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Czarnik T, Gawda R. Enhancing the Cleveland Clinic Score in cardiac surgery. Minerva Anestesiol 2024; 90:239-241. [PMID: 37987996 DOI: 10.23736/s0375-9393.23.17836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland -
| | - Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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Czarnik T, Gawda R. Better prognostication after intensive care unit cardiac arrest. Minerva Anestesiol 2024:S0375-9393.24.18087-X. [PMID: 38506119 DOI: 10.23736/s0375-9393.24.18087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland -
| | - Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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Gawda R, Marszalski M, Piwoda M, Molsa M, Pietka M, Filipiak K, Miechowicz I, Czarnik T. Infraclavicular, Ultrasound-Guided Percutaneous Approach to the Axillary Artery for Arterial Catheter Placement: A Randomized Trial. Crit Care Med 2024; 52:44-53. [PMID: 37548510 DOI: 10.1097/ccm.0000000000006015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To examine whether an ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to an ultrasound-guided cannulation of the common femoral artery for arterial catheter placement in critically ill patients. DESIGN Prospective, investigator-initiated, noninferiority randomized controlled trial. SETTING University-affiliated ICU in Poland. PATIENTS Mechanically ventilated patients with indications for arterial catheter placement. INTERVENTIONS Patients were randomly assigned into two groups. In the axillary group (A group), an ultrasound-guided infraclavicular, in-plane cannulation of the axillary artery was performed. In the femoral group (F group), an ultrasound-guided, out-of-plane cannulation of the common femoral artery was performed. MEASUREMENTS AND MAIN RESULTS A total of 1,079 mechanically ventilated patients were screened, of whom 110 were randomized. The main outcome was the cannulation success rate. The secondary outcomes included the artery puncture success rate, the first-pass success rate, number of attempts required to puncture, and the rate of early mechanical complications. The cannulation success rate in the A group and F group was 96.4% and 96.3%, respectively. The lower limit of 95% CI for the difference in cannulation success rate was above the prespecified noninferiority margin of-7% demonstrating noninferiority of infraclavicular approach. No significant differences were found between the groups in terms of puncture success rate and the rate of early mechanical complications. CONCLUSIONS An ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to the cannulation of the common femoral artery in terms of procedure success rate. We found no significant differences in early mechanical complications between the groups.
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Affiliation(s)
- Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Maciej Marszalski
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Maciej Piwoda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Maciej Molsa
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Marek Pietka
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Kamil Filipiak
- Department of Anesthesiology, Medical Center in Brzeg, Brzeg, Poland
| | - Izabela Miechowicz
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
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Gawda R, Czarnik T. Ultrasound-guided infraclavicular cannulation of the subclavian vein - still an ongoing misconception. J Intensive Care Soc 2023; 24:10. [PMID: 37928077 PMCID: PMC10621521 DOI: 10.1177/1751143720914188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole
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Wetterslev M, Hylander Møller M, Granholm A, Hassager C, Haase N, Lange T, Myatra SN, Hästbacka J, Arabi YM, Shen J, Cronhjort M, Lindqvist E, Aneman A, Young PJ, Szczeklik W, Siegemund M, Koster T, Aslam TN, Bestle MH, Girkov MS, Kalvit K, Mohanty R, Mascarenhas J, Pattnaik M, Vergis S, Haranath SP, Shah M, Joshi Z, Wilkman E, Reinikainen M, Lehto P, Jalkanen V, Pulkkinen A, An Y, Wang G, Huang L, Huang B, Liu W, Gao H, Dou L, Li S, Yang W, Tegnell E, Knight A, Czuczwar M, Czarnik T, Perner A. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Crit Care Med 2023; 51:1124-1137. [PMID: 37078722 DOI: 10.1097/ccm.0000000000005883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN Multicenter, prospective, inception cohort study. SETTING Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Sheila N Myatra
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yaseen M Arabi
- Department of Intensive Care Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jiawei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Maria Cronhjort
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Aneman
- Department of Intensive Care Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Clinical School, University of New South Wales, Warwick Farm, NSW, Australia
| | - Paul J Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Siegemund
- Intensive Care Medicine, Department of Acute Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thijs Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tayyba Naz Aslam
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mia S Girkov
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Mohanty
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Joanne Mascarenhas
- Department of Medicine and Critical Care, Breach Candy Hospital Trust, Mumbai, India
| | - Manoranjan Pattnaik
- Department of Pulmonary Medicine, SCB Medical College & Hospital, Cuttack, India
| | - Sara Vergis
- Department of Anaesthesia and Critical Care, MOSC Medical College, Kolenchery, India
| | | | - Mehul Shah
