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Initial High ScvO2 Is Related to Organ Dysfunction in Severe Sepsis and Septic Shock Patients
The Journal of Emergency Medicine (60%) in overall success rate within three attempts (p = 0.001) and the number of attempts (p < 0.001). There were significant differences between the two groups in puncture time (p = 0.004), hematoma (p = 0.048), and technical difficulty score (p < 0.001). Conclusions: The 45 set square method is an effective and safe method for ultrasound-guided internal jugular venous catheterization in the ED. , INITIAL HIGH ScvO2 IS RELATED TO ORGAN DYSFUNCTION IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS. S. Lee, Y. Hong, J. Park, E. Lee, S. Kim, Emergency Medicine, Korea University Anam Hospital, Seoul, KOREA. Objective: To find whether initial high ScvO2 is related to severity of organ dysfunction and predicts in-hospital mortality in severe sepsis or septic shock patients. Methods: This was a secondary analysis of 169 patients with severe sepsis or septic shock that were prospectively included in this study at an emergency department (ED). Hemodynamic variables, sepsis-related organ failure assessment (SOFA) score, arterial blood gas studies, and in-hospital mortality were obtained at the time of presentation. Oxygen extraction ratio (ER) was calculated with (1-ScvO2)/SaO2. We compared the data according to the level of ScvO2. Results: A total 133 patients were selected for analysis. The patients were classified into three groups according to the ScvO2 levels: low ScvO2 < 70% (n = 71), normal ScvO2 70–80% (n = 47), and high ScvO2 > 80% (n = 15). Extraction rates of each group were 36.3 6 18% for the low ScvO2 group, 20.6 6 4.6% for the normal ScvO2, and 13.1 6 5.5% for the high ScvO2. The SOFA scores of each group were 6.3 6 3.5, 5.7 6 3.1, and 8.3 6 4.5, respectively (p = 0.048). In-hospital mortality of each group was 29.6% for the low ScvO2, 21.3% for the normal ScvO2, and 46.7% for the high ScvO2 (p = 0.160). Conclusions: Initially high ScvO2 level was associated with the severity of organs dysfunction and high in-hospital mortality in severe sepsis and septic shock. These results may reflect low tissue oxygen extraction ratio due to microcirculatory and mitochondrial dysfunction in septic shock patients. , FACTORS ASSOCIATED WITH ACUTE KIDNEY INJURY IN PATIENTS AFTER CARDIAC ARREST TREATED WITH THERAPEUTIC HYPOTHERMIA. S. Kim, C. S. Youn, K. N. Park, Emergency Department, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KOREA. Objective: Acute kidney injury (AKI) caused by renal ischemic-reperfusion injury occurs in patients after cardiac arrest. AKI is a consistent and powerful predictor of in-hospital mortality, and is associated with an increase in hospital length of stay, hospital costs, and resource utilization. We investigate risk factors associated with AKI after cardiac arrest treated with therapeutic hypothermia (TH). Methods: We performed an observational cohort study of patients aged more than 18 years, who were successfully resuscitated following cardiac arrest and treated with TH by our institutional protocol from March 1, 2009 to May 31, 2012. Patients who were previous end-stage renal disease or pre-existing AKI patients on renal replacement therapy, and had no available biochemical results within 12 h
917 after cardiac arrest, were excluded from this study. AKI was categorized using the peak and estimated baseline serum creatinine, into: 1) no AKI, 2) risk of AKI, 3) Kidney injury, 4) Kidney failure; according to the RIFLE criteria. Results: There were 136 patients after cardiac arrest treated with TH during the study period; 130 patients were included in the final analysis. Twenty-seven of 130 patients (20.7%) had AKI class injury/failure during the first 3 days of hospitalization after cardiac arrest. On multivariate binary logistic regression analysis, the event of cardiogenic shock (odds ratio [OR] 5.949, 95% confidence interval [CI] 1.401–25.271, p = 0.016), higher serum lactate level at 6 h (OR 1.335, 95% CI 1.023–1.744, p = 0.034) after return of spontaneous circulation (ROSC) and the cumulative dose of epinephrine during resuscitation (OR 4.347, 95% CI 1.040– 18.164, p = 0.044) were independently associated with AKI. Conclusions: The development of AKI after cardiac arrest was associated with hemodynamic status during therapeutic hypothermia and serum lactate after ROSC. Theses associated risk factors for AKI after cardiac arrest could be useful in clinical decision-making, resources utilization, and outcome prediction. , WHAT IS THE OPTIMAL INSERTION ANGLE BETWEEN THE SKIN AND NEEDLE IN ULTRASOUND (US)-GUIDED INTERNAL JUGULAR VEIN (IJV) CATHETERIZATION? H. Jeon, Emergency Department, Bundang Jesaeng Hospital, Bundang, KOREA. Objective: We tried to identify whether the optimal insertion angle between the skin and needle in US-guided IJV catheterization would be changed depending on the patient’s central venous pressure (CVP). Methods: Using the 3.5-cm-long