Ryszard Gawda

Publications (3)9.81 Total impact

• Source

  Available from: wroc.pl

  Article: Supraclavicular approach is an easy and safe method of subclavian vein catheterization even in mechanically ventilated patients: analysis of 370 attempts.

  Tomasz Czarnik, Ryszard Gawda, Tadeusz Perkowski, Rafal Weron
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  ABSTRACT: Central venous catheters are commonly inserted for hemodynamic monitoring, volume monitoring, administration of medications, long-term total parenteral nutrition, access for renal replacement therapy, cardiopulmonary resuscitation, and difficult peripheral catheterization. The primary outcome of this study was to define venipuncture, catheterization and entire procedure success rates, and finally complication rate of subclavian venous catheterization via the supraclavicular approach with special focus on mechanically ventilated patients. The secondary outcome was to potentially make recommendations regarding this technique of central venous catheterization in mechanically ventilated patients. The methodology of this prospective cohort study included subclavian venous catheterization via the supraclavicular approach. The technique of cannulation was the same for both the right and left sides, but the right claviculosternocleidomastoid angle was the preferred catheterization site. All procedures were performed by the first three authors, each of whom had different levels of experience. Each physician had performed at least 20 procedures before starting the study. In the majority of patients, venipuncture occurred during the first attempt. In 362 patients, catheterization attempts were performed, in whom 311 catheterizations (85.6%) were successful during the first attempt. The overall subclavian venous catheterization via supraclavicular approach procedure complication rate reached 1.7% (95% confidence interval 0.6-3.6%). The overall subclavian venous catheterization via the supraclavicular approach procedure success rate reached 88.9% (95% confidence interval 85.1-91.9%, n = 359). Subclavian venous catheterization via the supraclavicular approach is an excellent method of central venous access in mechanically ventilated patients. The procedure success rate and the significant complication rate are comparable to other techniques of central venous catheterization.
  Anesthesiology 09/2009; 111(2):334-9. · 5.36 Impact Factor
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  Available from: wroc.pl

  Article: Associations between intracranial pressure, intraocular pressure and mean arterial pressure in patients with traumatic and non-traumatic brain injuries.

  Tomasz Czarnik, Ryszard Gawda, Waldemar Kolodziej, Dariusz Latka, Katarzyna Sznajd-Weron, Rafal Weron
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  ABSTRACT: Anatomical proximity of the eye and the intracranial space is a fact but the existence of physiological and pathophysiological relationships between them is elusive. The objective of this study was to explore anatomical and pathophysiological interactions between the eye and the intracranial space and to assess clinical utility of intraocular pressure measurement in estimation of intracranial pressure in patients with brain injuries and to discover how haemodynamic instability could influence these interactions. Controversy surrounds the recent literature concerning this problem and the consensus has not been achieved. We evaluated the correlation between intracranial pressure and intraocular pressure, intracranial pressure and mean arterial pressure, intraocular pressure and mean arterial pressure in 40 patients with brain injuries initially comatose, admitted to our hospital. All patients required the intracranial pressure monitoring on clinical grounds. Simultaneous recordings of intracranial pressure, intraocular pressure and mean arterial pressure were performed. We calculated both the linear correlation coefficient and the Spearman rank-order correlation coefficient for all three relations. We found significant correlation between intraocular pressure and mean arterial pressure in 63% of the tested population. When the power of the test was increased, by considering only patients with 11 or more observations, this ratio increased to 76%. However, the correlation between intraocular pressure and intracranial pressure, as well as, between intracranial pressure and mean arterial pressure was not significant. There is no anatomical and pathophysiological basis for the statement that intraocular pressure can be used as an indirect estimator of intracranial pressure.
  Injury 02/2009; 40(1):33-9. · 1.98 Impact Factor
• Source

  Available from: psu.edu

  Article: Noninvasive measurement of intracranial pressure: is it possible?

  Tomasz Czarnik, Ryszard Gawda, Dariusz Latka, Waldemar Kolodziej, Katarzyna Sznajd-Weron, Rafal Weron
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  ABSTRACT: Some publications suggest a strong correlation between the intracranial pressure and the intraocular pressure. Other studies claim no correlation between these two physiologic variables. Our aim was to study whether the tonometry could be a useful method to evaluate intracranial pressure in patients with suspected intracranial abnormality. We evaluated the correlation between the intracranial pressure and the intraocular pressure, the intracranial pressure and the mean arterial pressure, and the intraocular pressure and the mean arterial pressure in 22 patients, initially comatose, who were admitted to our hospital. All patients required the intracranial pressure monitoring on clinical grounds. Simultaneous measurements were performed and recorded. We calculated both the linear correlation coefficient and the Spearman rank-order correlation coefficient. We found significant correlation between the intraocular pressure and the mean arterial pressure in 12 patients; however, significant correlation between the intraocular pressure and the intracranial pressure was found in only 2 patients. Tonometry is not an appropriate method for the assessment of intracranial pressure increases.
  The Journal of trauma 02/2007; 62(1):207-11. · 2.48 Impact Factor