- Department of Critical Care Medicine, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Ziyokov Joshi
- Department of Cardiac Anaesthesiology and Critical Care, Tagore Hospital, Jalandhar, India
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Lehto
- Department of Anaesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Anni Pulkkinen
- Department of Anesthesia and Intensive Care, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Guoxing Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Huang
- Department of Intensive Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bin Huang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Liu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hengbo Gao
- Department of Critical Care Medicine, The Second Hospital, Hebei Medical University, Hebei, China
| | - Lin Dou
- Department of Intensive Care Medicine, Tianjin First Center Hospital, Tianjin, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Wanchun Yang
- Emergency Intensive Care Unit, Xinjiang Production and Construction Crops 13 div Red Star Hospital
| | - Emily Tegnell
- Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnes Knight
- Department of Anaesthesia and Intensive Care, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Miroslaw Czuczwar
- Second Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Gawda R, Czarnik T. The cephalic vein catheterization: maybe yes, but when there is no alternative. Crit Care 2023; 27:27. [PMID: 36653857 PMCID: PMC9847154 DOI: 10.1186/s13054-023-04321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ryszard Gawda
- grid.107891.60000 0001 1010 7301Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Al. Witosa 26, 45-401 Opole, Poland
| | - Tomasz Czarnik
- grid.107891.60000 0001 1010 7301Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Al. Witosa 26, 45-401 Opole, Poland
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Czarnik T, Gawda R. Searching for a new therapeutic target in sepsis. Minerva Anestesiol 2022; 89:253-255. [PMID: 36511220 DOI: 10.23736/s0375-9393.22.17102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland -
| | - Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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Płonka J, Gawda R, Sacha J, Bugajski J, Brzostowicz T, Molsa M, Czarnik T, Klingel K, Gierlotka M. Fulminant myocarditis and acute heart failure in the light of new American Heart Association 2020 guidelines. Mechanical cardiac support and endomyocardial biopsy. What should be first? Cardiol J 2022; 29:714-717. [PMID: 35762076 PMCID: PMC9273245 DOI: 10.5603/cj.a2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Joanna Płonka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland.
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Poland
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, University of Technology, Opole, Poland
- Department of Cardiology, Opole University Hospital, Poland
| | | | | | - Maciej Molsa
- Department of Anesthesiology and Intensive Care and Regional ECMO Center, Opole University Hospital, Opole, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Poland
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, Germany
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
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Wetterslev M, Møller MH, Granholm A, Hassager C, Haase N, Aslam TN, Shen J, Young PJ, Aneman A, Hästbacka J, Siegemund M, Cronhjort M, Lindqvist E, Myatra SN, Kalvit K, Arabi YM, Szczeklik W, Sigurdsson MI, Balik M, Keus F, Perner A, Huang B, Yan M, Liu W, Deng Y, Zhang L, Suk P, Mørk Sørensen K, Andreasen AS, Bestle MH, Krag M, Poulsen LM, Hildebrandt T, Møller K, Møller‐Sørensen H, Bove J, Kilsgaard TA, Salam IA, Brøchner AC, Strøm T, Sølling C, Kolstrup L, Boczan M, Rasmussen BS, Darfelt IS, Jalkanen V, Lehto P, Reinikainen M, Kárason S, Sigvaldason K, Olafsson O, Vergis S, Mascarenhas J, Shah M, Haranath SP, Van Der Poll A, Gjerde S, Fossum OK, Strand K, Wangberg HL, Berta E, Balsliemke S, Robertson AC, Pedersen R, Dokka V, Brügger‐Synnes P, Czarnik T, Albshabshe AA, Almekhlafi G, Knight A, Tegnell E, Sjövall F, Jakob S, Filipovic M, Kleger G, Eck RJ. Management of acute atrial fibrillation in the intensive care unit: An international survey. Acta Anaesthesiol Scand 2022; 66:375-385. [PMID: 34870855 DOI: 10.1111/aas.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. METHOD We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. RESULTS A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. CONCLUSION This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tayyba Naz Aslam
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Jiawei Shen
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Paul J. Young
- Intensive Care Specialist and co‐Director, Intensive Care Unit Wellington Hospital Wellington New Zealand
- Intensive Care Programme Director Medical Research Institute of New Zealand Wellington New Zealand
- Australian and New Zealand Intensive Care Research Centre Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anders Aneman
- Department of Intensive Care Medicine Liverpool Hospital South Western Sydney Local Health District and South Western Sydney Clinical School University of New South Wales Sydney Australia
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Intensive Care Medicine Department of Clinical Research University Hospital Basel and University of Basel Basel Switzerland
| | - Maria Cronhjort
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Sheila N. Myatra
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Yaseen M. Arabi
- Department of Intensive Care Medicine Ministry of National Guard Health Affairs King Saud bin Abdulaziz University for Health Sciences King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Martin I. Sigurdsson
- Division of Anaesthesia and Intensive Care Perioperative Services at Landspitali The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Martin Balik
- Department of Anesthesiology and Intensive Care 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic
| | - Frederik Keus
- Department of Critical Care University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Czarnik T, Gawda R. Massively bleeding trauma patient: intervene but not too late. Minerva Anestesiol 2022; 88:112-113. [PMID: 35072440 DOI: 10.23736/s0375-9393.21.16248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland -
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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Tycińska A, Grygier M, Biegus J, Czarnik T, Dąbrowski M, Depukat R, Gierlotka M, Gil M, Hawranek M, Hirnle T, Jemielity M, Kapelak B, Kralisz P, Kuliczkowski W, Kuśmierczyk M, Ligowski M, Łopatowska P, Puślecki M, Świątkowski A, Trzeciak P, Zawiślak B, Zembala M, Zymliński R. Mechanical circulatory support. An expert opinion of the Association of Intensive Cardiac Care and the Association of Cardiovascular Interventions of the Polish Cardiac Society. Kardiol Pol 2021; 79:1399-1410. [PMID: 34861044 DOI: 10.33963/kp.a2021.0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022]
Abstract
Mechanical circulatory support (MCS) methods are used in patients with both acute and chronic heart failure, who have exhausted other options for pharmacological or surgical treatments. The purpose of their use is to support, partially or completely, the failed ventricles and ensure adequate organ perfusion, which allows patients to restore full cardiovascular capacity, prolonging their life and effectively improving its quality. The three most popular devices include an intra-aortic balloon pump (IABP), percutaneous assist devices (including Impella, TandemHeart), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A multidisciplinary approach with the special participation of the Heart Team is required to determine the proper MCS strategy, the choice of the supporting method, and the time of its use. The studies published so far do not allow us to determine which MCS method is the safest and the most effective. Thus, the site experience and accessibility of the method seem to matter most today. MCS finds particular application in patients with acute coronary syndromes complicated by refractory cardiogenic shock, as well as in patients with acute heart failure of the high potential for reversibility. It can also serve as a backup for percutaneous coronary interventions of high risk (complex and high-risk indicated percutaneous coronary intervention [PCI], complex and high-risk indicated PCI [CHIP]). The use of appropriate supportive drugs, precise hemodynamic and echocardiographic monitoring, as well as optimal non-invasive or mechanical ventilation, are extremely important in the management of a patient with MCS. The most serious complications of MCS include bleeding, thromboembolic events, as well as infections, and hemolysis.
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Affiliation(s)
- Agnieszka Tycińska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland.
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Rafał Depukat
- Department of Anesthesiology and Intensive Care, University Hospital, Kraków, Poland
| | - Marek Gierlotka
- Department of Cardiology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Monika Gil
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Michał Hawranek
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Hirnle
- Department of Cardiac Surgery, Medical University of Bialystok, Białystok, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Bogusław Kapelak
- John Paul II Hospital, Kraków, Poland.,Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Kralisz
- Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | | | | | - Marcin Ligowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Paulina Łopatowska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Mateusz Puślecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland.,Department of Medical Rescue, Poznan University of Medical Sciences, Poznań, Poland
| | - Andrzej Świątkowski
- Intensive Cardiac Care Unit, 1st Department of Cardiology and Angiology, Silesian Center of Heart Diseases, Zabrze, Poland
| | - Przemysław Trzeciak
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Barbara Zawiślak
- Intensive Cardiac Care Unit, University Hospital, Kraków, Poland
| | - Michał Zembala
- Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland.,Pomeranian Medical University, Szczecin, Poland
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
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Czarnik A, Gawda R, Piwoda M, Marszalski M, Molsa M, Pietka M, Bolanowski M, Czarnik T. Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study. Endokrynol Pol 2021; 72:329-335. [PMID: 34010434 DOI: 10.5603/ep.a2021.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
Introduction Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure, undergoing CRRT by performing periodic PTH measurements in the acute phase of critical illness. Material and methods Single center, prospective, observational study conducted in an mixed, university affiliated, intensive care unit. Critically ill patients were included who fulfilled all of the following criteria: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dl; total ionized calcium plasma level > 1.35 mmol/l); parathyroid gland disease, end-stage renal disease, patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures, aged under 18 years, pregnant, life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator. Results Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p=0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5-8 relative to measurement 1, measurements 4-8 relative to measurement 2 (p.
