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Jean Carlet - One of the best experts on this subject based on the ideXlab platform.
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Central Vein catheter related thrombosis in intensive care patients incidence risks factors and relationship with catheter related sepsis
Chest, 1998Co-Authors: Jeanfrancois Timsit, Jeanchristophe Farkas, Jeanmarc Boyer, Jeanbaptiste Martin, Benoit Misset, Bertrand Renaud, Jean CarletAbstract:OBJECTIVE: To evaluate the incidence and risk factors for catheter-related Central Vein thrombosis in ICU patients. DESIGN: Observational prospective multicenter study. SETTING: An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. PATIENTS: During an 18-month period, 265 internaljugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or 64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). CONCLUSIONS: Catheter-related Central Vein thrombosis is a frequent complication of Central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
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Central Vein catheter related thrombosis in intensive care patients incidence risks factors and relationship with catheter related sepsis
Chest, 1998Co-Authors: Jeanfrancois Timsit, Jeanchristophe Farkas, Jeanmarc Boyer, Jeanbaptiste Martin, Benoit Misset, Bertrand Renaud, Jean CarletAbstract:Objective To evaluate the incidence and risk factors for catheter-related Central Vein thrombosis in ICU patients. Design Observational prospective multicenter study. Setting An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. Patients During an 18-month period, 265 internal jugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or Interventions None. Measurements and main results Fifty-seven catheters were excluded from the analysis. Therefore 208 catheters were analyzed. Mean age of patients was 64±15 years, simplified acute physiologic score was 12±5, organ system failure score at insertion was 1±1, and mean duration of catheterization was 9±5 days. A catheter-related internal jugular or subclavian Vein thrombosis occurred in 33% of the cases (42% [95% confidence interval (CI), 34 to 49%] and 10% [95% CI, 3 to 18%], respectively). Thrombosis was limited in 8%, large in 22%, and occlusive in 3% of the cases. Internal jugular route (relative risk [RR], 4.13; 95% CI, 1.72 to 9.95), therapeutic heparinization (RR 0.47; 95% CI, 0.23 to 0.99), and age >64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). Conclusions Catheter-related Central Vein thrombosis is a frequent complication of Central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
Jeanfrancois Timsit - One of the best experts on this subject based on the ideXlab platform.
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Central Vein catheter related thrombosis in intensive care patients incidence risks factors and relationship with catheter related sepsis
Chest, 1998Co-Authors: Jeanfrancois Timsit, Jeanchristophe Farkas, Jeanmarc Boyer, Jeanbaptiste Martin, Benoit Misset, Bertrand Renaud, Jean CarletAbstract:OBJECTIVE: To evaluate the incidence and risk factors for catheter-related Central Vein thrombosis in ICU patients. DESIGN: Observational prospective multicenter study. SETTING: An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. PATIENTS: During an 18-month period, 265 internaljugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or 64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). CONCLUSIONS: Catheter-related Central Vein thrombosis is a frequent complication of Central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
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Central Vein catheter related thrombosis in intensive care patients incidence risks factors and relationship with catheter related sepsis
Chest, 1998Co-Authors: Jeanfrancois Timsit, Jeanchristophe Farkas, Jeanmarc Boyer, Jeanbaptiste Martin, Benoit Misset, Bertrand Renaud, Jean CarletAbstract:Objective To evaluate the incidence and risk factors for catheter-related Central Vein thrombosis in ICU patients. Design Observational prospective multicenter study. Setting An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. Patients During an 18-month period, 265 internal jugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or Interventions None. Measurements and main results Fifty-seven catheters were excluded from the analysis. Therefore 208 catheters were analyzed. Mean age of patients was 64±15 years, simplified acute physiologic score was 12±5, organ system failure score at insertion was 1±1, and mean duration of catheterization was 9±5 days. A catheter-related internal jugular or subclavian Vein thrombosis occurred in 33% of the cases (42% [95% confidence interval (CI), 34 to 49%] and 10% [95% CI, 3 to 18%], respectively). Thrombosis was limited in 8%, large in 22%, and occlusive in 3% of the cases. Internal jugular route (relative risk [RR], 4.13; 95% CI, 1.72 to 9.95), therapeutic heparinization (RR 0.47; 95% CI, 0.23 to 0.99), and age >64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). Conclusions Catheter-related Central Vein thrombosis is a frequent complication of Central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
Y Fukuda - One of the best experts on this subject based on the ideXlab platform.
