RESUMO
BACKGROUND: The aim of this study was to examine the effects of controlled hemorrhage and shock on oxygenation and ventilation using needle cricothyroidotomy and jet ventilation in an animal model. METHODS: Twenty-four male pigs were randomly allocated into 4 groups: SHOCK (animals in hemorrhagic shock only), CRICH (animals that underwent needle cricothyroidotomy only), SHOCK+CRICH (animals in hemorrhagic shock + needle cricothyroidotomy), and SHAM (anesthetized animals submitted to surgical preparation only). All animals were surgically prepared and were observed for a period of 40 minutes (T0 - T40). Hemodynamic and blood gas variables were compared using analysis of variance and Bonferroni post hoc testing at a level of significance of 95%. RESULTS: CRICH and SHOCK+CRICH developed respiratory acidosis, with a progressive decrease of arterial pH after T20, and they presented a significant increase of PaCO(2) levels after T10, when compared with SHAM and SHOCK (P < .001). When SHOCK+CRICH was compared with CRICH, it presented a larger increase of PaCO(2) after T10 (P = .036) and an even more significant increase after T20 (P = .009). CONCLUSION: Hemorrhagic shock anticipated and intensified the retention of carbon dioxide and respiratory acidosis during manual jet ventilation through needle cricothyroidotomy in comparison with animals with jet ventilation but without shock. The results found in this work should be considered in future protocols for the assistance of victims of trauma in prehospital settings.
Assuntos
Ventilação em Jatos de Alta Frequência , Choque Hemorrágico/fisiopatologia , Traqueotomia , Animais , Pressão Sanguínea/fisiologia , Dióxido de Carbono/sangue , Débito Cardíaco/fisiologia , Cartilagem Cricoide/cirurgia , Masculino , Agulhas , Oxigênio/sangue , Artéria Pulmonar/fisiologia , SuínosRESUMO
BACKGROUND: This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. METHODS: A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008. Patients were randomly allocated to the subclavian or jugular vein group. The endpoint was complications that led to catheter revision or catheter removal. RESULTS: Six patients were excluded, 43 had the catheter implanted in the subclavian and 34 in the jugular vein. Subclavian catheters were used for up to 12.6 months, while jugular catheters were kept in place for up to 14.8 months (P = 0.38). No statistical differences were found between the groups concerning age, sex, leukocyte count, platelet count, type of admission (in or outpatient), or previous chemotherapy regimens. When analyzed individually, long-term complications did not present statistically significant differences either. Infection occurred in 20 and 11% (P = 0.44), while catheter embolism took place in 23 and 8% (P = 0.11) of patients with subclavian and jugular catheters, respectively. A statistical difference was seen in the total number of complications, which occurred in 48 and 23% (P = 0.02) of patients in the subclavian and in the jugular groups, respectively. CONCLUSIONS: Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein.