Cardiac tamponade complicating central venous catheterization for total parenteral nutrition: A review

Complications of care in a pediatric intensive care unit: a prospective study

OBJECTIVES

(a) To examine the frequency, type, and severity of complications occurring in a pediatric intensive care unit; (b) to identify populations at risk; and (c) to study the impact of complications on morbidity and mortality.

DESIGN

Prospective survey.

SETTING

Pediatric intensive care unit (PICU) of a university-affiliated hospital.

PATIENTS

1035 consecutive admissions over an 18-month period.

RESULTS

115 complications occurred during 83 (8.0%) admissions, for 2.7 complications per 100 PICU-days; 48 (42%) complications were major, 45 (39%) moderate, and 22 (19%) minor. Sixty complications (52%) were ventilator-related, 14 were drug-related, 13 procedure-related, 24 infectious, and 22 involved invasive devices (18 vascular catheters). Human error was involved in 41 (36%) cases, 21 of which were major (18%). Treatments included reintubation < 24 h (28), intravenous antimicrobials (24), and invasive bedside procedures (14). Cardiopulmonary resuscitation was required in 6 patients. Thirteen patients with complications died (15.7%); 2 deaths were directly due to complications. Patients with complications were younger, had longer lengths of stay, and had a higher mortality. Length of stay was a positive risk factor for complication risk (odds ratio = 1.09, 95% confidence interval: 1.05 to 1.13; p = 0.0001); other patient characteristics had no predictive effect. Kaplan-Meier estimates showed that the most severe complications occurred early in the PICU stay. The best indicators of patient mortality were number of complications (odds ratio = 2.96, 95% confidence interval 1.72 to 5.08; p = 0.0001), and mortality risk derived from the Pediatric Risk of Mortality Score (odds ratio = 1.08, 95% confidence interval 1.06 to 1.10; p = 0.0001). Mortality was correlated with increasing severity of complications.

CONCLUSION

Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PICU course, when the number of interventions may be greatest. Complications may increase patient mortality and predict patient death better than other patient variables.

Hydrothorax After Inadvertent Placement of a Central Venous Catheter in the Left Pericardiophrenic Vein

Angiography has a central role In both diagnosis and therapy of traumatic vascular injuries from blunt and penetrating mechanisms. Angiography is considered the “gold standard” for establishing the presence of vascular injury, but precise indications and appropriate timing of angiography in certain clinical situations, such as proximity injury to the extremities or penetrating neck injuries, remain controversial. We consider the role of angiography in the diagnosis of major arterial injury in the thorax, selective use of diagnostic and therapeutic angiography for intraabdominal trauma, identification and control of pelvic hemorrhage, and detection of vascular injury of the head, neck, and extremities.