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three step method for ultrasound guided Central Vein catheterization
BJA: British Journal of Anaesthesia, 2013Co-Authors: Joho Tokumine, Alan T Lefor, A Yonei, A Kagaya, K Iwasaki, Y FukudaAbstract:Background The long-axis view and in-plane needle approach (LAX-IP) for ultrasound-guided Central Vein catheterization is considered ideal because of the quality of real-time imaging. We describe a novel technique, using a step-by-step procedure, to overcome the pitfalls associated with the LAX-IP. This study was undertaken to demonstrate the clinical utility of this approach. Methods All operators underwent training before participation in this study. One hundred patients were enrolled in this study and underwent Central venous catheterization using this method. Using a portable ultrasound and Vein catheterization kit, patients were appropriately positioned and a straight portion of the Vein identified (Step 1). A needle guide was used (Step 2) and the Vein imaged in real time in two directions (Step 3), to identify the true long axis and prevent damage to surrounding tissues. Results The overall success rate for catheterization was 100% with a median of one puncture for each patient. All catheterizations were performed within three punctures. Problems with the first puncture included difficult insertion of the guide-wire due to coiling, difficult anterior wall puncture, less experience with the procedure, and other reasons. There were no complications associated with the procedure. Conclusions This three-step method is not dependent on an operator's ability to proceed based on spatial awareness, but rather depends on logic. This method can prevent difficulties associated with a two-dimensional ultrasound view, and may be a safer technique compared with others. Further clinical trials are needed to establish the safety of this technique.
Pascal Sati - One of the best experts on this subject based on the ideXlab platform.
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the Central Vein sign in patients with diagnostic red flags for multiple sclerosis a prospective multicenter 3t study
Multiple Sclerosis Journal, 2020Co-Authors: Pietro Maggi, Pascal Sati, Martina Absinta, Daniel S Reich, Gaetano Perrotta, Luca Massacesi, Bernard Dachy, Caroline Pot, Reto Meuli, Massimo FilippiAbstract:Background:The Central Vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective.Objectives:To prospectively assess t...
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swan venule an optimized mri technique to detect the Central Vein sign in ms plaques
American Journal of Neuroradiology, 2020Co-Authors: Maria I Gaitan, P Yanez, M Paday E Formenti, Ismael Calandri, E Figueiredo, Pascal Sati, Jorge CorrealeAbstract:BACKGROUND AND PURPOSE: Multiple sclerosis lesions develop around small Veins that are radiologically described as the so-called Central Vein sign. With 7T MR imaging and magnetic susceptibility–based sequences, the Central Vein sign has been observed in 80%–100% of MS lesions in patients’ brains. However, a lower proportion ∼50% has been reported at 3T using susceptibility-weighted angiography (SWAN). Our aim was to assess a modified version of SWAN optimized at 3T for sensitive detection of the Central Vein sign. MATERIALS AND METHODS: Thirty subjects with MS were scanned on a 3T clinical MR imaging system. 3D T2-weighted FLAIR and optimized 3D SWAN called SWAN-venule, were acquired after injection of a gadolinium-based contrast agent. Patients showing >3 focal white matter lesions were included. The Central Vein sign was recorded by 2 trained raters on SWAN-venule images in the supratentorial brain. RESULTS: Twenty patients showing >3 white matter lesions were included. A total of 380 white matter lesions (135 periventricular, 144 deep white matter, and 101 juxtacortical) seen on both FLAIR and SWAN-venule images were analyzed. Overall, the Central Vein sign was detected in 86% of the white matter lesions (periventricular, 89%; deep white matter, 95%; and juxtacortical, 78%). CONCLUSIONS: The SWAN-venule technique is an optimized MR imaging sequence for highly sensitive detection of the Central Vein sign in MS brain lesions. This work will facilitate the validation and integration of the Central Vein sign to increase the diagnostic certainty of MS and further prevent misdiagnosis in clinical practice.
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the Central Vein sign in inflammatory demyelination the role of fibrillar collagen type i
Annals of Neurology, 2019Co-Authors: Martina Absinta, Pascal Sati, Govind Nair, Maria Chiara Monaco, Dragan Maric, Nathanael J Lee, Nicholas J Luciano, Steven Jacobson, Daniel S ReichAbstract:Accumulating evidence corroborates the role of the "Central Vein sign" in the radiological diagnosis of multiple sclerosis (MS). Here, we report human magnetic resonance imaging (MRI) and corresponding pathological data that inflammation-dependent intracerebral remodeling of the vessel wall is directly associated with the prominence of intralesional Veins on susceptibility-based MRI. In adult marmosets with experimental autoimmune encephalomyelitis, vessel-wall fibrosis was detected early in the demyelinating process, even in lesions <2 weeks old, though fibrosis was more evident after 6 weeks. Vascular remodeling consisted of both luminal enlargement and eccentric thickening of the perivascular space (fibrillar collagen type I deposition) and affected almost exclusively white matter, but not subpial cortical, lesions. The long-term effect of vessel remodeling in MS lesions is currently unknown, but it might potentially affect tissue repair. ANN NEUROL 2019;85:934-942.
