Percutaneous drainage of large pericardial effusion in intensive care unit: Safety and outcome

Abstract Aims Acute pericarditis is considered one of the cardiovascular complications of COVID-19. The published data suggest that the diagnosis of acute pericarditis in patients with COVID-19 infection may be more frequent than usually diagnosed and as a consequence, undertreated. The proposed investigation is a retrospective observational study in which 170 patients, admitted to an Intensive Care Unit because of a COVID-19 diagnosis, were analysed. All patients underwent cardiological evaluation including a bedside echocardiogram. The aim of the study was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion. Methods and results The proposed investigation is a retrospective observational study enrolling patients admitted to Intensive Care Unit of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS-CoV-2 induced severe acute respiratory syndrome. No. 170 patients, admitted from 1 April 2020 to 30 April 2021, were enrolled. All patients presented a variable picture of bilateral interstitial pneumonia characterized by ground glass opacifications at HR-Chest CT. Some patients underwent oro-tracheal intubation and invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9-GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients (Table 1). The diagnosis of acute pericarditis was defined by: (i) different degree of pericardial effusion; (ii) C-reactive proteine elevation. All patients were divided in two groups: (1) pericarditis group (a); (2) pericarditis-free group (b). Of 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67.6 ± 13.3 [females: 70.5 (±16.2); males: 66.4 (±11.7)]. Of 170, n. 60 patients had a diagnosis of acute pericarditis (32.2%). Group A (patient with acute pericarditis) consisted of 60 patients, age 69.2 (±12.6), 39 (65%) male [age 69.3 (±10.6)], 21 (35%) female [age 69.1 (±16.0)]. Of 60, only 6 had a pericardial effusion >10 mm (10%); the remaining group A-patients (90%) had a mild pericardial effusion (<10 mm). No patient had tamponade picture. Group B (pericarditis-free patients) included 110 patients, age 66.7 (±13.7), 80 (72.7%) males [age 65.0 (±12.1)], 30 (27.3%) females [age 71.4 (±16.6)]. Group A-patients (with pericarditis) had more days of intubation and a prolonged global hospital stay compared with group B (pericarditis-free). Other demographic, clinical and laboratory parameters were similar between the two groups. Conclusions Pericarditis is a frequent cardiovascular complication of COVID-19 (32.2% in our study). It may have clinical and prognostic implications.

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Parainfluenza 3 Respiratory Infection Associated with Pericardial Effusion in a Very Low Birthweight Infant

Case Reports in Infectious Diseases ◽

10.1155/2017/5687490 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Cristina Aranda Cazón ◽

Luis Arruza Gómez ◽

Gloria Herranz Carrillo ◽

Cristina González Menchén ◽

Zarife Daoud Pérez ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pericardial Effusion ◽

Respiratory Infection ◽

Neonatal Intensive Care ◽

Low Birthweight ◽

Respiratory Infections ◽

Pediatric Population ◽

Very Low Birthweight ◽

Very Low Birthweight Infant

Parainfluenza 3 virus is a frequent cause of respiratory infections in the pediatric population although it is uncommonly diagnosed in neonates, being usually reported as neonatal intensive care unit microepidemics. We report a case of parainfluenza 3 respiratory infection associated with pericardial effusion in a very low birthweight infant.

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Percutaneous drainage of delayed post-cardiac surgery pericardial effusion

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v2i3.145 ◽

2020 ◽

Vol 2 (3) ◽

pp. 105-113

Author(s):

Mohammed Sanad ◽

Sherif Arafa ◽

Shady Elhusseiny ◽

Mohammed Adel ◽

Mohammed Elshabrawy Saleh

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Pericardial Effusion ◽

Aortic Valve ◽

Valve Replacement ◽

Percutaneous Drainage ◽

Artery Bypass ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Large Pericardial Effusion

Background: Pericardial effusion and tamponade are common following valve surgery. The optimal treatment of symptomatic pericardial effusions remains controversial. The objective of this study was to present our experience in non-surgical management of delayed postoperative pericardial effusion. Methods: This retrospective study was conducted on 64 patients who had delayed pericardial effusion after cardiac surgery from 2016 to 2020. Eight patients were excluded due to the presence of inaccessible posterior or clotted pericardial effusion and were managed surgically, and 56 patients had percutaneous drainage of the pericardial fluid and were included in the analysis. Results: The mean age was 46.84±11.67 years (range: 22- 68 years), and 46.43% were females. The patients had coronary artery bypass grafting (n= 9), Aortic valve replacements (n= 13), Mitral valve surgery (n= 21), double valve replacements (n= 8) and combined procedures (n= 5). All patients complained of varying degrees of exertional dyspnea. There were statistically significant differences between INR in different cardiac surgeries. Mean INR following mitral valve replacement (4.72±0.63) was significantly higher than in aortic valve replacement patients (3.32±0.34; p<0.001) and aortic valve patients (1.76±0.24; p<0.001). Fifteen patients (26.78%) had a large pericardial effusion. Successful drainage was achieved in all cases. Complications were pneumothorax (n= 2, 3.57%), recurrent effusions (n= 4, 7.14%), arrhythmias (n= 7, 12.5%), myocardial punctures (n= 2, 3.57%) and no mortality was reported. Conclusions: percutaneous drainage of postoperative pericardial effusion under radiological guidance is generally safe. Pericardial effusion is common after mitral valve surgery, which could be related to higher INR in these patients.

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Percutaneous Drainage with Ultrasound Guidance in the Intensive Care Unit

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2004.50.3.167 ◽

2004 ◽

Vol 50 (3) ◽

pp. 167

Author(s):

Doo Kyung Kang ◽

Je Hwan Won ◽

Jai Keun Kim ◽

Kwang Hun Lee ◽

Ji Hyung Kim

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Percutaneous Drainage ◽

Ultrasound Guidance

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Pericardial effusion and cardiac tamponade: a sudden and unexpected deterioration in a newborn in the neonatal intensive care unit

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2016.12828 ◽

2016 ◽

Vol 24 (4) ◽

pp. 777-778

Author(s):

Selma Aktas

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pericardial Effusion ◽

Neonatal Intensive Care Unit ◽

Cardiac Tamponade ◽

Neonatal Intensive Care

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Demons syndrome with pericardial effusion followed by intensive care unit-acquired weakness: A case report and literature review

SAGE Open Medical Case Reports ◽

10.1177/2050313x211069315 ◽

2022 ◽

Vol 10 ◽

pp. 2050313X2110693

Author(s):

Eri Obata ◽

Kentaro Kai ◽

Saki Aso ◽

Nao Tsukamoto ◽

Takuya Hanaoka ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Intensive Care ◽

Pericardial Effusion ◽

Ovarian Tumor ◽

Ventilator Weaning ◽

Serous Cystadenoma ◽

Japanese Woman ◽

Neurological Sequela ◽

Refractory Heart Failure

Demons syndrome is defined by hydrothorax and ascites associated with a benign genital tumor that resolves after resection of the tumor. However, Demons syndrome with pericardial effusion has never been reported. Intensive care unit–acquired weakness is a neurological sequela to sepsis/systemic inflammatory response syndrome, or multi-organ failure. A 47-year-old, nulligravid, Japanese woman, was transferred to our hospital for refractory heart failure and a ruptured ovarian tumor. She had an 11-cm left ovarian tumor with ascites, hydrothorax, and pericardial effusion; she was intubated for pulmonary hypertension and admitted to the intensive care unit for septic shock. Four days later, a left salpingo-oophorectomy was performed for Demons syndrome with pericardial effusion. The histological diagnosis indicated a serous cystadenoma with fibrotic changes. Following surgery, ventilator weaning was delayed due to intensive care unit–acquired weakness. The association between Demons syndrome and pericardial effusion should be recognized to ensure early treatment and for preventing sequalae from the disease.

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Factors Predicting Outcome in Intensive Care Unit-Admitted COVID-19 Patients: Using Clinical, Laboratory, and Radiologic Characteristics

Critical Care Research and Practice ◽

10.1155/2021/9941570 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Aminreza Abkhoo ◽

Elaheh Shaker ◽

Mohammad-Mehdi Mehrabinejad ◽

Javid Azadbakht ◽

Nahid Sadighi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Pericardial Effusion ◽

Clinical Laboratory ◽

Vital Signs ◽

Ground Glass Opacity ◽

Laboratory Findings ◽

Radiologic Findings ◽

Significant Difference

Purpose. To investigate the factors contributing to mortality in coronavirus disease 2019 (COVID-19) patients admitted in the intensive care unit (ICU) and design a model to predict the mortality rate. Method. We retrospectively evaluated the medical records and CT images of the ICU-admitted COVID-19 patients who had an on-admission chest CT scan. We analyzed the patients’ demographic, clinical, laboratory, and radiologic findings and compared them between survivors and nonsurvivors. Results. Among the 121 enrolled patients (mean age, 62.2 ± 14.0 years; male, 82 (67.8%)), 41 (33.9%) survived, and the rest succumbed to death. The most frequent radiologic findings were ground-glass opacity (GGO) (71.9%) with peripheral (38.8%) and bilateral (98.3%) involvement, with lower lobes (94.2%) predominancy. The most common additional findings were cardiomegaly (63.6%), parenchymal band (47.9%), and crazy-paving pattern (44.4%). Univariable analysis of radiologic findings showed that cardiomegaly p : 0.04 , pleural effusion p : 0.02 , and pericardial effusion p : 0.03 were significantly more prevalent in nonsurvivors. However, the extension of pulmonary involvement was not significantly different between the two subgroups (11.4 ± 4.1 in survivors vs. 11.9 ± 5.1 in nonsurvivors, p : 0.59 ). Among nonradiologic factors, advanced age p : 0.002 , lower O2 saturation p : 0.01 , diastolic blood pressure p : 0.02 , and hypertension p : 0.03 were more commonly found in nonsurvivors. There was no significant difference between survivors and nonsurvivors in terms of laboratory findings. Three following factors remained significant in the backward logistic regression model: O2 saturation (OR: 0.91 (95% CI: 0.84–0.97), p : 0.006 ), pericardial effusion (6.56 (0.17–59.3), p : 0.09 ), and hypertension (4.11 (1.39–12.2), p : 0.01 ). This model had 78.7% sensitivity, 61.1% specificity, 90.0% positive predictive value, and 75.5% accuracy in predicting in-ICU mortality. Conclusion. A combination of underlying diseases, vital signs, and radiologic factors might have prognostic value for mortality rate prediction in ICU-admitted COVID-19 patients.

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Differences in Morbidity and Mortality with Percutaneous versus Open Surgical Drainage of Postoperative Intra-abdominal Infections: A Review of 686 Cases

The American Surgeon ◽

10.1177/000313481107700720 ◽

2011 ◽

Vol 77 (7) ◽

pp. 862-867 ◽

Cited By ~ 15

Author(s):

Amani D. Politano ◽

Tjasa Hranjec ◽

Laura H. Rosenberger ◽

Robert G. Sawyer ◽

Carlos A. Tache Leon

Keyword(s):

Intensive Care Unit ◽

Multivariate Analysis ◽

Intensive Care ◽

Percutaneous Drainage ◽

Apache Ii ◽

Morbidity And Mortality ◽

Surgical Drainage ◽

Open Drainage ◽

Intensive Care Unit Treatment ◽

Abdominal Infections

Intra-abdominal infections following surgical procedures result from organ-space surgical site infections, visceral perforations, or anastomotic leaks. We hypothesized that open surgical drainage is associated with increased patient morbidity and mortality compared with percutaneous drainage. A single-institution, prospectively collected database over a 13-year period revealed 2776 intra-abdominal infections, 686 of which required an intervention after the index operation. Percutaneous procedures (simple aspiration or catheter placement) were compared with all other open procedures by univariate and multivariate analyses. Analysis revealed 327 infections in 240 patients undergoing open surgical drainage and 359 infections in 260 patients receiving percutaneous drainage. Those undergoing open drainage had significantly higher Acute Physiology Score (APS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores and were more likely to be immunosuppressed, require intensive care unit treatment, and have longer hospital stays. Mortality was higher in the open group: 14.6 versus 4.2 per cent ( P = 0.0001). Variables independently associated with death by multivariate analysis were APACHE II, dialysis, intensive care unit (ICU) care, age, immunosuppression, and drainage method. Open intervention for postsurgical intra-abdominal infections is associated with increased mortality compared with percutaneous drainage even after controlling for severity of illness by multivariate analysis. Although some patients are not candidates for percutaneous drainage, it should be considered the preferential treatment in eligible patients.

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Diagnosis of Pericardial Effusion with a New Generation Hand-Carried Ultrasound Device in Cardiothoracic Intensive Care Unit Patients

Acta Radiologica ◽

10.1258/ar.2012.120343 ◽

2012 ◽

Vol 53 (10) ◽

pp. 1133-1136 ◽

Cited By ~ 5

Author(s):

S Schleder ◽

M Dittmar ◽

F Poschenrieder ◽

C Dornia ◽

C Schmid ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pericardial Effusion ◽

Ultrasound Device ◽

New Generation

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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