Pericardiocentesis

2015 ◽  
Author(s):  
Gerard Martí Aguasca ◽  
Bruno Garcia del Blanco ◽  
Jaume Sagristà Sauleda
Keyword(s):  
Cardiac Tamponade ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Procedure ◽  
Pericardial Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Optimal Imaging

Cardiac tamponade is a life-threatening condition that may require the urgent removal of pericardial fluid. Therefore, the pericardiocentesis procedure should be part of the skills of physicians treating critically ill patients. The pericardiocentesis technique has evolved from a blind and unguided procedure, prone to complications, to a safer and more effective guided technique by using echocardiography or fluoroscopy. However, as in any invasive procedure, complications still occur. Therefore, indications should be restricted to patients with cardiac tamponade or a high suspicion of specific aetiologies when performed for diagnostic purposes. Accurate indications, optimal imaging assessment, knowledge of materials required, familiarization with different techniques, and rapid recognition of complications are key for a successful procedure.

scholarly journals Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

2021 ◽  
Vol 7 (5) ◽  
pp. 376
Author(s):  
Tobias Lahmer ◽  
Gonzalo Batres Baires ◽  
Roland M. Schmid ◽  
Johannes R. Wiessner ◽  
Jörg Ulrich ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Ascites Fluid ◽  
Candida Spp ◽  
Fungal Peritonitis ◽  
Penetration Ratio ◽  
Threatening Condition ◽  
Liquid Chromatography Tandem Mass ◽  
Life Threatening ◽  
Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

Pleural Diseases in Critical Care Medicine

2019 ◽  
pp. 161-165
Author(s):  
Karthika R. Linga ◽  
Neal M. Patel
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Catheter Placement ◽  
Critical Care Medicine ◽  
Pleural Disease ◽  
Pleural Diseases ◽  
Threatening Condition ◽  
Life Threatening

Pleural disease often affects critically ill patients and is usually related to trauma (including accidental perforation) or infection. Pneumothorax, a potentially life-threatening condition, requires early clinical recognition and sometimes urgent treatment. General intensivists often encounter pneumothorax after a procedure such as catheter placement. Neurointensivists often encounter pneumothorax after polytrauma or recent tunneling of a ventriculoperitoneal catheter.

Cardiac Tamponade

2019 ◽  
pp. 66-75
Author(s):  
Todd Novak ◽  
Silas Hoxie
Keyword(s):  
Cardiac Tamponade ◽  
Early Recognition ◽  
Hemodynamic Instability ◽  
Pericardial Fluid ◽  
Anesthetic Techniques ◽  
Physiological Changes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cardiac Filling

Cardiac tamponade is a life-threatening condition that occurs when accumulating pericardial fluid results in impaired cardiac filling and hemodynamic instability. Most of the clinical features of tamponade are subtle and nonspecific and may not be appreciated until cardiovascular collapse is imminent. Understanding the physiological changes that occur during tamponade are essential for early recognition and intervention. While cardiac tamponade is a clinical diagnosis, echocardiography is the modality of choice in facilitating the prompt identification of extraneous pericardial contents and the determination of the hemodynamic significance. This chapter discusses the presentation, pathophysiology, and echocardiographic signs of tamponade, as well the differential diagnosis and confounding conditions most pertinent to the anesthesiologist. Both medical and surgical management are also addressed, including a review of perioperative and anesthetic techniques.

scholarly journals Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery—A Report of 100 Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Hasan Ali Gumrukcuoglu ◽  
Dolunay Odabasi ◽  
Serkan Akdag ◽  
Hasan Ekim
Keyword(s):  
Surgical Treatment ◽  
Cardiac Tamponade ◽  
Total Mortality ◽  
Invasive Procedure ◽  
Mortality Rates ◽  
Pericardial Fluid ◽  
Complication Rates ◽  
Optimal Method ◽  
First Choice ◽  
Group A

Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes.Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected.Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A.Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates.

Spirituality and Surgery

2019 ◽  
pp. 43-54
Author(s):  
Daniel B. Hinshaw
Keyword(s):  
Nineteenth Century ◽  
Critically Ill ◽  
Spiritual Care ◽  
Critically Ill Patients ◽  
Basic Skills ◽  
Close Connection ◽  
Spiritual Needs ◽  
Human Suffering ◽  
Scientific Medicine ◽  
Life Threatening

Increasing evidence has demonstrated the importance of spirituality and spiritual care for patients with life-threatening illnesses. With the growth of scientific medicine from the nineteenth century, a medical dualism has developed with an intense focus on identifying and treating disease almost to the exclusion of caring for the suffering of the person with the disease. This chapter provides surgeons with an understanding of human suffering and its close connection to spirituality, reviews studies highlighting the importance of spirituality and spiritual care to critically ill patients, and outlines some basic skills surgeons can develop to address the spiritual needs of their patients.

scholarly journals Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

2020 ◽  
Vol 60 ◽  
pp. 328-333 ◽  
Author(s):  
Fahad Faqihi ◽  
Abdulrahman Alharthy ◽  
Mohammed Alodat ◽  
Demetrios J. Kutsogiannis ◽  
Peter G. Brindley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

Blood product therapy in the ICU

2016 ◽  
Author(s):  
Lirong Qu ◽  
Darrell J. Triulzi
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Large Body ◽  
Invasive Procedure ◽  
Transfusion Practice ◽  
Transmission Risk ◽  
Haemostatic Agents ◽  
Circulatory Overload ◽  
Red Cell Transfusion ◽  
Transfusion Guidelines

Transfusions are among the most common medical procedures in the intensive care unit. Several randomized controlled trials (RCT) indicate that restrictive red cell transfusion practice using a haemoglobin of <7g/dL is safe in critically-ill patients. Although similar RCT are not available for plasma or platelet transfusion guidelines, a large body of observational studies suggest that plasma transfusion for an invasive procedure has not been shown to be of benefit in patients with INR <2.0. Similarly, in thrombocytopenic patients, the target platelet count for bleeding or for an invasive procedure is 50,000/µl. Viral transmission risk has become exceedingly low. Other risks such as transfusion-associated circulatory overload and, to a lesser extent, transfusion-related acute lung injury, are much more common. Storage of red cells does not seem to be associated with adverse clinical outcomes. Alternatives using haemostatic agents, salvaged blood, and adherence to evidence-based transfusion guidelines probably reduce the need for transfusion in critically-ill patients.

scholarly journals Cardiac tamponade as a late complication of a minor trauma due to syncope: A case report and literature review

2018 ◽  
Vol 27 (2) ◽  
pp. 103-106 ◽  
Author(s):  
Matteo Guarino ◽  
Alessandra Bologna ◽  
Alfredo De Giorgi ◽  
Michele D Spampinato ◽  
Christian Molino ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cardiac Tamponade ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Late Complication ◽  
Minor Trauma ◽  
Threatening Condition ◽  
Life Threatening ◽  
A Minor

Haemopericardium with cardiac tamponade following minor blunt trauma is a rare, life-threatening condition. The diagnosis of cardiac tamponade as well as therapeutic management may be delayed, since the link between trauma and illness is often overlooked. We report the case of an old woman who developed a relatively delayed cardiac tamponade due to an otherwise minor blunt chest trauma following syncope.

Sign in / Sign up

Export Citation Format

Share Document