Acute and Critical Care

Original Articles

Cardiology
The incidence of phlebitis development of high concentration of continuous amiodarone infusion with in-line filter compared to the low concentration without in-line filter: a retrospective propensity score-matched analysis: Sirichai Cheewatanakornkul, Piyanai Vattanaprasan, Supattra Uppanisakorn, Rungsun Bhurayanontachai; Acute Crit Care. 2022;37(3):391-397. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00080

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Background
Phlebitis-associated peripheral infusion of intravenous amiodarone is common in clinical practice, with an incidence between 5% and 65%. Several factors, including drug concentration, catheter size, and in-line filter used, are significantly associated with phlebitis occurrence. We performed a retrospective propensity score-matched analysis to find out whether in-line filter will reduce the incidence of amiodarone-induced phlebitis (AIP) in high concentration of amiodarone infusion compared to low concentration without in-line filter.
Methods
Clinical records of all patients who required intravenous amiodarone infusion for cardiac arrhythmias, between January 2017 to December 2019 were retrieved. The incidence of AIP was recorded and subsequently compared among high concentration (2 mg/ml) with an in-line filter and low concentration (1.5 mg/ml) infusion without an in-line filter after a 1 to 2 propensity score matched.
Results
The data indicated that among the 214 cases of amiodarone infusion collected, 28 cases used an in-line filter with high concentration while 186 cases received a low concentration of amiodarone infusion without an in-line filter. After 1:2 propensity score matching, the incidence of phlebitis in the high concentration with in-line filter group was significantly higher than the low concentration without in-line filter group (28.6% vs. 3.6%, P<0.01).
Conclusions
Despite the usage of in-line filter, the high concentration of amiodarone infusion resulted in a higher incidence of peripheral phlebitis. Central venous catheterization for a high concentration of amiodarone infusion is recommended.

Citations

Citations to this article as recorded by

The Effect of Propolis Cream on Phlebitis and Catheter-Related Bloodstream Infections: A Double-Blinded Randomised Clinical Trial
Hassan Pakdaman, Ali Khodadadizadeh, Gholamreza Bazmandegan, Hadi Hasani, Majid Kazemi
Journal of Herbal Medicine.2024; 43: 100829. CrossRef

Cardiology
Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for, persistence after hospital discharge: Abarna Ramanathan, John Paul Pearl, Manshi Li, Xiaofeng Wang, Divyajot Sadana, Abhijit Duggal; Acute Crit Care. 2021;36(4):317-321. Published online November 29, 2021; DOI: https://doi.org/10.4266/acc.2021.00577

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Abstract PDF: Background
Atrial fibrillation of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years post hospital discharge for critically ill patients.
Methods
This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1st, 2012, to October 31st, 2015, were screened. Those designated with atrial fibrillation (AF) for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model.
Results
Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence.
Conclusions
Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.

Case Report

Atrial Fibrillation Developed after Induction of General Anesthesia in an Elderly Patient: A case report: Seok Ho Han, Jin Woo Choi; Korean J Crit Care Med. 1998;13(2):261-261.

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Abstract PDF: It is known that the incidence of arrhythmia related to anesthesia and operation is significantly higher in thoracic surgery such as cardiac, lung operation than any other operation, and atrial fibrillation is the most common arrhythmia among these arrhythmias. Besides operative sites, age and underlying cardiac problem such as hypertension, cardiomegaly can be important risk factors for intra, post-operative atrial fibrillation in non-thoracic surgery. Through many investigations, we can find that age is the most important because age related anatomical, physiological cardiac changes make elderly patients more susceptible to development of atrial fibrillation. In this case, we report atrial fibrillation that occurred after induction of general anesthesia in an elderly patient undergoing open reduction of upper arm fracture.

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