International Journal of Critical Illness and Injury Science最新文献

Background: Train collision accidents are tragic events associated with high mortality. The study aimed to comprehensively describe the clinical-epidemiological profile, disaster emergency response, and management following a train collision accident in Odisha, India.

Methods: This observational study was conducted by a tertiary care hospital in eastern India. Data were collected from the hospital records, telephonically from the victims or their relatives, and from electronic and print media. Subjects with complete data were included. Those who had died on the spot or upon arrival to the emergency department (ED) and with incomplete or unavailable data were excluded. Statistical analysis of data was performed using R 4.1.0 software.

Results: After triaging, 198 subjects were included and analyzed. Most of the subjects were young (29 [34-40] years), belonging to male 182 (92%) gender. At ED triage, 41 (21%) subjects were categorized as red, 103 (52%) as yellow, 54 (27%) as green, and two subjects as black. Regarding the mode of transport to the ED, 57 (29%), 17 (9%), and 124 (63%) subjects were transported by ambulances, police vans, and private vehicles, respectively. Among the included subjects, 96 (48%), 65 (33%), and 49 (25%) had head injuries, maxillofacial injuries, and blunt chest trauma, respectively, and the majority (n = 185 [93.4%]) had associated external injuries.

Conclusions: A coordinated effort by various government, nongovernment agencies, and local communities played an important role in the aftermath of the disaster to save lives. A well-trained medical emergency disaster response team involving multiple stakeholders can help mitigate such tragic incidents.

Background: Remdesivir is commonly used for inpatient treatment of coronavirus disease of 2019 (COVID-19) and may be associated with bradycardia. The objective is to investigate the incidence of bradycardia in patients with COVID-19 receiving remdesivir and evaluate potential risk factors associated with bradycardia.

Methods: This single-center, retrospective, cohort study evaluated the incidence of bradycardia during and up to 48 h after remdesivir administration in adults admitted to the medical center for treatment of COVID-19. Secondary endpoints included time to bradycardia after remdesivir administration, incidence of severe bradycardia, incidence of early remdesivir discontinuation due to bradycardia, interventions to treat bradycardia, and inpatient mortality. Univariate analyses were performed to determine factors associated with remdesivir-related bradycardia. Risk factors significant at the 0.20 level in the univariate analysis were entered into a stepwise backward regression analysis to evaluate potential risk factors.

Results: Bradycardia occurred in 61 (49.2%) of patients with a median nadir of 50 bpm. Median baseline heart rate (HR) was lower in patients who developed bradycardia (79 [67-89] vs. 91 [80-100] P < 0.001). Patients who developed bradycardia had a trend for more nonblack race, higher severity of illness, concurrent acute respiratory distress syndrome diagnosis, history of liver disease, and less hypomagnesemia. Only baseline HR as measured before remdesivir initiation was independently associated with bradycardia by multivariate analysis. Patients who developed bradycardia had a higher inpatient mortality (26.2% vs. 11.1%, P = 0.03).

Conclusion: Remdesivir-associated bradycardia is common. Baseline HR was identified as an independent risk factor for bradycardia in hospitalized patients being treated with remdesivir for COVID-19.

Background: One of the most vital forms of the affected patient safety is pressure ulcers (PUs), which can be a critical health problem that every day impacts sufferers and healthcare structures. This study aimed to explore the level of nurse's knowledge and perceived barriers regarding PUs prevention among critically ill patients.

Methods: This cross-sectional study was conducted among 100 nurses who working in the critical care units (CCUs) at tertiary teaching hospitals in Baghdad City, the study extended from April to June 2024 to assess the nurses' knowledge level using the knowledge perceived barriers on the prevention of PUs questionnaire. The data were analyzed using descriptive and inferential statistics (SPSS version 26).

Results: The age of the participants included in this study ranged between 18 and 27 years with a mean age of (28.61 ± 6.603) years and females accounted 55% of total study participants. The highest group of the study population has finished their bachelor's degree (74%). Moreover, less than half of the study population (43%) had <5 years of experience in CCU.

Conclusions: Nurses' knowledge on the prevention of PU in CCUs is satisfactory in this study and moderately has a high level of perceived barriers toward PU prevention. Several barriers perceived to affect patients' quality of care regarding proper prevention of PUs were identified by Iraqi CCUs. The findings of this study suggest that several barriers need to be resolved if proper prevention of PUs is to be guaranteed in CCUs.

Background: Sepsis, a major global health concern, leads to millions of deaths annually, hence the need for early and reliable prognostic tools to assess patient risk and guide clinical decision making becomes crucial. This cross-sectional study evaluated the prognostic accuracy of integrating blood lactate and serum procalcitonin (PCT) levels with the National Early Warning Score (NEWS) for predicting mortality in sepsis patients. The objective was to assess whether this lactate and procalcitonin integrated with NEWS score (LP NEWS) could serve as a more effective early prognostic tool compared to established severity scores.

Methods: Spanning 12 months, the study enrolled adult patients meeting the criteria of sepsis in the ICU and medicine ward of a tertiary care hospital in North India. Data collection included demographics, clinical characteristics, and blood samples for lactate and PCT at admission. NEWS, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and LP-NEWS scores were calculated with treatment administered per Surviving Sepsis-3 guidelines.

Results: The research included 200 participants, uncovering significant correlations between blood lactate, PCT levels, and mortality. Survivors had a mean lactate of 2.12 ± 0.70 and PCT of 11.27 ± 11.75, while nonsurvivors had 3.30 ± 1.17 and 30 ± 18.48, respectively (P < 0.001). LP-NEWS significantly differentiated survivors from nonsurvivors (8.23 ± 2.02 vs. 14.12 ± 2.23), with a cutoff of 11 showing 96.9% sensitivity and 88.5% specificity for predicting mortality. LP-NEWS had the highest odds ratio = 3.12, P < 0.001, and area under the receiver operating characteristic curve value (0.966), outperforming APACHE II and SOFA scores.

Conclusion: The LP-NEWS score which integrates blood lactate and serum PCT levels could serve as an effective standalone bedside score, particularly in the initial risk stratification of sepsis.

Background: Neonatal sepsis is a significant cause of mortality in children under 5 years of age globally, with the highest incidence reported in India. The challenges in diagnosing neonatal sepsis often result in the irrational use of antibiotics. The aim of the study was to determine the diagnostic efficacy of interleukin 27 (IL-27) as a novel biomarker for the early diagnosis of neonatal sepsis.

Methods: This prospective cohort study was conducted at a tertiary care hospital in North India from May 2019 to April 2020. Eighty neonates suspected of sepsis were enrolled based on the sepsis screen criteria approved by the National Neonatal Forum of India. Blood samples were collected for culture and biomarker analysis, with C-reactive protein (CRP), procalcitonin (PCT), and IL-27 levels measured. The diagnostic performance of IL-27 was compared to that of CRP and PCT.

Results: Out of 80 neonates, 56% were male and 44% were female. Blood cultures were positive in 51.2% of cases. The most common pathogens isolated were Gram-negative bacteria (41%), fungi (34%), and Gram-positive bacteria (25%). IL-27 demonstrated a sensitivity of 78.05%, specificity of 61.54%, positive predictive value of 68.09%, and negative predictive value (NPV) of 72.73%. In comparison, PCT showed the highest sensitivity (82.93%), and CRP had the highest specificity (79.49%). IL-27 levels were notably higher in blood culture-positive cases.

Conclusions: IL-27 is a promising biomarker for the early diagnosis of neonatal sepsis, showing comparable sensitivity and NPV to PCT, but with lower specificity than CRP.

Background: Sepsis-induced acute kidney injury (AKI) is difficult to prevent because most patients are diagnosed after they develop it. Standard serum and urine creatinine levels are insensitive and nonspecific for detecting kidney injury in its early stages. Glutathione S-transferase (GST) has received little attention as a biomarker in AKI.

Methods: This study included 65 adult patients with sepsis who developed oliguria within 72 h of admission. Baseline serum creatinine values were recorded at least 1 month before or after intensive care unit (ICU) admission. The clinical endpoints were defined as the occurrence of advanced AKI stages 2 or 3 according to the KDIGO classification. Serum creatinine and urinary GST levels were measured every 6 h from admission until 72 h postoliguria development. The primary objective was to assess the correlation between urinary GST and serum creatinine levels in patients with sepsis-induced AKI.

Results: Among the 65 patients, 13 (20%) progressed to AKI Grade I, while 52 (80%) progressed to AKI Grade II or III. Both groups exhibited an increasing trend in serum creatinine and urinary GST levels up to 72 h. Significant mean differences between the two AKI groups were observed at 48 and 72 h for serum creatinine (P = 0.021 and P = 0.007, respectively) and at 18 h for urinary GST levels (P = 0.044).

