Gunshot model of junctional femoral artery hemorrhage in swine under ultrasonic guidance

Background In a combat setting, uncontrolled junctional hemorrhage constitutes a major source of potentially preventable deaths. It is very important to establish a model of massive hemorrhage of gunshot wound at junction area which can simulate field rescue conditions. Methods Picco monitoring was instrumented for the anesthetized Landrace pigs, and the right femoral artery was located by portable ultrasound. The pistol bullet hit the right femoral artery, resulting in an artery rupture. After 30 seconds of uncontrolled hemorrhage, the ballistic wound was filled with combat gauze (QuikClot) to stop bleeding in the BT group (n = 10). Combat gauze was used to stop bleeding when the mean arterial pressure (MAP) decreased by 30% in the MD group (n = 10). The sham-operated pigs (n = 10) underwent the same anesthetic and surgical procedures, but neither shooting nor gauze filling therapy was performed. Blood samples were taken 15 min before injury, and then 10 min, 30 min, and 60 min after the injury. Results Histologic anatomy indicated that the right femoral artery and vein were completely ruptured in all 20 swine of MD and BT groups. The blood loss of pre-tamponade (4.97 ± 2.47 mL/kg vs 18.26 ± 3.47 mL/kg, P < 0.001), pro-tamponade (4.58 ± 1.49 mL/kg vs 7.20 ± 1.99 mL/kg, P = 0.004) and the total amount of bleeding (9.54 ± 3.80 mL/kg vs 25.46 ± 3.68 mL/kg, P < 0.001) in MD group were more than those in BT group. There were differences in body temperature, PH, PT, LAC of MD group compared with BT and SHAM groups 60 minutes after injury (all P < 0.0167). The survival time of MD group was shorter than that of BT group (P = 0.029). Conclusion We established a reliable gunshot model of junctional hemorrhage in swine, which had high accuracy for femoral arterial rupture under ultrasonic guidance and provided consistent and reproducible field-simulation conditions. In this junctional hemorrhage model, blood loss of 30-second free bleeding did not meet the criteria for shock. The MAP decrease of 30% emerged as a better predictor of a successful shock model.

The fluid management and hemodynamic characteristics of PiCCO employed on young children with severe hand, foot, and mouth disease—a retrospective study

Background Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which is particularly common in preschool children. Severe HFMD is prone to cause pulmonary edema before progressing to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important to the treatment process. Methods We did a review of young patients who had been successfully treated in our department for severe HFMD, which had been caused by EV71. A total of 20 patients met the inclusion criteria. Eight cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group (8 patients) and the control group (12 patients). The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve patients’ clinical outcomes. Results After analysis, the findings informed that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or lower the number of cases which required mechanical ventilation, PiCCO did reduce the incidence of fluid overload (p = 0.085) and shorten the days of mechanical ventilation (p = 0.028). After effective treatment, PiCCO monitoring indicated that the cardiac index (CI) increased gradually(p < 0.0001), in contrast to their pulse (P, p < 0.0001), the extra vascular lung water index (EVLWI, p < 0.0001), the global end diastolic volume index (GEDVI, p = 0.0043), and the systemic vascular resistance index (SVRI, p < 0.0001), all of which decreased gradually. Conclusion Our study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has some potential benefits, such as reducing fluid overload and the duration of mechanical ventilation. However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.

The fluid management and hemodynamic characteristics of PiCCO employed on young children with severe Hand, Foot, and Mouth Disease—a retrospective study

Background Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which are particularly common in preschool children. Severe HFMD is prone to cause pulmonary edema, and successively progresses to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important in the treatment process. Methods We reviewed young patients with severe HFMD, caused by EV71, and who had been successfully treated in our department. A total of 20 patients met the inclusion criteria. Eight cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group (8 patients) and the control group (12 patients). The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve the clinical outcomes. Results After analysis, the findings were that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or reduce the number of cases which needed mechanical ventilation, it did reduce the incidence of fluid overload (p=0.085) and shortened the days of mechanical ventilation (p=0.028). After effective treatment, PiCCO monitoring showed that the cardiac index (CI) increased gradually(p<0.0001), whereas the pulse (P, p<0.0001), the extra vascular lung water index (EVLWI, p<0.0001), the global end diastolic volume index (GEDVI, p=0.0043), and the systemic vascular resistance index (SVRI, p<0.0001) all decreased gradually. Conclusion Our study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has potential clinical benefits, such as reducing fluid overload and duration of mechanical ventilation. However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.

The Fluid Management and Hemodynamic Characteristics of PiCCO Employed on Young Children with Severe Hand, Foot, and Mouth Disease—A Retrospective Study

Background Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which are particularly common in preschool children. Severe HFMD is prone to pulmonary edema, and successively progresses to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important in the treatment process. Methods We reviewed young patients with severe HFMD, caused by EV71, and who had been successfully treated in our department. A total of 20 patients met the inclusion criteria. Some cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group and the control group. The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve the clinical outcomes. Results After analysis, the findings were that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or reduce the number of cases which needed mechanical ventilation, it did reduce the incidence of fluid overload and shortened the days of mechanical ventilation. After effective treatment, PiCCO monitoring showed that the cardiac index (CI) increased gradually(p<0.0001), whereas the pulse (P, p<0.0001), the extra vascular lung water index (EVLWI, p<0.0001), the global end diastolic volume index (GEDVI, p=0.0043), and the systemic vascular resistance index (SVRI, p<0.0001) all decreased gradually. ConclusionOur study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has potential clinical benefits which can reduce fluid overload(p=0.085) and duration of mechanical ventilation(p=0.028). However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.

Clinical significance of pulse index contour continuous cardiac output monitoring in patients with constrictive pericarditis undergoing pericardiectomy

OBJECTIVES The efficacy of pulse index contour continuous cardiac output (PiCCO) monitoring in patients with constrictive pericarditis undergoing pericardiectomy remains unclear. The goal of this study was to explore whether PiCCO monitoring could improve clinical outcomes in these patients. METHODS We retrospectively studied 74 patients with constrictive pericarditis undergoing pericardiectomy and assigned them to a PiCCO group and a control group. Postoperative and survival outcomes were compared between the 2 groups. RESULTS There were 33 (44.6%) cases in the PiCCO group and 41 (55.4%) cases in the control group. The baseline characteristics were comparable between the 2 groups. In comparison to the control group, the PiCCO group showed more intraoperative fluid infusion (P = 0.003), higher postoperative central venous pressure (P = 0.007) and lower levels of postoperative brain natriuretic peptide (P = 0.021). The incidence of postoperative complications (P = 0.004) including cardiac complications (P = 0.033) was also lower in the PiCCO group. Despite no difference in survival outcomes, duration of chest drainage (P = 0.032), length of stay in the intensive care unit (P &lt; 0.001) and the postoperative hospital stay (P = 0.044) were significantly shorter in the PiCCO group. CONCLUSIONS This study confirmed the clinical significance of PiCCO monitoring in the enhanced recovery of patients with constrictive pericarditis undergoing pericardiectomy and provided new evidence for applying PiCCO monitoring in these patients.