linear probe, we measured the distance from the skin to the IJV’s outer and inner surface on the longitudinal scan’s midline in supinepositioned patients who were indicated for central venous catheterization regardless of suspected diagnoses in the Emergency Department. We calculated the angle between the skin and the imaginary line from the puncture site to the IJV’s internal center on screen’s midline (defined as optimal angle, which is considered as the safest approach) on the longitudinal scan. We measured patients’ CVP after catheterization. We divided the patients into three groups based on the CVP (low CVP < 5 cm H2O, 5 # middle CVP # 10 cm H2O, and high CVP > 10 cm H2O) and compared their mean anteroposterior (AP) diameters and optimal angles using analysis of variance statistics. Results: A total 56 patients were enrolled; 36 were women (64.3%). Mean age, AP diameter, and optimal angle were 62.9 6 16.8 years, 1.01 6 0.40 cm, and 29.1 6 5.01 , respectively. Thirteen, 32, and 11 patients belonged to the low, middle, and high CVP groups, respectively. Normality was acquired in AP diameter and optimal angle by Shapiro-Wilk test (p > 0.05). The mean AP diameter of the low CVP group was significantly lower than the middle and high CVP groups (0.68 6 0.30, 1.06 6 0.31, and 1.23 6 0.49 cm, respectively, p < 0.05). There was no significant difference among the three groups’ mean optimal angles (28.1 6 6.1, 30.1 6 4.5, and 28.0 6 5.0 , respectively). Conclusions: The optimal angle between the skin and needle in ultrasound-guided IJV catheterization remained at about 30 regardless of CVP, even though the IJV’s diameter is altered in proportion to the CVP.
917 after cardiac arrest, were excluded from this study. AKI was categorized using the peak and estimated baseline serum creatinine, into: 1) no AKI, 2) risk of AKI, 3) Kidney injury, 4) Kidney failure; according to the RIFLE criteria. Results: There were 136 patients after cardiac arrest treated with TH during the study period; 130 patients were included in the final analysis. Twenty-seven of 130 patients (20.7%) had AKI class injury/failure during the first 3 days of hospitalization after cardiac arrest. On multivariate binary logistic regression analysis, the event of cardiogenic shock (odds ratio [OR] 5.949, 95% confidence interval [CI] 1.401–25.271, p = 0.016), higher serum lactate level at 6 h (OR 1.335, 95% CI 1.023–1.744, p = 0.034) after return of spontaneous circulation (ROSC) and the cumulative dose of epinephrine during resuscitation (OR 4.347, 95% CI 1.040– 18.164, p = 0.044) were independently associated with AKI. Conclusions: The development of AKI after cardiac arrest was associated with hemodynamic status during therapeutic hypothermia and serum lactate after ROSC. Theses associated risk factors for AKI after cardiac arrest could be useful in clinical decision-making, resources utilization, and outcome prediction. , WHAT IS THE OPTIMAL INSERTION ANGLE BETWEEN THE SKIN AND NEEDLE IN ULTRASOUND (US)-GUIDED INTERNAL JUGULAR VEIN (IJV) CATHETERIZATION? H. Jeon, Emergency Department, Bundang Jesaeng Hospital, Bundang, KOREA. Objective: We tried to identify whether the optimal insertion angle between the skin and needle in US-guided IJV catheterization would be changed depending on the patient’s central venous pressure (CVP). Methods: Using the 3.5-cm-long linear probe, we measured the distance from the skin to the IJV’s outer and inner surface on the longitudinal scan’s midline in supinepositioned patients who were indicated for central venous catheterization regardless of suspected diagnoses in the Emergency Department. We calculated the angle between the skin and the imaginary line from the puncture site to the IJV’s internal center on screen’s midline (defined as optimal angle, which is considered as the safest approach) on the longitudinal scan. We measured patients’ CVP after catheterization. We divided the patients into three groups based on the CVP (low CVP < 5 cm H2O, 5 # middle CVP # 10 cm H2O, and high CVP > 10 cm H2O) and compared their mean anteroposterior (AP) diameters and optimal angles using analysis of variance statistics. Results: A total 56 patients were enrolled; 36 were women (64.3%). Mean age, AP diameter, and optimal angle were 62.9 6 16.8 years, 1.01 6 0.40 cm, and 29.1 6 5.01 , respectively. Thirteen, 32, and 11 patients belonged to the low, middle, and high CVP groups, respectively. Normality was acquired in AP diameter and optimal angle by Shapiro-Wilk test (p > 0.05). The mean AP diameter of the low CVP group was significantly lower than the middle and high CVP groups (0.68 6 0.30, 1.06 6 0.31, and 1.23 6 0.49 cm, respectively, p < 0.05). There was no significant difference among the three groups’ mean optimal angles (28.1 6 6.1, 30.1 6 4.5, and 28.0 6 5.0 , respectively). Conclusions: The optimal angle between the skin and needle in ultrasound-guided IJV catheterization remained at about 30 regardless of CVP, even though the IJV’s diameter is altered in proportion to the CVP.