Conclusion: Urinary GST levels demonstrated an earlier elevation than serum creatinine levels in critically ill sepsis patients, underscoring their utility as a valuable tool for the early diagnosis and predicting AKI following admission to the ICU.

Over the past three decades, awareness regarding pain management in neonates has risen significantly. It has been very well established that neonates can perceive, feel, and react to stimuli that cause pain and discomfort to them. Neonates admitted to neonatal intensive care units (NICUs) are repeatedly subjected to invasive treatments, most of which are painful. These procedures, nevertheless, are still performed, sometimes without sufficient analgesia. Exposure to frequent traumatic and painful procedures has been associated with several adverse effects such as altered brain growth and signs of internalization. Both inadequate and excessive analgesia during this period of rapid development may lead to profound neurodevelopmental outcomes. Ensuring the avoidance of pain in NICUs is a crucial obligation from both ethical and medical standpoints. Despite established international criteria, there is currently insufficient adherence to this criterion, highlighting the need for additional development in uniformly providing effective pain management to newborns in NICUs.

Background: Hospitalized patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are at risk of further clinical deterioration and poor outcome. In this study, clinical risk factors of the requirement of mechanical ventilation within the first 24 h of hospital admission in coronavirus disease 2019 pneumonia patients have been evaluated.

Methods: In this retrospective study, admission characteristics of SARS-CoV-2-infected patients and risk factors for requiring mechanical ventilation and death within 24 h of admission have been evaluated. Predictive ability was evaluated by area under the receiver operating characteristic (AUROC) curve and independent association was checked by a logistic regression model.

Results: One hundred and forty-three subjects were recruited in this study and the median (interquartile range) age of the included subjects was 51 (40-60) years, and 68.5% (98 of 143) patients were male. Subjects who required mechanical ventilation in the first 24 h of admission had higher baseline respiratory rate (P < 0.0001), lower oxyhemoglobin saturation (P < 0.0001), higher serum lactate (P < 0.0001), and higher percentage of subjects complained of shortness of breath at the time of presentation (P = 0.005) and higher sequential organ function assessment (SOFA) score (P < 0.001). Serum lactate, baseline respiratory rate, and oxyhemoglobin saturation were predictors of the requirement of mechanical ventilation with an AUROC (95% confidence interval) of 0.80 (0.72-0.88), 0.75 (0.66-0.84), and 0.77 (0.68-0.86), respectively. Logistic regression revealed that a model reported that baseline serum lactate (P < 0.001) and SOFA score (P < 0.001) were independent predictors of mechanical ventilation within 24 h of intensive care unit admission.

Conclusion: Baseline serum lactate level predicts early requirement of mechanical ventilation in adult subjects with SARS-CoV-2 infection even after adjustment of disease severity parameters, SOFA score.

The current literature provides contradictory results concerning the impact of ketamine-induced anesthesia on traumatic brain injury (TBI) outcomes. This study aimed to investigate the potential of ketamine boluses to influence the brain pathophysiology in TBI patients. Twenty-one studies (n = 886) were extracted from PubMed, Web of Science, Scopus, CINAHL, and Cochrane Library. The primary endpoints included intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The secondary endpoints were mean arterial pressure (MAP), heart rate (HR), electroencephalography (EEG), mean cerebral blood flow velocity, jugular oxygen saturation, ventilation, neurological outcomes, mortality, and overall efficacy and side-effects of ketamine-induced anesthesia. Four studies indicated a statistically significant decline in ICP in TBI patients, with ketamine sedation. Contrastingly, two studies revealed statistically significant ICP elevations, after ketamine-induced anesthesia, in TBI patients. Five studies negated any correlation between ketamine dosages and ICP changes. Three studies indicated a statistically significant increase in CPP after ketamine-induced anesthesia in TBI patients. One study revealed CPP decline after the administration of ketamine-midazolam treatment to TBI patients. Five studies revealed no noticeable influence of ketamine bolus on CPP in TBI patients. Similarly, inconsistent variations were observed in most of the secondary endpoints, including electroencephalography, neurologic outcomes, and ketamine-related side effects (all P <0.05). This systematic review emphasizes the role of ketamine-induced anesthesia in inconsistently improving or deteriorating clinical outcomes in patients with TBI. Future studies should evaluate the predominant causes (i.e., factors and attributes) of ketamine-related clinical outcomes in the TBI setting.