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the Central Vein sign in radiologically isolated syndrome
American Journal of Neuroradiology, 2019Co-Authors: Suradech Suthiphosuwan, Pascal Sati, Daniel S Reich, Melanie Guenette, Xavier Montalban, Aditya BharathaAbstract:BACKGROUND AND PURPOSE: Radiologically isolated syndrome describes asymptomatic individuals with incidental radiologic abnormalities suggestive of multiple sclerosis. Recent studies have demonstrated that >40% of white matter lesions in MS (and often substantially more) have visible Central Veins on MR imaging. This “Central Vein sign” reflects perivenous inflammatory demyelination and can assist in differentiating MS from other white matter disorders. We therefore hypothesized that >40% of white matter lesions in cases of radiologically isolated syndrome would show the Central Vein sign. MATERIALS AND METHODS: We recruited 20 participants diagnosed with radiologically isolated syndrome after evaluation by a neurologist. We performed 3T MR imaging of the brain and cervical spinal cord. White matter lesions were analyzed for the Central Vein sign. RESULTS: Of 391 total white matter lesions, 292 (75%) demonstrated the Central Vein sign (Central Vein sign+). The median proportion of Central Vein sign+ lesions per case was 87% (range, 29%–100%). When the “40% rule” that has been proposed to distinguish MS from other disorders was applied, of 20 participants, 18 cases of radiologically isolated syndrome (90%) had ≥40% Central Vein sign+ lesions (range, 55%–100%). Two participants (10%) had P = .002; P = .06, respectively). CONCLUSIONS: Most cases of radiologically isolated syndrome had a high proportion of Central Vein sign+ lesions, suggesting that lesions in these individuals reflect perivenous inflammatory demyelination. Moreover, we found correlations between the proportion of Central Vein sign+ lesions and spinal cord lesions, a known risk factor for radiologically isolated syndrome progressing to MS. These findings raise the possibility, testable prospectively, that the Central Vein sign may have prognostic value in distinguishing patients with radiologically isolated syndrome at risk of developing clinical MS from those with white matter lesions of other etiologies.
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the Central Vein sign and its clinical evaluation for the diagnosis of multiple sclerosis a consensus statement from the north american imaging in multiple sclerosis cooperative
Nature Reviews Neurology, 2016Co-Authors: Pascal Sati, Luca Massacesi, Todd R Constable, Nikos Evangelou, Charles R G Guttmann, Roland G Henry, Eric C Klawiter, Caterina Mainero, Henry F Mcfarland, Flavia NelsonAbstract:Over the past few years, MRI has become an indispensable tool for diagnosing multiple sclerosis (MS). However, the current MRI criteria for MS diagnosis have imperfect sensitivity and specificity. The Central Vein sign (CVS) has recently been proposed as a novel MRI biomarker to improve the accuracy and speed of MS diagnosis. Evidence indicates that the presence of the CVS in individual lesions can accurately differentiate MS from other diseases that mimic this condition. However, the predictive value of the CVS for the development of clinical MS in patients with suspected demyelinating disease is still unknown. Moreover, the lack of standardization for the definition and imaging of the CVS currently limits its clinical implementation and validation. On the basis of a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Multiple Sclerosis (NAIMS) Cooperative, this article provides statements and recommendations aimed at helping radiologists and neurologists to better understand, refine, standardize and evaluate the CVS in the diagnosis of MS.
Benoit Misset - One of the best experts on this subject based on the ideXlab platform.
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Central Vein catheter related thrombosis in intensive care patients incidence risks factors and relationship with catheter related sepsis
Chest, 1998Co-Authors: Jeanfrancois Timsit, Jeanchristophe Farkas, Jeanmarc Boyer, Jeanbaptiste Martin, Benoit Misset, Bertrand Renaud, Jean CarletAbstract:OBJECTIVE: To evaluate the incidence and risk factors for catheter-related Central Vein thrombosis in ICU patients. DESIGN: Observational prospective multicenter study. SETTING: An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. PATIENTS: During an 18-month period, 265 internaljugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or 64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). CONCLUSIONS: Catheter-related Central Vein thrombosis is a frequent complication of Central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
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Central Vein catheter related thrombosis in intensive care patients incidence risks factors and relationship with catheter related sepsis
Chest, 1998Co-Authors: Jeanfrancois Timsit, Jeanchristophe Farkas, Jeanmarc Boyer, Jeanbaptiste Martin, Benoit Misset, Bertrand Renaud, Jean CarletAbstract:Objective To evaluate the incidence and risk factors for catheter-related Central Vein thrombosis in ICU patients. Design Observational prospective multicenter study. Setting An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. Patients During an 18-month period, 265 internal jugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or Interventions None. Measurements and main results Fifty-seven catheters were excluded from the analysis. Therefore 208 catheters were analyzed. Mean age of patients was 64±15 years, simplified acute physiologic score was 12±5, organ system failure score at insertion was 1±1, and mean duration of catheterization was 9±5 days. A catheter-related internal jugular or subclavian Vein thrombosis occurred in 33% of the cases (42% [95% confidence interval (CI), 34 to 49%] and 10% [95% CI, 3 to 18%], respectively). Thrombosis was limited in 8%, large in 22%, and occlusive in 3% of the cases. Internal jugular route (relative risk [RR], 4.13; 95% CI, 1.72 to 9.95), therapeutic heparinization (RR 0.47; 95% CI, 0.23 to 0.99), and age >64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). Conclusions Catheter-related Central Vein thrombosis is a frequent complication of Central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.