Pub Date : 2022-02-01DOI: 10.1097/ej9.0000000000000038
E. Mahdy, A. El-Hamid, Reham Mahmoud Shady, Basem Aglan
{"title":"Choosing Between Enoxaparin and Fondaparinux for the Prevention of Thromboembolism: A Meta-Analysis of Randomized Trials","authors":"E. Mahdy, A. El-Hamid, Reham Mahmoud Shady, Basem Aglan","doi":"10.1097/ej9.0000000000000038","DOIUrl":"https://doi.org/10.1097/ej9.0000000000000038","url":null,"abstract":"","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44467173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The role of anticoagulation in preventing and treating thromboembolic events due to presence of micro thrombosis that may affect various end-organs especially in coronavirus disease-19 (COVID-19). Patients receiving some form of anticoagulation therapy are predisposed to more risks of bleeding complications. These bleeding may range from minor to major, or even life-threatening events. Purpose: Low molecular weight heparin (LMWH) is one of the commonly used treatment modalities in COVID-19 and its complications are thrombocytopenia, anemia, bruises, and the rare ones are ecchymosis and/ or hematoma. Case presentation: A 75-year-old male COVID-19 patient weighing 85 kg was admitted to our intensive care unit (ICU) with shortness of breath, dry cough, and myalgia. On the 10th day, he develops ecchymotic patches over the anterior abdominal wall following administration of subcutaneous enoxaparin. This case describes the importance ofindividualizing the dose ofLMWH based on several risk factors.
{"title":"Anterior Abdominal Wall Ecchymosis in COVID-19 Patient Following Enoxaparin Use","authors":"Neeraj Kumar, Abhyuday Kumar, Amarjeet Kumar, Ammu Rose Shaju, Kunal Singh","doi":"10.1097/ej9.0000000000000041","DOIUrl":"https://doi.org/10.1097/ej9.0000000000000041","url":null,"abstract":"Background: The role of anticoagulation in preventing and treating thromboembolic events due to presence of micro thrombosis that may affect various end-organs especially in coronavirus disease-19 (COVID-19). Patients receiving some form of anticoagulation therapy are predisposed to more risks of bleeding complications. These bleeding may range from minor to major, or even life-threatening events. Purpose: Low molecular weight heparin (LMWH) is one of the commonly used treatment modalities in COVID-19 and its complications are thrombocytopenia, anemia, bruises, and the rare ones are ecchymosis and/ or hematoma. Case presentation: A 75-year-old male COVID-19 patient weighing 85 kg was admitted to our intensive care unit (ICU) with shortness of breath, dry cough, and myalgia. On the 10th day, he develops ecchymotic patches over the anterior abdominal wall following administration of subcutaneous enoxaparin. This case describes the importance ofindividualizing the dose ofLMWH based on several risk factors.","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48941305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-31DOI: 10.1097/ej9.0000000000000040
Hesham S Abdelwahed, F. Martinez
{"title":"Multiple Rib Fractures Management in a Tertiary Trauma Center: A Retrospective Observational Study","authors":"Hesham S Abdelwahed, F. Martinez","doi":"10.1097/ej9.0000000000000040","DOIUrl":"https://doi.org/10.1097/ej9.0000000000000040","url":null,"abstract":"","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44776873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diaphragmatic Function Assessment Using Chest Ultrasonography as a Predictor for Weaning from Mechanical Ventilation","authors":"Tamer Sayed Abdel Mawla, Sherif Fattah, Afnan Mahmoud Abdel Halim, Radwa Ahmed Elhefeny","doi":"10.1097/ej9.0000000000000039","DOIUrl":"https://doi.org/10.1097/ej9.0000000000000039","url":null,"abstract":"","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45981905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-02DOI: 10.1097/EJ9.0000000000000002
Walid K. M. Ahmed, Ramy Mohamed El Sayed Ibrahim Kishk, D. Ragab, M. Desouky
Introduction: Venous-to-arterial carbon dioxide pressure and ratio of carbon dioxide gap divided by difference in arterial-venous oxygen content might be relevant in septic shock management. The aim of this study was to evaluate whether carbon dioxide gap and ratio of carbon dioxide gap divided by difference in oxygen content following septic shock resuscitation could predict mortality. Methods: Fifty septic shock patients were included in this study. Arterial and central venous blood gas samples were measured before and 6hours following fluid resuscitation and vasopressors. Results:Our study population was 61.6±7.4 years (31males). Thirty-three patients survived. Paired comparisons in nonsurvivors showed worsening hemodynamics, carbon dioxide gap, ratio of carbon dioxide gap divided by difference in oxygen content, and lactate clearance. Mortality prediction cutoffs for lactate (40mg/dl) with sensitivity (88.2%) and specificity (78.8%), carbon dioxide gap (6 mmHg) with sensitivity (94.1%) and specificity (63.6%) and ratio of carbon dioxide gap divided by difference in oxygen content (1.6) with sensitivity (88.2%) and specificity (60.6%). Combined lactate and the ratio of carbon dioxide gap divided by difference in oxygen content had sensitivity of 88.2% and specificity of 93.9%. Combined lactate and carbon dioxide gap had sensitivity of 82.4% and specificity of 90.9%. Discussion: Changes in carbon dioxide gap and ratio of carbon dioxide gap divided by difference in arterial-venous oxygen content during resuscitation of septic shock were related to in-hospital mortality. