Dominic Wichmann, MD, DTM; Stefan Kluge, MD
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1201.
Wichmann D., Kluge S.; Virtual Autopsy in the Intensive Care Unit. Ann Intern Med. 2012;156:839. doi: 10.7326/0003-4819-156-11-201206050-00015
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Published: Ann Intern Med. 2012;156(11):839.
We appreciate the comments from Dr. Kirsch and agree that, especially for cervical central lines, ultrasonography is an easy-to-perform, noninvasive method to control the correct positioning of the device. This case once more underscores the value of virtual and classic autopsy forms for quality control (1), because control mechanisms were not sufficient to prevent the displacement of the device. This is why we disagree with Dr. Kirsch in classifying the event as minor. In a patient with septic shock, measuring central venous pressure and providing adequate volume and vasopressor therapy are considered crucial (2). Because this cannot be assured, we classified the central venous line placed into the sigmoid sinus as a “new major finding.”
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