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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ultrasound-guided vascular cannulation is currently the standard in adult critical care medicine&#44; largely replacing the traditional technique for central venous and arterial catheter placement&#46; In addition&#44; it improves the success rate of peripheral venous cannulation in patients with difficult intravenous access&#46; Although international guidelines provide clear statements emphasizing the use of ultrasound guidance for this procedure&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> many of these recommendations are based on studies performed mostly outside the intensive care unit &#40;ICU&#41;&#44; particularly in the operating room&#46; While extrapolation is valid&#44; it is noteworthy that patients in the ICU have unique factors that make cannulation challenging&#44; such as shock&#44; edema&#44; or obesity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study by Gutte et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> has a very important strength&#58; it was performed entirely in ICU patients&#46; Unsurprisingly&#44; ultrasound-guided cannulation outperformed palpation for arterial line placement in the radial&#44; dorsalis pedis&#44; and femoral arteries&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First and foremost&#44; ultrasound guidance won the battle for first-pass success&#46; This outcome is of pivotal relevance&#44; given that repeated punctures may complicate subsequent cannulation due to vasospasm or acute hematoma formation&#44; incrementing complications and patient discomfort&#44; and ultimately delaying the measurement of arterial pressure&#46; Second&#44; and linked to the high rate of first-pass success&#44; the cannulation time was shorter with ultrasound guidance than with palpation&#46; The efficiency matters&#44; and here&#44; ultrasound guidance won again&#46; Third&#44; interestingly&#44; the authors pointed out the performance of ultrasound guidance in patients with variables common to the ICU population&#44; such as shock and the intensity of pharmacological support &#40;using the vasoactive-inotropic score or VIS&#41;&#44; and a body mass index &#62;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Again&#44; ultrasound was better than palpation&#44; confirming that in these frequent ICU scenarios&#44; pulse palpation is equivocal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Readers may highlight the typical limitations of a study that may lead to biased results&#44; such as the sample size&#44; approach used &#40;in-plane vs&#46; out-of-plane&#41; and operator expertise&#46; One may also argue that the performance of ultrasound guidance should be tested on other arteries&#44; such as the ulnar artery &#40;in some patients&#44; it is larger than the radial artery<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#41; and the brachial&#44; axillary&#44; or even popliteal arteries&#46; However&#44; based on the findings of this study&#44; which reproduced real-world ICU scenarios&#44; intensivists should consider using ultrasound guidance instead of palpation for arterial line placement&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary&#44; the research by Gutta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> brings light to practice&#44; providing evidence that palpation seems to have lost most if not all lives in the game of arterial cannulation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to disclose&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This work has not been presented at any conferences&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This work has not been supported by any grants&#46;</p></span></span>"
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Editorial
Ultrasound-guided arterial cannulation: Is the game over for the palpation technique?
Canulación arterial ecodirigida: ¿se terminó el juego para la técnica palpatoria?
Pablo Blanco
High-dependency Unit, Hospital “Dr. Emilio Ferreyra”, 4801, 59 Ave., Necochea 7630, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ultrasound-guided vascular cannulation is currently the standard in adult critical care medicine&#44; largely replacing the traditional technique for central venous and arterial catheter placement&#46; In addition&#44; it improves the success rate of peripheral venous cannulation in patients with difficult intravenous access&#46; Although international guidelines provide clear statements emphasizing the use of ultrasound guidance for this procedure&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> many of these recommendations are based on studies performed mostly outside the intensive care unit &#40;ICU&#41;&#44; particularly in the operating room&#46; While extrapolation is valid&#44; it is noteworthy that patients in the ICU have unique factors that make cannulation challenging&#44; such as shock&#44; edema&#44; or obesity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study by Gutte et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> has a very important strength&#58; it was performed entirely in ICU patients&#46; Unsurprisingly&#44; ultrasound-guided cannulation outperformed palpation for arterial line placement in the radial&#44; dorsalis pedis&#44; and femoral arteries&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First and foremost&#44; ultrasound guidance won the battle for first-pass success&#46; This outcome is of pivotal relevance&#44; given that repeated punctures may complicate subsequent cannulation due to vasospasm or acute hematoma formation&#44; incrementing complications and patient discomfort&#44; and ultimately delaying the measurement of arterial pressure&#46; Second&#44; and linked to the high rate of first-pass success&#44; the cannulation time was shorter with ultrasound guidance than with palpation&#46; The efficiency matters&#44; and here&#44; ultrasound guidance won again&#46; Third&#44; interestingly&#44; the authors pointed out the performance of ultrasound guidance in patients with variables common to the ICU population&#44; such as shock and the intensity of pharmacological support &#40;using the vasoactive-inotropic score or VIS&#41;&#44; and a body mass index &#62;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Again&#44; ultrasound was better than palpation&#44; confirming that in these frequent ICU scenarios&#44; pulse palpation is equivocal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Readers may highlight the typical limitations of a study that may lead to biased results&#44; such as the sample size&#44; approach used &#40;in-plane vs&#46; out-of-plane&#41; and operator expertise&#46; One may also argue that the performance of ultrasound guidance should be tested on other arteries&#44; such as the ulnar artery &#40;in some patients&#44; it is larger than the radial artery<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#41; and the brachial&#44; axillary&#44; or even popliteal arteries&#46; However&#44; based on the findings of this study&#44; which reproduced real-world ICU scenarios&#44; intensivists should consider using ultrasound guidance instead of palpation for arterial line placement&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary&#44; the research by Gutta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> brings light to practice&#44; providing evidence that palpation seems to have lost most if not all lives in the game of arterial cannulation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to disclose&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This work has not been presented at any conferences&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This work has not been supported by any grants&#46;</p></span></span>"
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