International Journal of Critical Illness and Injury Science最新文献

Introduction: Myocardial stunning, a temporary reduction in cardiac contractility, is well-recognized in chronic hemodialysis patients but less studied in critically ill patients undergoing continuous renal replacement therapy (CRRT).

Methods: A prospective observational 11-month study included 38 intensive care unit (ICU) patients with acute kidney injury at Mohammed V University Hospital. Myocardial stunning was evaluated using echocardiographic parameters such as global longitudinal strain and left ventricular ejection fraction.

Results: Myocardial stunning was observed in 60.5% of patients. It was strongly associated with increased vasopressor requirements, longer ICU stays, and higher mortality (47.8% vs. 6.7%).

Conclusion: The high incidence of myocardial stunning in critically ill patients undergoing CRRT highlights the need for vigilant cardiac monitoring and targeted interventions to improve patient outcomes.

Introduction: Early identification of pancreatic necrosis in severe acute pancreatitis (SAP) is essential for timely intervention and improved outcomes. While prior studies have established the diagnostic value of perfusion computed tomography (PCT), they often lacked early follow-up and clinical integration. This study aims to evaluate PCT not only as a predictive tool for early necrosis but also as a clinically actionable modality for risk stratification and management planning.

Methods: A prospective cross-sectional study was conducted on 50 SAP patients who underwent PCT within 72 h of symptom onset. PCT was performed to assess pancreatic blood flow (PBF), pancreatic blood volume (PBV), mean transit time, and time to peak. Follow-up contrast-enhanced CT was performed at 2 weeks to confirm necrosis. Perfusion parameters were compared between necrosis and non-necrosis groups. Diagnostic performance metrics (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were calculated.

Results: Perfusion defects were identified in 21 patients, with 18 (85.7%) subsequently confirmed to have necrosis. The necrosis group had significantly lower PBF (35.49 ± 21.62 mL/100 mL/min) and PBV (11.16 ± 4.84 mL/100 mL) than the non-necrosis group (125.72 ± 50.37 and 17.67 ± 3.80, respectively, P < 0.05). PCT achieved 100% sensitivity, 90.6% specificity, 85.7% PPV, and 90.6% NPV. Optimal cutoff values were BF ≤57.87 and BV ≤14.90.

Conclusion: PCT provides high diagnostic accuracy and valuable prognostic insight in SAP, allowing for early necrosis detection and patient stratification. Its integration into early assessment may improve outcomes and resource utilization.

Introduction: Neurogenic fever (NF) is a noninfectious, centrally mediated hyperthermia seen in patients with traumatic brain injury (TBI) and other neurological conditions. Fever exacerbates secondary brain injury, increases metabolic demand, and worsens patient outcomes. Dopamine agonists such as bromocriptine, which modulate hypothalamic thermoregulation, have been proposed as potential therapeutic agents. This study evaluates the efficacy of prophylactic bromocriptine in preventing NF in patients with severe TBI.

Methods: In this randomized, double-blind, placebo-controlled trial, 100 adult patients with isolated severe TBI admitted within 24 h of injury were assigned to receive either bromocriptine (5 mg twice daily, n = 50) or placebo (n = 50) through enteral administration. NF was defined as a temperature >38.3°C for at least one episode over 2 consecutive days after excluding infectious causes. The primary outcome was NF incidence. Secondary outcomes included fever severity, frequency, onset, mortality, and heart rate-temperature correlation. Data were analyzed using parametric and nonparametric statistical methods.

Results: After exclusions and dropouts, 43 patients in the bromocriptine group and 45 in the placebo group were analyzed. NF incidence was lower in the bromocriptine group (41.86%) compared to placebo (55.56%), but the difference was not statistically significant (P = 0.199). No differences were observed in fever onset, mortality, or heart rate-temperature correlation. Bromocriptine was associated with a reduction in peak temperature on day 5 (P < 0.05).

Conclusion: Prophylactic bromocriptine did not significantly reduce NF incidence in severe TBI but showed trends toward lower fever severity. Further research with larger cohorts and optimized dosing is warranted.

Introduction: Rapid and complete reversal of neuromuscular blockade (NMB) allows for the adequate return of respiration and motor function, thereby expediting recovery and preventing micro-aspirations postoperatively. Diaphragmatic ultrasonography (DUS) is an easy, noninvasive and reliable diagnostic tool to quantify and assess respiratory function and exclude any postoperative residual curarization (PORC). Sugammadex, a modified gamma cyclodextrin reverses NMB faster and more reliably from a deep or profound blockade. We aimed to evaluate the efficacy of Sugammadex for the reversal of NMB in patients undergoing major upper abdominal surgery and to determine the risk of PORC using DUS.

Methods: The present prospective, observational study included patients aged 18-65 years undergoing major upper abdominal surgery. The participants of Group A received Sugammadex and Group B received Neostigmine-Glycopyrrolate as reversal agent. Time of extubation and diaphragmatic thickness was noted at base line, 10 min-30 min postextubation. The statistical analysis was done using SPSS (Statistical Package for the Social Sciences) Version 21.0.

Results: The time required to extubate was significantly shorter in Group A as compared to Group B (81.96 ± 37.30 s vs. 204.20 ± 99.91 s, P < 0.001). The diaphragm thickness at 10 min after extubation was higher in Group A compared to Group B (0.42 ± 0.04 cm vs. 0.4 ± 0.04 cm, P = 0.043).

Conclusion: Sugammadex is more effective in achieving rapid reversal of NMB compared to neostigmine. The use of diaphragm ultrasonography provides valuable insights into respiratory function and the risk of PORC postoperatively.

Background: The aim of this study was to evaluate and compare the ease, difficulties, and complication rate of subclavian venous catheterization using the supraclavicular (SC) and infraclavicular (IC) approach under real-time ultrasound (USG) guidance in intensive care unit (ICU). The primary objective was to compare total procedure time during USG-guided subclavian vein catheterization.

Methods: This was a prospective randomized comparative study. Eighty ICU patients of age >18 years of both genders requiring central venous catheterization were included in the study. Patients were randomly assigned to two groups using computer-generated random number table. USG guide central venous catheterization was done through SC approach in Group SC and through IC approach in Group IC after taking written consent.

Results: The total procedure time was 304.5 ± 9.35 s in Group SC compared to 389.63 ± 18.04 s in Group IC (P < 0.001). The scanning time in SC approach was 85.60 ± 10.67 s and in IC approach 95.95 ± 11.22 s (P < 0.001). The needling time in Group SC was 30.88 ± 4.37 s compared to Group IC (33.08 ± 4.24 s) (P = 0.025). The quality of needle visualization was observed better in Group SC (82.5%) compared to Group IC (47.5%) (P = 0.001). The incidence of arterial puncture (20% vs. 5%), subcutaneous emphysema (2.5% vs. none), hematoma (12.5% vs. 5%), and pneumothorax (7.5% vs. none) has been observed in Group IC versus Group SC, respectively (P > 0.05).

Conclusion: USG-guided SC approach of subclavian vein catheterization has shorter procedural time with better needle visualization and less complication rates than the IC approach.

As gender-affirming surgery becomes more widespread, it is important that healthcare providers recognize complications related to gender-affirming surgery. Although rates of postoperative bleeding after gender-affirming vaginoplasty are relatively low, it is imperative that this potentially life-threatening complication is recognized and managed quickly. This case highlights the importance of a multidisciplinary approach to the management of neovaginal bleeding that was unable to be controlled intraoperatively by suture ligation.

Background: Road traffic accidents (RTAs) remain a prominent cause of mortality and morbidity worldwide. Wearing a helmet while riding a motorbike can significantly minimize injury severity and fatality. This study aimed to identify the factors associated with the use and nonuse of helmets among motorized two-wheelers.

Methods: This observational study was conducted on victims of RTAs who presented to the emergency department of a hospital in Eastern India. Data were collected through a semi-structured questionnaire from March 2021 to December 2021. The data on sociodemographic details of the victims and various extrinsic and intrinsic factors associated with the nonuse of helmets were collected and analyzed.

