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array:23 [ "pii" => "S021056912300058X" "issn" => "02105691" "doi" => "10.1016/j.medin.2023.02.013" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "1861" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2023;47:371-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0210569122002273" "issn" => "02105691" "doi" => "10.1016/j.medin.2022.06.006" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "1805" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2023;47:373-82" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prognostic value of the novel P/FPE index to classify ARDS severity: A cohort study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "373" "paginaFinal" => "382" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor pronóstico del nuevo índice P/FPE para clasificar la severidad del SDRA: Estudio de cohorte" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2113 "Ancho" => 2508 "Tamanyo" => 152898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of participants (dates of inclusion: between January 2018 and December 2020). ARDS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>acute respiratory distress syndrome; ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intensive care unit; IMV<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>invasive mechanical ventilation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.D. Martos-Benítez, R. Estévez-Muguercia, V. Orama-Requejo, T. del Toro-Simoni" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F.D." "apellidos" => "Martos-Benítez" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Estévez-Muguercia" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Orama-Requejo" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "del Toro-Simoni" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569122002273?idApp=WMIE" "url" => "/02105691/0000004700000007/v1_202306271124/S0210569122002273/v1_202306271124/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0210569123000086" "issn" => "02105691" "doi" => "10.1016/j.medin.2023.01.003" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "1846" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2023;47:391-401" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Arterial cannulation in adult critical care patients: A comparative study between ultrasound guidance and palpation technique" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:4 [ 0 => "en" 1 => "en" 2 => "en" 3 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "391" "paginaFinal" => "401" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Canulación arterial en pacientes adultos de cuidados críticos: un estudio comparativo entre la guía ecográfica y la técnica palpatoria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0035" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 881 "Tamanyo" => 91525 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Shreyas Gutte, Afzal Azim, Banani Poddar, Mohan Gurjar, Anup Kumar" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Shreyas" "apellidos" => "Gutte" ] 1 => array:2 [ "nombre" => "Afzal" "apellidos" => "Azim" ] 2 => array:2 [ "nombre" => "Banani" "apellidos" => "Poddar" ] 3 => array:2 [ "nombre" => "Mohan" "apellidos" => "Gurjar" ] 4 => array:2 [ "nombre" => "Anup" "apellidos" => "Kumar" ] ] ] ] "resumen" => array:2 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0035"></elsevierMultimedia></p></span>" ] 1 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">First study comparing USG vs. direct palpation technique at three arterial sites.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">First attempt success rate of 83.3% vs. 55.6% in USG vs. direct palpation group.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Comparison of both techniques in VIS > 10 and BMI ≥ 25, was a unique part.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Key limitation: Single-center study with small sample size.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572723000061" "doi" => "10.1016/j.medine.2023.02.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000061?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123000086?idApp=WMIE" "url" => "/02105691/0000004700000007/v1_202306271124/S0210569123000086/v1_202306271124/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Ultrasound-guided arterial cannulation: Is the game over for the palpation technique?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "371" "paginaFinal" => "372" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pablo Blanco" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Pablo" "apellidos" => "Blanco" "email" => array:1 [ 0 => "ohtusabes@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "High-dependency Unit, Hospital “Dr. Emilio Ferreyra”, 4801, 59 Ave., Necochea 7630, Argentina" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Canulación arterial ecodirigida: ¿se terminó el juego para la técnica palpatoria?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ultrasound-guided vascular cannulation is currently the standard in adult critical care medicine, largely replacing the traditional technique for central venous and arterial catheter placement. In addition, it improves the success rate of peripheral venous cannulation in patients with difficult intravenous access. Although international guidelines provide clear statements emphasizing the use of ultrasound guidance for this procedure,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> many of these recommendations are based on studies performed mostly outside the intensive care unit (ICU), particularly in the operating room. While extrapolation is valid, it is noteworthy that patients in the ICU have unique factors that make cannulation challenging, such as shock, edema, or obesity.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study by Gutte et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> has a very important strength: it was performed entirely in ICU patients. Unsurprisingly, ultrasound-guided cannulation outperformed palpation for arterial line placement in the radial, dorsalis pedis, and femoral arteries.</p><p id="par0015" class="elsevierStylePara elsevierViewall">First and foremost, ultrasound guidance won the battle for first-pass success. This outcome is of pivotal relevance, given that repeated punctures may complicate subsequent cannulation due to vasospasm or acute hematoma formation, incrementing complications and patient discomfort, and ultimately delaying the measurement of arterial pressure. Second, and linked to the high rate of first-pass success, the cannulation time was shorter with ultrasound guidance than with palpation. The efficiency matters, and here, ultrasound guidance won again. Third, interestingly, the authors pointed out the performance of ultrasound guidance in patients with variables common to the ICU population, such as shock and the intensity of pharmacological support (using the vasoactive-inotropic score or VIS), and a body mass index >25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. Again, ultrasound was better than palpation, confirming that in these frequent ICU scenarios, pulse palpation is equivocal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Readers may highlight the typical limitations of a study that may lead to biased results, such as the sample size, approach used (in-plane vs. out-of-plane) and operator expertise. One may also argue that the performance of ultrasound guidance should be tested on other arteries, such as the ulnar artery (in some patients, it is larger than the radial artery<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>) and the brachial, axillary, or even popliteal arteries. However, based on the findings of this study, which reproduced real-world ICU scenarios, intensivists should consider using ultrasound guidance instead of palpation for arterial line placement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary, the research by Gutta et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> brings light to practice, providing evidence that palpation seems to have lost most if not all lives in the game of arterial cannulation.</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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This work has not been presented at any conferences.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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