International Journal of Critical Illness and Injury Science最新文献

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.

Background: Intraoperative chest pain is common in parturients undergoing lower segment cesarean section (LSCS) with subarachnoid block (SAB). The study aimed to quantify the incidence of intraoperative chest pain after oxytocin in patients undergoing LSCS with SAB and to find out its association with relevant factors.

Methods: Consenting parturients undergoing LSCS with SAB were recruited. Those who had any cardiac disease, altered sensorium, had the suboptimal effect of SAB, or needed the use of any other anesthetic agent or additional uterotonic were excluded. Chest pain was graded as follows: Grade 1 - Patient lifted shoulder without restlessness, Grade 2 - Patient lifted shoulder with restlessness, Grade 3 - Patient explicitly complained of chest pain, and Grade 4 - Patient complained of chest pain with desaturation or hypotension or both.

Results: Of 2086 subjects recruited, 4.84% had chest discomfort/pain. The age and the volume of bupivacaine used in SAB were comparable between the groups who had chest pain and those without. Thirty-five (34.65%), 18 (17.82%), 21 (20.8%), and 27 (26.73%) patients had Grade 1, 2, 3, and 4 chest pain/discomfort, respectively. Logistic regression analysis showed that with an increase in age by 1 unit, the odds of chest pain decreased by 1%. With an increase in parity by one, the odds of chest pain decreased by 8%, while those who did not have comorbidities had 11.7% less odds of occurrence of chest pain than those with comorbidities.

Conclusion: The study reliably measured the incidence and characteristics of chest pain/discomfort following oxytocin during LSCS under SAB and its association with relevant factors.

Background: Chronic conditions such as obesity are associated with adverse outcomes in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. The aim of our study was to evaluate the relationship between BMI and outcomes in critically ill patients with COVID-19 ARDS.

Methods: A retrospective study including all patients with COVID-19 and ARDS on mechanical ventilation admitted to the intensive care unit (ICU) over 2 years. Patients with obesity (BMI ≥30 kg/m²) were compared with those without obesity (BMI >18.5 up to 29.9 kg/m²). Outcomes compared were primary (mortality, duration of mechanical ventilation, and length of ICU stay) and secondary complications during the ICU course (inotrope requirement, acute kidney injury [AKI] requiring renal replacement therapy [RRT], and bloodstream and urinary tract infections).

Results: One hundred and eight patients were included in the study. The mean age of patients was 52 years, and 94 (87%) patients were males. As compared to COVID-19 ARDS patients without obesity, COVID-19 patients with obesity were more prone to develop complications like AKI, necessitating continuous RRT (P = 0.005). There was no significant difference in other complications between the two groups (all P > 0.05). There was no increased mortality in these obese patients (P = 0.056). In these patients with obesity, those who also had ischemic heart disease had an increased likelihood of mortality (P = 0.036).

Conclusion: Our study concludes that patients with COVID-19 ARDS who are obese are not at higher risk of mortality and more likely to develop renal complications. When these patients develop cardiac complications or bloodstream infections, they have a significantly higher risk of mortality.

Background: Maintaining cerebral oxygenation is advocated to decrease these central nervous system morbidity and mortality after cardiopulmonary bypass (CPB). This study aimed to assess the effect of temperature and duration of CPB on cerebral saturation during open-heart surgeries and its correlation with postoperative neurological outcomes.

Methods: Patients aged 18-60 years of either sex undergoing open-heart surgeries on CPB were included in the study. Near-infrared spectroscopy was used to monitor regional cerebral saturation (rSO2). Postoperative cognitive dysfunction (POCD) was assessed by mini-mental state examination (MMSE) and trail-making test (TMT-A). Postoperative neurological deficit was assessed clinically and by the western perioperative neurologic scale (WPNS). All patients were followed up for 6 months.

Results: Sixty patients were included in the study. After the institution of CPB, mean core body temperature (CBT) decreased from baseline (36.29 ± 0.21) till 40 min and mean rSO2 decreased from baseline (72.48 ± 3.81) till 60 min. No significant correlation was found between mean CBT and mean rSO2. For every 5-min increase in total CPB duration, a decrease of minimum rSO2 by 2.48 was observed (P < 0.001). Based on the MMSE score and TMT-A, minimum rSO2 values and POCD were significantly associated at postextubation and 24 h postextubation. Based on the WPNS score, minimum rSO2 and postoperative neurological deficit were significantly associated with 24 h postextubation (P = 0.040).

Conclusion: Early rewarming on CPB is associated with relatively low rSO2. Intraoperative rSO2 desaturation showed a significant association with early cognitive decline, but its role is debatable in assessing late cognitive decline.

Background: This study intended to assess the quality of life (QOL) with telephonic interview using the Short Form 12 (SF-12) Scale in follow-up patients admitted to the intensive care unit (ICU) with COVID-19 pneumonia.

Methods: This prospective, noninterventional follow-up study was conducted at a tertiary care center. COVID-19 pneumonia patients discharged from ICU were recruited for telephonic interviews. Interviews were performed using SF-12 Scale to assess QOL 6 months after discharge. The SF-12 survey measures general health status in eight domains. A radar chart was used for the interpretation of health component scores.

Results: One hundred and fifty patients could complete the telephonic interview. The first-stage depression risk was 50%, which was 30% more than general position incidence (20%). As compared to the general population, physical component summary (PCS-12) was 60% below and mental component summary (MCS-12) was 67% below the general norm. Role emotional was the most affected followed by role physical.

Conclusions: QOL in follow-up ICU patients with COVID-19 pneumonia was worse in terms of physical and mental scores. By employing a comprehensive, longitudinal assessment of QOL in follow-up patients, using validated SF-12 Scale, this study captures a multifaceted view of their health status postrecovery.

Background: Optic nerve sheath diameter (ONSD) is used as a surrogate for intracranial pressure (ICP) with a marked variation in its optimal cutoff in various subgroups of neurocritical illnesses. Real-world data on ultrasound (US)-ONSD performance among a diverse population and its trend corresponding with clinical deterioration are scarce. We aim to determine the diagnostic performance of ONSD compared to computed tomography (CT) in predicting elevated ICP in a mixed population of neurocritical patients.

Methods: Baseline ONSD measurements (T1) using B-mode US were recorded among eligible patients. Follow-up ONSD (T2) was recorded during clinical deterioration defined by ≥2 drops in Glasgow Coma Scale/Full Outline of UnResponsiveness (GCS/FOUR) scores. Its diagnostic performance in predicting elevated ICP was assessed by comparing it with the concurrently taken CT findings as a reference standard. The difference between the two ONSD measurements was termed delta ONSD.

Results: In the final analysis, 129 participants were included. The population comprised traumatic brain injury, stroke (hemorrhagic and ischemic), intracranial space-occupying lesions, and other medical conditions. The optimal ONSD (T2) cutoff of 5.23 mm had a diagnostic accuracy of 80.73% to predict elevated ICP (sensitivity: 82%; specificity: 78%; area under the curve: 0.88; and 95% confidence interval [CI]: 0.819-0.941). Each unit increase in delta ONSD was associated with increased odds of need for surgical intervention (odds ratio [OR]: 3.91; 95% CI: 1.31-12.6, P = 0.017) and death at intensive care unit discharge (OR: 8.24; 95% CI: 1.78-41.15, P = 0.007).

Conclusions: ONSD cutoff of 5.23 mm has a good diagnostic accuracy in predicting elevated ICP compared to CT during clinical deterioration. ONSD measurements correlate well with corresponding GCS/FOUR scores.