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Abstract：
Critical care patients often require central venous cannulation (CVC). We hypothesized that real-time biplane ultrasound-guided CVC would improve first-puncture success rate and reduce mechanical complications. The purpose of this study was to compare the success rate and safety of single-plane and real-time biplane approaches for ultrasound-guided CVC.
From October 2022 to March 2023, 256 participants with critical illness requiring CVC were randomized to either the single-plane (n = 128) or biplane (n = 128) ultrasound-guided cannulation groups. The success rate, number of punctures, procedure duration, incidence of catheterization-related complications, and confidence score of operators were documented.
The central vein was successfully cannulated in all 256 participants (163 [64%] man and 93 [36%] women; mean age 69 ± 19 [range 13-104 years]), including 182 and 74 who underwent internal jugular vein cannulation (IJVC) and femoral vein cannulation (FVC), respectively. The incidence of successful puncture on the first attempt was higher in the biplane group than that in the single-plane group (91.6% vs. 74.7%; relative risk (RR), 1.226; 95% confidence interval (CI), 1.069-1.405; P = 0.002 for the IJVC and 90.9% vs. 68.3%; RR, 1.331; 95% CI, 1.053-1.684; P = 0.019 for the FVC). The biplane group was also associated with a higher first-puncture single-pass catheterization success rate (87.4% vs. 69.0% and 90.9% vs. 68.3%), fewer undesired punctures (1[1-1(1-2)] vs. 1[1-2(1-4)] and 1[1-1(1-3)] vs. 1[1-2(1-4)]), shorter cannulation time (205 s [162-283 (66-1,526)] vs. 311 s [243-401 (136-1,223)] and 228 s [193-306 (66-1,669)] vs. 340 s [246-499 (130-944)]), and fewer immediate complications (10.5% vs. 28.7% and 9.1% vs. 34.1%) for both IJVC and FVC (all P < 0.05).
Real-time biplane imaging of ultrasound-guided CVCs offers advantages over the single-plane approach for critically ill patients.
This prospective RCT was registered at Chinese Clinical Trial Registry (ChiCTR2200064843). Registered 19 October 2022.
From October 2022 to March 2023, 256 participants with critical illness requiring CVC were randomized to either the single-plane (n = 128) or biplane (n = 128) ultrasound-guided cannulation groups. The success rate, number of punctures, procedure duration, incidence of catheterization-related complications, and confidence score of operators were documented.
The central vein was successfully cannulated in all 256 participants (163 [64%] man and 93 [36%] women; mean age 69 ± 19 [range 13-104 years]), including 182 and 74 who underwent internal jugular vein cannulation (IJVC) and femoral vein cannulation (FVC), respectively. The incidence of successful puncture on the first attempt was higher in the biplane group than that in the single-plane group (91.6% vs. 74.7%; relative risk (RR), 1.226; 95% confidence interval (CI), 1.069-1.405; P = 0.002 for the IJVC and 90.9% vs. 68.3%; RR, 1.331; 95% CI, 1.053-1.684; P = 0.019 for the FVC). The biplane group was also associated with a higher first-puncture single-pass catheterization success rate (87.4% vs. 69.0% and 90.9% vs. 68.3%), fewer undesired punctures (1[1-1(1-2)] vs. 1[1-2(1-4)] and 1[1-1(1-3)] vs. 1[1-2(1-4)]), shorter cannulation time (205 s [162-283 (66-1,526)] vs. 311 s [243-401 (136-1,223)] and 228 s [193-306 (66-1,669)] vs. 340 s [246-499 (130-944)]), and fewer immediate complications (10.5% vs. 28.7% and 9.1% vs. 34.1%) for both IJVC and FVC (all P < 0.05).
Real-time biplane imaging of ultrasound-guided CVCs offers advantages over the single-plane approach for critically ill patients.
This prospective RCT was registered at Chinese Clinical Trial Registry (ChiCTR2200064843). Registered 19 October 2022.
摘要：
背景：重症监护患者通常需要中心静脉插管（CVC）。我们假设实时双平面超声引导下的CVC将提高首次穿刺成功率并减少机械并发症。这项研究的目的是比较超声引导的CVC的单平面和实时双平面方法的成功率和安全性。
方法：从2022年10月至2023年3月，256名需要CVC的重症患者被随机分为单平面（n=128）或双平面（n=128）超声引导插管组。成功率,穿刺次数,程序持续时间,导管插入相关并发症的发生率，并记录操作员的信心评分。
结果：所有256名参与者（男性163[64％]，女性93[36％]；平均年龄69±19[范围13-104岁]），包括182名和74名接受颈内静脉插管（IJVC）和股静脉插管（FVC）的患者，分别。双平面组首次穿刺成功的发生率高于单平面组（91.6％vs.74.7%；相对风险(RR)，1.226；95%置信区间(CI)，1.069-1.405；IJVC的P=0.002，90.9%与68.3%；RR，1.331；95%CI，1.053-1.684；FVC的P=0.019）。双平面组还与较高的首次穿刺单程导管插入成功率（87.4％vs.69.0%和90.9%与68.3%），更少的非期望穿刺(1[1-1(1-2)]与1[1-2(1-4)]和1[1-1(1-3)]vs.1[1-2(1-4)]),更短的插管时间(205s[162-283(66-1,526)]vs.311s[243-401（136-1,223）]和228s[193-306（66-1,669）]vs.340s[246-499(130-944)])，和较少的直接并发症(10.5%vs.28.7%和9.1%与IJVC和FVC均为34.1％）（均P<0.05）。
结论：对于危重患者，超声引导的CVC实时双平面成像比单平面方法具有优势。
背景：该前瞻性RCT已在中国临床试验注册中心（ChiCTR2200064843）注册。2022年10月19日注册。
方法：从2022年10月至2023年3月，256名需要CVC的重症患者被随机分为单平面（n=128）或双平面（n=128）超声引导插管组。成功率,穿刺次数,程序持续时间,导管插入相关并发症的发生率，并记录操作员的信心评分。
结果：所有256名参与者（男性163[64％]，女性93[36％]；平均年龄69±19[范围13-104岁]），包括182名和74名接受颈内静脉插管（IJVC）和股静脉插管（FVC）的患者，分别。双平面组首次穿刺成功的发生率高于单平面组（91.6％vs.74.7%；相对风险(RR)，1.226；95%置信区间(CI)，1.069-1.405；IJVC的P=0.002，90.9%与68.3%；RR，1.331；95%CI，1.053-1.684；FVC的P=0.019）。双平面组还与较高的首次穿刺单程导管插入成功率（87.4％vs.69.0%和90.9%与68.3%），更少的非期望穿刺(1[1-1(1-2)]与1[1-2(1-4)]和1[1-1(1-3)]vs.1[1-2(1-4)]),更短的插管时间(205s[162-283(66-1,526)]vs.311s[243-401（136-1,223）]和228s[193-306（66-1,669）]vs.340s[246-499(130-944)])，和较少的直接并发症(10.5%vs.28.7%和9.1%与IJVC和FVC均为34.1％）（均P<0.05）。
结论：对于危重患者，超声引导的CVC实时双平面成像比单平面方法具有优势。
背景：该前瞻性RCT已在中国临床试验注册中心（ChiCTR2200064843）注册。2022年10月19日注册。
