scholarly journals Are high flow arteriovenous accesses associated with worse haemodialysis?

2018 ◽  
Vol 40 (2) ◽  
pp. 136-142 ◽  
Author(s):  
Ivo Laranjinha ◽  
Patrícia Matias ◽  
Ana Azevedo ◽  
David Navarro ◽  
Carina Ferreira ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cardiac Output ◽  
Retrospective Study ◽  
Randomized Controlled Trials ◽  
Volume Overload ◽  
Dry Weight ◽  
High Flow ◽  
Controlled Trials ◽  
Bioimpedance Spectroscopy ◽  
Randomized Controlled

ABSTRACT Introduction: An arteriovenous (AV) access flow (Qa) of 400 mL/min is usually sufficient for an effective hemodialysis (HD), but some accesses continue developing and become high flow accesses (HFA). Some authors postulated that an HFA might shift a significant portion of dialyzed blood from the cardiac output, which could decrease HD efficiency and lead to volume overload. Objective: The aim of our study was to evaluate if HFA is associated with reduced HD efficiency and/or volume overload in prevalent HD patients. Methods: We performed a 1-year retrospective study and assessed HD efficiency by the percentage of sessions in which the Kt/V > 1.4 and volume overload by bioimpedance spectroscopy. Results: The study included 304 prevalent HD patients with a mean age of 67.5 years; 62.5% were males, 36.2% were diabetics, with a median HD vintage of 48 months. Sixteen percent of the patients had a HFA (defined as Qa > 2 L/min). In multivariate analysis, patients with HFA presented higher risk of volume overload (OR = 2.67, 95%CI = 1.06-6.71) and severe volume overload (OR = 4.06, 95%CI = 1.01-16.39) and attained dry weight less frequently (OR = 0.37, 95%CI = 0.14-0.94). However, HFA was not associated with lower Kt/V. Conclusion: Our results suggest that patients with HFA have higher risk of volume overload. However, contrarily to what has been postulated, HFA was not associated with less efficient dialysis, measured by Kt/V. Randomized controlled trials are needed to clarify these questions.

scholarly journals High-flow nasal oxygenation reduces the risk of desaturation in adults receiving procedural sedation: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hsin-Yi Liu ◽  
Ka-Wai Tam ◽  
El-Wui Loh ◽  
Wan-Chi Liu ◽  
Hsien-Cheng Kuo ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Oxygen Therapy ◽  
Therapy Group ◽  
Meta Analysis ◽  
High Flow ◽  
Adult Patients ◽  
Procedural Sedation ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Procedural sedation reduces patients’ discomfort and anxiety, facilitating performance of the examination and intervention. However, it may also cause adverse events, including airway obstruction and hypoxia. We conducted this systematic review and meta-analysis to evaluate the efficacy of high-flow nasal oxygenation (HFNO) compared with that of standard oxygen therapy in adult patients undergoing procedural sedation. Methods We identified randomized controlled trials published before November 2020 based on PubMed, Embase, and Cochrane Library databases and ClinicalTrials.gov registry. Intraprocedural desaturation [peripheral oxygen saturation (SpO2) < 90%] was evaluated as the primary outcome. The secondary outcomes were the lowest SpO2, need for airway intervention, oxygen therapy-related complications, and patient, operator, and anesthetist’s satisfaction. Results Six trials with a total of 2633 patients were reviewed. Patients using HFNO compared with standard oxygen therapy had a significantly lower risk of intraprocedural desaturation [risk ratio 0.18, 95% confidence interval (CI) 0.04-0.87]. The lowest intraprocedural SpO2 in HFNO group was significantly higher than that in standard oxygen therapy group (mean difference 4.19%, 95% CI 1.74-6.65). Conclusions Compared with standard oxygen therapy, HFNO may reduce the risk of desaturation and increase the lowest SpO2 in adult patients undergoing sedation for medical procedures.

scholarly journals Bile Duct Injury During Cholecystectomy: Necessity to Learn How to Do and Interpret Intraoperative Cholangiography

2021 ◽  
Vol 8 ◽  
Author(s):  
Niki Christou ◽  
Alexia Roux-David ◽  
David N. Naumann ◽  
Stephane Bouvier ◽  
Thibaud Rivaille ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Retrospective Study ◽  
Bile Duct ◽  
Randomized Controlled Trials ◽  
Biliary Duct ◽  
Controlled Trials ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Randomized Controlled

Introduction: Biliary duct injury (BDI) is a serious complication during cholecystectomy. Perioperative cholangiography (POC) has recently been generating interest in order to prevent BDI. However, the current literature (including randomized controlled trials) cannot conclude whether POC is protective or not against the risk of BDI. The aim of our study was to investigate whether POC could demonstrate earlier BDI and which criteria are required to make that diagnosis.Methods: We performed a retrospective study between 2005 and 2018 in our French tertiary referral center, which included all patients who had presented following BDI during cholecystectomy.Results: Twenty-two patients were included. Nine patients had POC, whereas 13 did not. When executed, POC was interpreted as normal for three patients and abnormal for six. In this latter group, only two cases had a BDI diagnosed intraoperatively. In other cases, the interpretation was not adequate.Conclusion: BDIs are rare but may reduce patients' quality of life. Our study highlights the surgeon's responsibility to learn how to perform and interpret POC in order to diagnose and manage BDIs and potentially avoid catastrophic consequences.

Heated, Humidified High-Flow Nasal Cannulae as a Form of Noninvasive Respiratory Support for Preterm Infants and Children with Acute Respiratory Failure

2016 ◽  
Vol 33 (11) ◽  
pp. 1058-1061 ◽  
Author(s):  
Veronica Mardegan ◽  
Elena Priante ◽  
Elisabetta Lolli ◽  
Paola Lago ◽  
Eugenio Baraldi
Keyword(s):  
Randomized Controlled Trials ◽  
Critically Ill ◽  
Preterm Infants ◽  
Observational Studies ◽  
High Flow ◽  
Infants And Children ◽  
Respiratory Support ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Nasal Cannulae

Heated, humidified high-flow delivered by nasal cannulae (HHHFNC) is increasingly used for noninvasive respiratory support in preterm infants and critically ill children due to its perceived effectiveness and ease of use. Evidence from randomized controlled trials suggests that HHHFNC and continuous positive airway pressure (CPAP) are equally effective as postextubation support in preterm infants. HHHFNC is also used for weaning preterm infants from CPAP. Data on HHHFNC used as the primary support for treating respiratory distress syndrome are conflicting. HHHFNC use in preterm infants is associated with reduced nasal trauma. Inability to measure the pressure generated by HHHFNC systems is a concern because overexpansion can lead to an air leak and lung injury. Great caution is warranted when HHHFNC is used in extremely low-birth-weight infants (who were rarely included in these randomized controlled trials) because a recent retrospective study found its use is associated with a higher likelihood of bronchopulmonary dysplasia or death in this population. HHHFNC has also become popular in pediatric intensive care units and pediatric wards as a method for delivering oxygen and noninvasive respiratory support. Most published studies were conducted on infants and young children with bronchiolitis. The results of a few observational studies and two randomized trials suggest that HHHFNC therapy is effective in the treatment of bronchiolitis. This review discusses the proposed mechanisms of action behind HHHFNC, the results of observational studies, and the evidence emerging from clinical trials on the use of HHHFNC in preterm infants and children critically ill with bronchiolitis.

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