Over the past two decades, ultrasound (US) has become widely accepted to guide safe and accurate insertion of vascular devices in critically ill patients. We emphasize central venous catheter ...insertion, given its broad application in critically ill patients, but also review the use of US for accessing peripheral veins, arteries, the medullary canal, and vessels for institution of extracorporeal life support. To ensure procedural safety and high cannulation success rates we recommend using a systematic protocolized approach for US-guided vascular access in elective clinical situations. A standardized approach minimizes variability in clinical practice, provides a framework for education and training, facilitates implementation, and enables quality analysis. This review will address the state of US-guided vascular access, including current practice and future directions.
There is a lack of standard minimal requirements for the training of insertion techniques and maintenance of central venous access devices (CVADs). An international evidence-based consensus task ...force was established through the World Congress of Vascular Access (WoCoVA) to provide definitions and recommendations for training and insertion of CVADs. Medical literature published from February 1971 to April 2012 regarding ‘central vascular access', ‘training', ‘competency', ‘simulation', and ‘ultrasound' was reviewed on Pubmed, BioMed Central, ScienceDirect, and Scopus databases. The GRADE and the GRADE-RAND methods were utilized to develop recommendations. Out of 156 papers initially identified, 83 papers described training for central vascular access placement. Sixteen recommendations are proposed by this task force, each with an evidence level, degree of consensus, and recommendation grade. These recommendations suggest central venous access education include didactic or web-based teaching with insertion procedure, infection prevention, complications, care, and maintenance of devices, along with laboratory models and tools for simulation practice incorporating ultrasound. Clinical competence should be determined by observation during clinical practice using a global rating scale rather than by the number of procedures performed. Ensuring safe insertion and management of central venous devices requires standardized education, simulation practice, and supervised insertions.
Abstract
In this paper we propose multispectrum rotational states distribution thermometry as an optical method for primary thermometry. It relies on a global fitting of multiple absorption lines of ...the same band at different pressures. The approach allows leveraging both the temperature-dependent Doppler width and the temperature-dependent distribution of line intensities across the ro-vibrational band. We provide a proof-of-principle demonstration of the approach on the 3
ν
1
+
ν
3
band of CO
2
, for which several accurate line-strength models of both theoretical and experimental origin are available for the global fitting. Our experimental conditions do not allow to test the methodology beyond a combined uncertainty of 530 ppm, but the comparative analysis between different line-strength models shows promise to reduce the error budget to few tens of ppm. As compared to Doppler-broadening thermometry, the approach is advantageous to mitigate systematic errors induced by a wrong modelling of absorption line-shapes and to reduce, for a given experimental dataset, the statistical uncertainty by a factor of 2. When applied in a reverse way, i.e. using a gas of known temperature, the approach becomes a stringent testbed for the accuracy of the adopted line-strength model.
The predictive value of the El-Ganzouri risk index (EGRI) for difficult intubation has been evaluated using Macintosh laryngoscopy as reference standard. The Glidescope® videolaryngoscope provides ...improved visualization of the glottis. We studied the predictive value of the EGRI using videolaryngoscopy as reference standard.
Data from two subsequent groups of patients, intubated with Macintosh laryngoscopy (ML, n = 994) and videolaryngoscopy (VL, n = 843), were retrospectively analysed. The EGRI was taken as index test. The two types of laryngoscopy were adopted as reference for the presence of Cormack and Lehane grading III–IV. For both groups, sensitivity, specificity, and positive and negative post-test probabilities (PTP) were calculated for thresholds on the EGRI scale. Receiver operating characteristic curves and corresponding areas (AUC) were obtained.
Sensitivity and specificity were 69.7% and 66.3% at the cut-off value of 2 in the ML group, and 93.3% and 76.6% at the cut-off value of 3 in the VL group. Corresponding positive and negative PTP were 12.81% and 3.15% in the ML group, and 6.73% and 0.16% in the VL group. At the threshold of 4, positive and negative PTP were 31.34% and 4.85% in the ML group. At the threshold of 7, positive and negative PTP were 85.71% and 1.08% in the VL group. The AUC was 0.74 in the ML group and 0.91 in the VL group.
The predictive value of the EGRI may have been underestimated due to limited accuracy of Macintosh laryngoscopy. Using videolaryngoscopy, the EGRI might be reconsidered as a decisional tool.
We investigate the nonlinear absorption of laser energy in the bulk of transparent dielectrics for femtosecond and picosecond laser pulses focused by a conical lens. We highlight the influence of the ...pulse duration, laser pulse energy, and cone angle on laser energy absorption in transparent dielectrics. We provide a semi-analytical model allowing the calculation of maps for the density of nonlinear absorption of energy in BK7 and in SiO2 as a function of the pulse duration and peak fluence in the focal region. The comparison of the density of nonlinear absorption of energy with the available energy density determines optimal pulse durations and Bessel beam cone angles compatible with uniform laser energy deposition in the Bessel zone. The results reproduce quantitatively the transmission measurements for experiments in BK7 with picosecond pulses and suggest that the loss of propagation invariance and uniform laser energy deposition is responsible for a previously reported transition between different types of damage morphology in SiO2 M. K. Bhuyan et al., Appl. Phys. Lett. 104, 021107 (2014).
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