International Journal of Critical Illness and Injury Science最新文献

Boerhaave's syndrome (BS), or spontaneous esophageal perforation, is a rare and life-threatening condition. Despite advancements in medical and surgical management, BS carries a high mortality rate, up to 50%, and presents significant diagnostic and therapeutic challenges. Management options include both surgical and nonoperative approaches, with the Pittsburgh score providing a useful tool for predicting outcomes and guiding treatment. Complications such as mediastinitis and sepsis are common. This review explores the demographics, risk factors, clinical presentation, diagnostic modalities, and management strategies for BS. Furthermore, it stresses the importance of early diagnosis and individualized treatment to improve the outcomes in patients with BS.

Artificial intelligence (AI) refers to machines capable of imitating human cognition, with abilities to learn, apply logic and reasoning, and adapt to new information. The scope of AI in medicine ranges from prehospital triage to assisting in diagnosis and prognosticating patients. AI has shown incredible potential in pediatric emergency department by focusing on the development of clinical prediction models, triage systems, and diagnostic aids, contributing to higher accuracy and efficiency in patient management, along with hospital management, medical education, and training. Our review article discusses the current applications of AI in pediatric emergency and explores the barriers to AI in health care and ways to circumnavigate them moving forward. We aim to offer an insight into this less-explored world where technology meets the unpredictable and fast-paced environment of pediatric emergency medicine, building a future with a promise of innovation and redefining standards of care.

Introduction: Stroke is a leading cause of mortality and disability in India, and the hospital and intensive care unit (ICU) beds are limited. This randomized controlled trial (RCT) aimed to assess the effectiveness of early tracheostomy (ET) in reducing 30-day mortality in stroke patients, and secondary objectives included evaluating rates of ventilator-associated pneumonia (VAP) and length of ICU stay compared to late tracheostomy (LT).

Methods: This open-label RCT was conducted over 18 months at a tertiary care hospital in north India, involving 60 patients (30 in each group). Eligible participants were adults (≥18 years) with nontraumatic stroke (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and vasculitic infarcts) requiring prolonged intubation (stroke-related early tracheostomy score ≥8). Exclusions included preexisting pneumonia, high oxygen needs, pregnancy, and those on ventilation for over 4 days. Patients were assigned to ET (day 4) or LT (day 10), with demographics and clinical characteristics recorded. Mortality was assessed on day 30 postintubation and data for secondary outcomes were collected every other day.

Results: Sixty-four patients were randomized, 30 to the ET group, and 34 to the LT group, with a mean age of 55.48 (±15.94) years. Mortality within 30 days was 50% in both groups. VAP rates were 43.3% in the ET group and 50% in the LT group (P = 0.605). The mean ICU length of stay was 12.07 days for ET and 18.43 days for LT (P = 0.0001).

Conclusion: The RCT found no significant differences in mortality or VAP rates but noted reduced ICU hospital stays for the ET group, suggesting benefits for severe stroke patients.

Introduction: Chronic liver disease is the destruction and regeneration process of the liver parenchyma. Liver cirrhosis is associated with a wide range of cardiovascular abnormalities including hyperdynamic circulation, cirrhotic cardiomyopathy (CCM), and pulmonary vascular abnormalities. CCM was first defined in 2005 at the Montreal World Congress of Gastroenterology. It is considered a condition of latent heart failure that manifests only under stress, resulting in a blunted increase in cardiac output during exercise.

Methods: A total of 100 cases as per the diagnostic criteria of liver cirrhosis were enrolled from the Department of General Medicine of PGIMS, Rohtak. The assessment of cardiac function was done in all the patients. Two-dimensional echocardiogram was done to find evidence of cardiomyopathy and electrocardiogram (ECG) was done to find QT-interval prolongation. Child Turcotte Pugh (CTP) score was calculated for severity. The cardiac dysfunction was compared to the seriousness of the CTP score.

Results: In our study, 57% of patients showed diastolic dysfunction while systolic dysfunction was not seen in any case. Furthermore, 56% of the cases had prolonged QTc interval in ECG. Our study also shows that there is a definitive association between QTc prolongation and disease severity.

Conclusion: CCM is considered an important predictor of morbidity and mortality. The left ventricular ejection fraction at rest is normal in CCM, but there is a blunted increase in cardiac index and cardiac output during exercise. This is difficult to identify because these symptoms are similar to fatigue and exercise intolerance commonly seen in cirrhotic patients.

Introduction: Septic shock is characterized by heterogeneous microcirculatory alterations that may contribute to organ hypoperfusion and eventual death. The microcirculatory alteration can manifest in various clinical indicators, such as the core-to-skin temperature gradient (CSTG) and capillary refill time (CRT), reflecting the microcirculatory state. This prospective observational study explored the prognostic significance of the CSTG and CRT in septic shock.

Methods: The study involved 54 patients over 18 months. The primary objective was to investigate the association between the CSTG measured using infrared thermography with an esophageal temperature probe and 8-day mortality in septic shock cases. Secondary objectives included comparing this gradient with CRT and assessing other parameters such as mean arterial pressure, arterial lactate values, urine output, vasopressor doses, and intensive care unit (ICU) length of stay.