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Affiliation(s)
- Aneta Czarnik
- Department of Endocrinology, Voivodeship Hospital in Opole, Poland
| | - Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole
| | - Maciej Piwoda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole
| | - Maciej Marszalski
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole
| | - Maciej Molsa
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Opole University Hospital
| | - Marek Pietka
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Opole University Hospital
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University
| | - Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole.
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Piwowarczyk P, Borys M, Kutnik P, Szczukocka M, Sysiak-Sławecka J, Szułdrzyński K, Ligowski M, Drobiński D, Czarnik T, Czuczwar M. Unfractionated Heparin Versus Subcutaneous Nadroparin in Adults Supported With Venovenous Extracorporeal Membrane Oxygenation: a Retrospective, Multicenter Study. ASAIO J 2021; 67:104-111. [PMID: 32404610 DOI: 10.1097/mat.0000000000001166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) requires constant management of coagulation. Whereas unfractionated heparin remains the anticoagulant of choice, experienced centers report high bleeding rates. Biocompatibility of the extracorporeal circuit enables management of anticoagulation with subcutaneous low-molecular-weight heparins only. The aim of this study was to evaluate the safety and feasibility of anticoagulation with subcutaneous nadroparin compared with unfractionated heparin during respiratory ECMO in patients. We assessed for thrombotic complications and number of bleeding and life-threatening bleeding events. Additionally, we evaluated the change in resistance to flow in the oxygenator and the number of transfused blood products. Nadroparin and unfractionated heparin were comparable in terms of number of bleeding (34 vs. 53%; p = 0.12), life-threatening bleeding (2.8 vs. 9.3%; p = 0.26) events, and daily red blood cell transfusion rates (0.79 units/patient/day vs. 0.71 units/patient/day in nadroparin group; p = 0.87) during respiratory ECMO. The relative change in resistance to flow in the oxygenator was similar between groups (8.03 vs. 11.6%; p = 0.27). Nadroparin seemed equivalent to unfractionated heparin in the number of thrombotic and hemorrhagic events as well as in the daily red blood cell transfusion rates during venovenus-ECMO.
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Affiliation(s)
- Paweł Piwowarczyk
- From the II Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Michał Borys
- From the II Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Paweł Kutnik
- Student's Scientific Association at II Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Marta Szczukocka
- From the II Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Justyna Sysiak-Sławecka
- From the II Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | | | - Marcin Ligowski
- Department of Anesthesiology and Intensive Care, Medical University of Poznan, Poznan, Poland
| | - Dominik Drobiński
- Department of Anesthesiology and Intensive Care, Central Clinical Hospital in Warsaw, Warsaw, Poland; and
| | - Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, Opole University, Opole, Poland
| | - Mirosław Czuczwar
- From the II Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
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Czarnik T, Gawda R. Indications for ECMO: we need to look at the patient first. Minerva Anestesiol 2020; 87:147-149. [PMID: 33325221 DOI: 10.23736/s0375-9393.20.15136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland -
| | - Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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Darocha T, Podsiadło P, Polak M, Hymczak H, Krzych Ł, Skalski J, Witt-Majchrzak A, Nowak E, Toczek K, Waligórski S, Kret A, Drobiński D, Barteczko-Grajek B, Dąbrowski W, Lango R, Horeczy B, Romaniuk T, Czarnik T, Puślecki M, Jarmoszewicz K, Sanak T, Gałązkowski R, Drwiła R, Kosiński S. Prognostic Factors for Nonasphyxia-Related Cardiac Arrest Patients Undergoing Extracorporeal Rewarming - HELP Registry Study. J Cardiothorac Vasc Anesth 2020; 34:365-371. [DOI: 10.1053/j.jvca.2019.07.152] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 11/11/2022]
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Gawda R, Marszalski M, Molsa M, Piwoda M, Pietka M, Gawor M, Mielnicki W, Dyla A, Czarnik T. Implementation of veno-venous extracorporeal membrane oxygenation in a COVID-19 convalescent. Anaesthesiol Intensive Ther 2020; 52:253-255. [PMID: 32876414 PMCID: PMC10172959 DOI: 10.5114/ait.2020.97956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Maciej Marszalski
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Maciej Molsa
