International Journal of Critical Illness and Injury Science最新文献

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.

Severe and nonsevere forms of repeated malaria can cause numerous cognitive impairments, usually in the aspects of problem-solving, executive function, memory, and attention. Several studies have suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of cerebral malaria (CM). Virtual reality (VR) technology potentiates as a useful tool for the assessment and rehabilitation of cognitive processes. The aim of the present systematic review is to examine neuropsychological and behavioral benefits of virtual cognitive rehabilitation training among children with Malaria. Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database (PEDro), Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PubMed, Web of Science, Google Scholar, ClinicalTrials.gov., and Global Health databases were searched for studies that investigated the effect of VR on cognitive functions post-CM. The methodological quality was evaluated using PEDro scale. Six studies were included for qualitative analyses, with five being randomized controlled trials and one was parallel-group randomized trial. The scores on the PEDro scale ranged from 5 to 7 with a mean score of 6. The results showed improvement in various aspects of cognitive functions such as: memory, executive function, and attention in CM survivors. Using computerized cognitive rehabilitation training with the treatment protocol of 16-24 sessions, each of 45-60 min in duration, with 2-3 sessions per week, may improve neuropsychological performance and behavior in terms of executive functions, working memory, and attention in severe malaria survivors.

Background: In the acute care chain, a heterogeneous group of patients seeks medical attention, of whom a small proportion become critically ill. Prediction models, such as the Modified Early Warning Score (MEWS), may assist in the identification of these patients and thereby prevent serious adverse events. The delta score within the emergency room (emergency department [ED]) is associated with outcome. However, it is unknown which factors contribute to these changes in MEWS scores.

Methods: This is a retrospective cohort study at the Amsterdam University Medical Center, which included adult patients presented to the ED by ambulance from March 2022 to October 2022. We collected MEWS at ambulance arrival and 3 h after ED admission, as well as information about diagnostic tests, therapy, and interventions. Our primary outcome was the association of patients' characteristics and acute care actions (diagnostics, therapy, and interventions) with changes in the MEWS score.

Results: A total of 261 patients were included. A higher MEWS at presentation with subsequent improvement was related to better outcomes and they received more therapeutic interventions and the administration of therapy, although these results may have been biased by the need for oxygen supply in respiratory unstable patients. In comparison with patients with normal and stable MEWS scores, they received overall less therapy.

Conclusion: MEWS could be used to predict short-term critical illness in patients presenting to the ED. Further research is needed to evaluate the association of the acute care chains' performance and changes in MEWS scores.