International Journal of Critical Illness and Injury Science最新文献

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.

Background: Accurately monitoring blood glucose levels is vital for critically ill individuals. Point-of-care (POC) glucose meters are commonly used in local intensive care units (ICUs). This study aimed to assess the precision of POC glucose meter readings in critically ill individuals with specific evaluation in patients with and without shock against the reference standard of venous blood glucose measurements.

Methods: An observational study was done on adult patients admitted in the ICU at a teaching institution. Capillary blood samples were collected from the patient's fingertip using lancet device with aseptic measures. The sample was analyzed using the GlucoCare Sense Glucometer (RMD Mediaids Limited, Taiwan). At the same time, 2 ml of blood was drawn from the patient's peripheral veins and analyzed by glucose oxidase-peroxidase method as reference.

Results: POC glucose measurements averaged 140 ± 20.23 mg/dl, while laboratory values were recorded as 116.10 ± 17.13 mg/dl. The difference between the two methods was 24.34 ± 12.01 mg/dl. A strong correlation (r = 0.805) was found between capillary and laboratory blood glucose levels, indicating a significant association (P < 0.0001). Twenty-two (44%) patients were in shock during the study. The mean difference between laboratory and POC blood glucose levels was higher in patients with circulatory shock (36.82 ± 4.84 mg/dl) than those without shock (14.61 ± 4.49 mg/dl), P < 0.05.

Conclusion: POC glucose meters may lead to underdetection of hypoglycemia in critically ill patients, as their values are higher than laboratory values. Moreover, the results showed that POC glucometers are inaccurate for monitoring glucose in hypotensive patients in shock. Standard venous glucose monitoring methods may be more appropriate for these patients.

Background: Many protocols for the treatment of coronavirus disease 2019 (COVID-19) have been published. In addition to an abundance of studies and meta-analyses on the treatment of COVID-19, different medications used in the intensive care unit will have a significant impact on mortality. The study attempted to highlight, compare, and quantify the impact on outcomes.

Methods: Data were collected from subjects' files, encompassing all physiological parameters, hematological profiles, and available laboratory results. In addition, all treatment modalities administered to the subjects were documented in medical files. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards.

Results: The study included 120 subjects with confirmed COVID-19. Subjects treated with systemic corticosteroids (hazard Ratio [HR 0.45, 95% Confidence Interval [CI] 0.01-1.32; P = 0.01) and tocilizumab (HR 0.98, 95% CI 0.49-1.98; P = 0.05) exhibited lower mortality, while those treated with remdesivir (HR 1.13, 95% CI 0.53-2.43; P = 0.05) showed increased mortality. In patients with COVID-19, improved mortality was observed with early rather than late treatment with noninvasive mechanical ventilation (NIV) (HR 0.01 vs. 1.72, P = 0.05) and tocilizumab (HR 0.45 vs. 1.50, P = 0.05).

Conclusions: The early use of NIV is associated with decreased mortality compared to late use. Corticosteroids demonstrate a mortality-reducing effect. In addition, early administration of tocilizumab is associated with decreased mortality compared to late use.

Background: The 2021 Surviving Sepsis Campaign Guidelines recommend the use of hydrocortisone in patients who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy. Fludrocortisone has been used concomitantly with hydrocortisone in some studies without a clearly defined role or known clinical benefit. The purpose of this study was to assess the impact of fludrocortisone added to hydrocortisone on shock-free days for septic shock.

Methods: A single-center, retrospective propensity score-weighted study was conducted to compare hydrocortisone versus hydrocortisone plus fludrocortisone for septic shock. Adults admitted to the medical intensive care unit (ICU) from 2015 to 2020 were included in the study. All patients received ≥200 mg/day hydrocortisone for at least 24 h ± fludrocortisone initiated within 72 h of vasopressors. The primary outcome was shock-free days by day 14. The secondary outcomes included duration of shock, change in Sequential Organ Failure Assessment (SOFA) score, hospital and ICU length of stay, and all-cause inhospital mortality.

Results: A total of 228 patients met inclusion criteria with 212 patients retained after propensity score weighting. There was no difference between groups in 14-day shock-free days (6.3 vs. 6.1 days; P = 0.781). Furthermore, no significant differences were observed for the secondary outcomes of ICU/hospital length of stay, duration of shock, change in SOFA score, and all-cause inhospital mortality.

Conclusion: The addition of fludrocortisone to hydrocortisone in septic shock did not increase shock-free days by day 14. These results suggest that the use of hydrocortisone alone may be an adequate adjunctive therapy in septic shock. A prospective randomized controlled trial is needed to confirm results.