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Maciej Piwoda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Marek Pietka
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Maciej Gawor
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, University Hospital, Opole, Poland
| | - Wojciech Mielnicki
- Anaesthesiology and Intensive Care Unit, District Hospital in Olawa, Poland
| | - Agnieszka Dyla
- Anaesthesiology and Intensive Care Unit, District Hospital in Olawa, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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Czarnik A, Czarnik T, Kapłon R, Bolanowski M. [Trends in parathyroid hormone plasma concentration in critically ill patients: prospective observational study]. Wiad Lek 2019; 72:40-46. [PMID: 30796860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Introduction: There is no data in the literature regarding trends in parathormone serum concentration assessment in critically ill patients. The aim: To assess the parathyroid hormone plasma concentrations and kinetics in critically ill patients admitted to the intensive care unit due to multiorgan failure. PATIENTS AND METHODS Materials and methods: Thirty multiorgan failure (at least circulatory and respiratory failure) patients were included. Patients who met any of the following criteria were excluded: acute liver failure, end stage renal disease, hypercalcemia, parathyroid gland disease, severe vitamin D deficiency, admission from another ICU or readmission, age younger than 18 years, or lack of consent from relatives. We performed the parathyroid hormone plasma measurements in 12-hour time intervals. RESULTS Results: The initial parathyroid hormone plasma concentration levels in the study group were rather variable and medians exceeded laboratory reference values. Especially in the acute kidney injury subpopulation treated with continuous renal replacement therapy these trends were emphasized. The initial parathyroid hormone plasma concentration levels in this group significantly exceeded laboratory reference values in 80% of patients. After initial spike we observed subsequent drop between second and third measurement. The distribution of plasma levels was rather variable between second and third measurement in this group of patients. CONCLUSION Conclusions: The parathyroid hormone plasma concentration levels in the critically ill patients are variable. In the acute kidney injury subpopulation treated with continuous renal replacement therapy after initial significant spike we observed subsequent drop between second and third measurement.
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Affiliation(s)
- Aneta Czarnik
- Oddział Endokrynologii, Szpital Wojewódzki w Opolu, Opole, Polska
| | - Tomasz Czarnik
- Oddział Anestezjologii i Intensywnej Terapii, Uniwersytecki Szpital Kliniczny w Opolu, Opole, Polska
| | - Robert Kapłon
- Wydział Informatyki i Zarządzania, Politechnika Wrocławska, Wrocław, Polska
| | - Marek Bolanowski
- Katedra i Klinika Endokrynologii, Diabetologii i Leczenia Izotopami, Uniwersytet Medyczny we Wrocławiu, Wrocław, Polska
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Czarnik T, Czarnik A, Gawda R, Gawor M, Piwoda M, Marszalski M, Maj M, Chrzan O, Said R, Rusek-Skora M, Ornat M, Filipiak K, Stachowicz J, Kaplon R, Czuczwar M. Vitamin D kinetics in the acute phase of critical illness: A prospective observational study. J Crit Care 2017; 43:294-299. [PMID: 28968524 DOI: 10.1016/j.jcrc.2017.09.179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/14/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this study was to assess the vitamin D kinetics in critically ill patients by performing periodic serum vitamin D measurements in short time intervals in the initial phase of a critical illness. MATERIALS AND METHODS We performed vitamin D serum measurements: at admission and then in 12-hour time intervals. The minimum number of vitamin D measurements was 4, and the maximum was 8 per patient. RESULTS A total of 363 patients were evaluated for participation, and 20 met the inclusion criteria. All patients had an initial serum vitamin D level between 10.6 and 39ng/mL. Nineteen patients had vitamin D levels between 10 and 30ng/mL, which means that they had vitamin D insufficiency or deficiency, and only one patient had a normal vitamin D serum plasma level. We observed that the median of the vitamin D level decreases until the fourth measurement then stabilizes around the 4th and 5th measurement and then appears to increase unevenly. The highest drop is at the very beginning. CONCLUSIONS The vitamin D serum level is changeable in the initial phase of a critical illness. We hypothesize that the serum vitamin D concentration can mirror the severity of illness.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland.
| | - Aneta Czarnik
- Department of Endocrinology, Szpital Wojewodzki w Opolu, ul. Kosnego 53, 45-372 Opole, Poland
| | - Ryszard Gawda
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Maciej Gawor
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Maciej Piwoda
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Maciej Marszalski
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Magdalena Maj
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Olimpia Chrzan
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Rahim Said
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Maja Rusek-Skora
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Marta Ornat
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Kamil Filipiak
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Jakub Stachowicz
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Robert Kaplon
- Department of Operations Research, Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Miroslaw Czuczwar
- 2nd Department of Anesthesiology and Critical Care, Medical University of Lublin, ul. Staszica 16, 20-081 Lublin, Poland
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Gawda R, Czarnik T, Łysenko L. Infraclavicular access to the axillary vein - new possibilities for the catheterization of the central veins in the intensive care unit. Anaesthesiol Intensive Ther 2016; 48:360-366. [PMID: 27869288 DOI: 10.5603/ait.a2016.0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022] Open
Abstract
Central vein cannulation is one of the most commonly performed procedures in intensive care. Traditionally, the jugular and subclavian vein are recommended as the first choice option. Nevertheless, these attempts are not always obtainable for critically ill patients. For this reason, the axillary vein seems to be a rational alternative approach. In this narrative review, we evaluate the usefulness of the infraclavicular access to the axillary vein. The existing evidence suggests that infraclavicular approach to the axillary vein is a reliable method of central vein catheterization, especially when performed with ultrasound guidance.
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Affiliation(s)
- Ryszard Gawda
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Poland.
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Czarnik T, Gawda R, Nowotarski J. Real-time ultrasound-guided infraclavicular axillary vein cannulation: A prospective study in mechanically ventilated critically ill patients. J Crit Care 2016; 33:32-7. [PMID: 26993368 DOI: 10.1016/j.jcrc.2016.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/16/2016] [Accepted: 02/22/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The main purpose of this study was to define the venipuncture and catheterization success rates and early mechanical complication rates of ultrasound-guided infraclavicular axillary vein cannulation. MATERIALS AND METHODS We performed in-plane, real-time, ultrasound-guided infraclavicular axillary vein catheterizations under emergency and nonemergency conditions in mechanically ventilated, critically ill patients. RESULTS We performed 202 cannulation attempts. One hundred and twenty-six procedures (62.4%) were performed under emergency conditions. The puncture of the axillary vein was successful in 98.5% of patients, and the entire procedure success rate was 95.1% (95% confidence interval, 91.1%-97.6%). For the majority of patients (84.1%; P<.001, exact test), the venipuncture occurred during the first attempt. We noted a 22.4% overall complication rate, and most of the complications were malpositions (13.4%). We observed 8.5% of cases with potentially serious complications (puncture of the axillary artery and needle contact with the brachial plexus) and 1 case (0.5%) of pneumothorax. The puncture of the axillary artery occurred in 5 (2.5%) patients. CONCLUSIONS In-plane, real-time, ultrasound-guided, infraclavicular axillary vein cannulation in mechanically ventilated, critically ill patients is a safe and reliable method of central venous cannulation and can be considered to be a reasonable alternative to other central venous catheterization techniques.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418, Opole, Poland.
| | - Ryszard Gawda
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418, Opole, Poland
| | - Jakub Nowotarski
- Department of Operations Research, Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
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Czarnik T, Gawda R, Nowotarski J. Real-time, ultrasound-guided infraclavicular axillary vein cannulation for renal replacement therapy in the critical care unit—A prospective intervention study. J Crit Care 2015; 30:624-8. [PMID: 25697988 DOI: 10.1016/j.jcrc.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/14/2014] [Accepted: 01/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The cannulation of the axillary vein for renal replacement therapy is a rarely performed procedure in the critical care unit. We defined the venipuncture and catheterization success rates and early mechanical complication rates of this technique in critical care patients with acute kidney injury. MATERIALS AND METHODS Twenty-nine mechanically ventilated patients with clinical indications for insertion of temporary hemodialysis catheters enrolled in a registered trial (NCT01919528) as a pilot cohort. We performed 29 real-time, ultrasound-guided infraclavicular axillary vein cannulation attempts for renal replacement therapy. We defined the venipuncture and catheterization success rates and early mechanical complication rates for this technique. RESULTS The puncture of the axillary vein was successful in 28 (96.5%) patients. In 22 patients (75.9%), venipuncture occurred during the first attempt and in 6 patients during the second (20.7%). The overall cannulation success rate was 93.1% (95% confidence interval, 77%-99%). We noted 6.8% potentially serious complications rate, 10.3% minor complications rate, and 0% life-threatening early mechanical complications. We achieved an 89.6% renal replacement therapy success rate and low rate of catheters malfunction. CONCLUSIONS Real-time, ultrasound-guided, infraclavicular axillary vein cannulation for renal replacement therapy in the critical care unit is a reliable method of dual-lumen hemodialysis catheter insertion and can be considered a reasonable alternative to jugular and femoral routes in special clinical circumstances.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland.
| | - Ryszard Gawda
- Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland
| | - Jakub Nowotarski
- Department of Operations Research, Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
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Czarnik T, Gawda R, Kolodziej W, Latka D, Sznajd-Weron K, Weron R. Associations between intracranial pressure, intraocular pressure and mean arterial pressure in patients with traumatic and non-traumatic brain injuries. Injury 2009; 40:33-9. [PMID: 19135194 DOI: 10.1016/j.injury.2008.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 10/02/2008] [Accepted: 10/08/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anatomical proximity of the eye and the intracranial space is a fact but the existence of physiological and pathophysiological relationships between them is elusive. The objective of this study was to explore anatomical and pathophysiological interactions between the eye and the intracranial space and to assess clinical utility of intraocular pressure measurement in estimation of intracranial pressure in patients with brain injuries and to discover how haemodynamic instability could influence these interactions. Controversy surrounds the recent literature concerning this problem and the consensus has not been achieved. MATERIALS AND METHODS We evaluated the correlation between intracranial pressure and intraocular pressure, intracranial pressure and mean arterial pressure, intraocular pressure and mean arterial pressure in 40 patients with brain injuries initially comatose, admitted to our hospital. All patients required the intracranial pressure monitoring on clinical grounds. Simultaneous recordings of intracranial pressure, intraocular pressure and mean arterial pressure were performed. RESULTS We calculated both the linear correlation coefficient and the Spearman rank-order correlation coefficient for all three relations. We found significant correlation between intraocular pressure and mean arterial pressure in 63% of the tested population. When the power of the test was increased, by considering only patients with 11 or more observations, this ratio increased to 76%. However, the correlation between intraocular pressure and intracranial pressure, as well as, between intracranial pressure and mean arterial pressure was not significant. CONCLUSIONS There is no anatomical and pathophysiological basis for the statement that intraocular pressure can be used as an indirect estimator of intracranial pressure.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anaesthesia and Critical Care, Regional Medical Centre, Aleja Witosa 26, 45-418 Opole, Poland.
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Abstract
BACKGROUND Some publications suggest a strong correlation between the intracranial pressure and the intraocular pressure. Other studies claim no correlation between these two physiologic variables. Our aim was to study whether the tonometry could be a useful method to evaluate intracranial pressure in patients with suspected intracranial abnormality. METHODS We evaluated the correlation between the intracranial pressure and the intraocular pressure, the intracranial pressure and the mean arterial pressure, and the intraocular pressure and the mean arterial pressure in 22 patients, initially comatose, who were admitted to our hospital. All patients required the intracranial pressure monitoring on clinical grounds. Simultaneous measurements were performed and recorded. RESULTS We calculated both the linear correlation coefficient and the Spearman rank-order correlation coefficient. We found significant correlation between the intraocular pressure and the mean arterial pressure in 12 patients; however, significant correlation between the intraocular pressure and the intracranial pressure was found in only 2 patients. CONCLUSION Tonometry is not an appropriate method for the assessment of intracranial pressure increases.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesia and Critical Care, Regional Medical Center, Opole, Poland.
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Czarnik T, Czarnik B. 2000 Reviewers. J Comb Chem 2000; 2:12. [PMID: 27518112 DOI: 10.1021/cc000087k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Czarnik T, Skapska-Bielecka A, Skolicki Z. [2 cases of cervical pregnancy]. Pol Tyg Lek 1975; 30:1963-4. [PMID: 1197074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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