Results: A total of 346 patients were included. The prevalence of helmet use was 35.7%, and most young adults were helmet nonusers (32.31 ± 12.3 vs. 37.1 ± 12.3, P = 0.15). The pillion riders, alcohol abuse, lower educational levels, and riding on municipal/panchayat roads were associated with statistically significant (P < 0.05) nonuse of helmets. The injury severity score was significantly higher in helmet nonusers (13.20 ± 6.44 vs. 11.23 ± 6.01, P = 0.004). Among the extrinsic factors, fewer traffic checkpoints (P < 0.001), visibility issues (P = 0.02), and use of ear pods (P = 0.01) were significant factors for the nonuse of helmets. In the intrinsic factors, traveling short distances (P < 0.001) and forgetfulness (P < 0.01) were significant factors for the nonuse of helmets.

Conclusions: Traveling short distances, forgetfulness, and fewer traffic check posts are significantly associated with the nonuse of helmets among motorcyclists. Traveling on village or municipality roads and alcohol abuse is significantly associated with helmet nonuse.

Background: Respiratory tract (RT) colonization with Candida spp. is common in ventilated patients. We aimed to investigate the epidemiology of candidal colonization of the RT in patients with malignancies and to assess its prognostic impact.

Methods: A retrospective study was conducted in two intensive care units (ICUs). All adult patients with proven malignancies requiring invasive mechanical ventilation ≥48 h were included. Two groups were compared (Candida+ and Candida-).

Results: One hundred and sixty-one patients were included. Twenty-one (13%) patients grew Candida species in their endotracheal cultures. Candida albicans represented 47.6% of the isolates. In a multivariate analysis, only candiduria was associated with candidal colonization of the RT (odds ratio = 3.86; 95% confidence interval: 1.47-10.13; P = 0.006). The incidence of ventilator-acquired pneumonia was similar between Candida+ and Candida- groups (38.1% and 32.1%, respectively; P = 0.588). The 28-day mortality rate was 55.9% with no significant difference between Candida+ and Candida- groups (66.7% and 54.3%, respectively; P = 0.287). However, Candida+ patients had a longer duration of mechanical ventilation (16 [9.5-29] vs. 6 [2-16] days; P = 0.002) and length of ICU stay (LOS; 20 [11.1-26.5] vs. 9 [3-19] days; P = 0.004).

Conclusion: Candidal colonization of the RT has no impact on 28-day mortality. However, it significantly increases the duration of mechanical ventilation and the LOS.

Background: This article has examined the possibility of communicating with conscious intubated patients using an application and its effect on anxiety and satisfaction.

Methods: This clinical trial study was conducted from March 5, 2021, to August 8, 2023, with the target population of conscious intubated patients hospitalized in intensive care units (ICUs) of hospitals affiliated with Qom University of Medical Sciences in Iran. Patients who met the inclusion criteria were randomly assigned to groups using a randomized block method with blocks of four (27 people in each group). Subjects completed the Hamilton Anxiety Rating Scale questionnaire along with a researcher-made questionnaire to assess satisfaction levels. After 4 days, the questionnaires were re-administered and the results were analyzed using descriptive and analytical statistics, as well as Kruskal-Wallis and t-tests with SPSS version 16.

Results: Both the control and intervention groups had similar demographic characteristics. Postintervention, the satisfaction levels in the intervention group (mean 92.13 ± 16.25) significantly increased compared to the control group (mean 70.50 ± 6.06) (P = 0.001). In addition, anxiety levels after the intervention were lower in the intervention group (mean 29.12 ± 6.51) than in the control group (mean 88.49 ± 46.31) (P = 0.001).

Conclusion: These results have significant implications for patients in ICU who may struggle to communicate their needs. In addition, this communication tool has the potential to enhance the quality of communication between patients and nurses, boost adherence to care plans, lower rates of re-hospitalization, and ultimately improve patient health.