
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Yanagawa Y, Nishi K, Sakamoto T, Okada Y. Early Diagnosis of Hypovolemic Shock by Sonographic Measurement of Inferior Vena Cava in Trauma Patients. ACTA ACUST UNITED AC 2005; 58:825-9. [PMID: 15824662 DOI: 10.1097/01.ta.0000145085.42116.a7] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diameter of the inferior vena cava in trauma patients may be useful for evaluating hypovolemia. METHODS Between June 2003 and September 2003, 35 injured patients transferred to the authors' hospital were prospectively investigated. They were divided into two groups: a shock group (n = 10) and a control group (n = 25). The maximum anteroposterior diameter of the inferior vena cava was measured using a sonography at arrival and on hospital day 5. RESULTS The average diameter of the inferior vena cava in the shock group was significantly smaller than in the control group. There was no significant change in the diameter of the inferior vena cava in the control group, but significant change was seen in the shock group between arrival and hospital day 5. CONCLUSION The diameter of the inferior vena cava was found to correlate with hypovolemia in trauma patients.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Namiki Tokorozawa Saitama, Japan
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