Results: The results indicated a meaningful correlation between the CSTG and 8-day mortality. The mean difference between CSTG was 1.21°C (0.65°C-1.77°C) higher in patients who died within 8 days of ICU admission than in those alive after 8 days of ICU admission. Notably, this temperature gradient demonstrated superior predictive capabilities compared to CRT, as at 6 h after admission, CRT of >4 s could predict 8-day mortality with a sensitivity of 25.6%. At the same time, CSTG of >7°C could predict 8-day mortality with a sensitivity of 87.2%.

Conclusion: The CSTG is a robust predictor of 8-day mortality in septic shock with superior predictive capabilities compared to CRT.

Introduction: Trauma scoring systems are essential for predicting outcomes in trauma patients, guiding clinical decisions, and optimizing resource allocation. Common systems include the Injury Severity Score (ISS), New ISS (NISS), Revised Trauma Score (RTS), Trauma and ISS (TRISS), Emergency Trauma Score (EMTRAS), and Rapid Emergency Medicine Score (REMS). This study aims to evaluate the predictive accuracy of REMS and EMTRAS in comparison to traditional trauma scoring systems.

Methods: This prospective observational study involved 1090 trauma patients admitted to the Department of Emergency Medicine from January 2021 to December 2023. Eligible patients were aged 18 or older with documented trauma. Data collection encompassed demographics, clinical parameters, and trauma severity, assessed using six scoring systems. Outcomes were monitored until patient discharge or death.

Results: The cohort consisted of 915 (83.9%) male patients with a mean age of 36.1 years. Road traffic accidents were the leading cause of trauma, 934 (85.6%). Intensive care unit patients exhibited higher ISS and lower RTS scores (P < 0.0001), indicating more severe injuries. Nonsurvivors showed higher ISS and NISS and lower RTS and TRISS scores. EMTRAS demonstrated higher sensitivity and specificity than REMS, while TRISS proved the most effective in predicting trauma outcomes.

Conclusions: REMS and EMTRAS had reasonable sensitivity and specificity but were less effective than traditional systems such as ISS, NISS, RTS, and TRISS. TRISS emerged as the most reliable tool for predicting outcomes, supporting its continued use as the gold standard in trauma assessment.

Introduction: Chronic low back pain (LBP) is a widespread condition that significantly affects daily life. High mobility group box 1 (HMGB1), a proinflammatory cytokine, may contribute to the pathophysiology of LBP, particularly in relation to nucleus pulposus herniation (NHP). This study aimed to examine the correlation between herniation severity and lumbosacral HMGB1 levels in chronic LBP patients.

Methods: This analytical observational study with a cross-sectional design was conducted in 2023 at Anutapura General Hospital, Palu. A total of 64 chronic LBP patients participated. Serum HMGB1 levels were measured, and magnetic resonance imaging was used to assess herniation severity. Pain severity was evaluated using the Numeric Pain Rating Scale (NPRS).

Results: The mean HMGB1 level was 4701 (±1001.88). LBP onset was most common between 4 and 12 months (mean duration: 11.52 ± 5.54 months), with pain more frequently located on the right side (59%). Grade 3 herniation occurred most often (59%), and moderate pain (NPRS score 6) was the most common. HMGB1 levels peaked in Grade 2 herniation (5939.10 ± 873.26). NPRS scores increased with herniation severity, but weak correlations were found between NHP and HMGB1 (r = 0.174) and between HMGB1 and NPRS (r = 0.114).

Conclusions: No strong relationship was found between NHP and HMGB1 levels in chronic LBP patients. Further studies are needed to clarify HMGB1's role in LBP pathophysiology and its potential as a biomarker for disease severity or treatment response.

Introduction: Bloodstream infections (BSIs) caused by multidrug-resistant (MDR) Gram-negative bacilli pose a significant challenge in healthcare settings around the world. The main objective of this research was to determine the incidence, etiology, risk factors, and sources of BSIs among patients treated at Sohar Hospital in Oman.

Methods: The study employed a retrospective methodology at Sohar Hospital, Oman, analyzing patients with BSIs from January 2018 to December 2019 utilizing electronic health data. Demographic data, bacterial etiology, antibiotic susceptibility, and patient outcomes were obtained from electronic health records. The statistical tools employed comprised t-tests, Mann-Whitney tests, Chi-square tests, and Fisher's exact tests for variable comparison, alongside univariate odds ratios computed for mortality correlations utilizing the R package GTSUMMARY. Bacterial identification and testing was performed in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines utilizing both traditional methods and automated technologies.

Results: The majority of BSIs occur in elderly individuals with comorbidities. Surgical intervention was identified as a predominant risk factor for adverse consequences. MDR infections were linked with higher mortality rates. Klebsiella pneumoniae and Acinetobacter baumannii were prevalent, with K. pneumoniae exhibiting resistance to several antibiotics.

Conclusions: The study highlights the urgent requirement for effective monitoring, management and infectious control measures to reduce the impact of BSIs and MDR pathogens on patient outcomes. It contributes valuable insights into the local epidemiology of BSIs in Oman. It emphasizes the significance of tailored interventions and precise medications to address the growing threat of antimicrobial resistance in healthcare settings.