Background Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 μg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]).
Methods Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 μg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded.
Results No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau.
Conclusions For patients under general anesthesia receiving dopamine at 10 μg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.
Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.
A 57-year-old female with lumbar spinal stenosis at L4-S1 was scheduled to undergo posterolateral interbody fusion.
Intubation with a 7.0 size ID cuffed reinforced tracheal tube (Mallinckrodt(TM), Mallinckrodt Medical Atholen, Ireland) was uncomplicated, and any air leakage was not detected at that time. Two hours after the start of operation, an air leak was apparent at the trachea during ventilation in the prone position. Closer inspection of the inflation tube and pilot balloon showed that the pilot balloon had become detached. Because she was being operated on in the prone position, and ventilation was only possible at a less than optimal state, we attempted to fix this without having to reintubate the patient's trachea. Our solution involved inserting a 21-gauge needle into the inflation tube and a handheld aneroid manometer was then connected to it. The tube cuff was thereafter inflated up to a pressure of 20 cmH2O. In conclusion, careful manipulation is recommended when performing intubation and a needle connector may help secure the airway if the pilot balloon becomes detached during the procedure.
BACKGROUND Nutritional support is important in intensive care for critically ill patients in an effort to decrease the mortality and morbidity. This study was conducted to evaluate the propriety of nutritional support and to understand the effect of a nutrition consultationin critically ill patients to assess and analyze nutritional status. METHODS Between January and December 2006, patients who were admitted to the intensive care unit (ICU) > or = 7 days and between 20 and 80 years of age were included. Patients transferred to another hospital, patients discharged against medicine advice, and patients with unknown weight were excluded. Two hundred sixty-two patients were enrolled. The demographic data of patients and the state of nutritional support were reviewed by medical records. RESULTS Two hundred sixty-two patients stayed in the ICU a mean of 16.0 +/- 9.8 days and received nutrition support for 11.0 +/- 8.4 days. Except 15 patients who did not receivenutritional support, the mean daily calculated caloric requirement of 247 patients was 1,406.2 +/- 253.8 kcal, the mean daily delivered caloric amount was 899.5 +/- 338.7 kcal, and the total delivered/required caloric ratio was 66.4 +/- 28.1%. The total delivered/required caloric ratio of the patients who received a nutritional consultation and the patients who did not receive nutritional consultation were 72.6 +/- 25.8% and 55.9 +/- 33.3%. CONCLUSIONS In this study, we identified that critically ill patients received insufficient nutritional support. We recommend continuous monitoring and management for nutritional support by systematic administration of nutritional support teams.
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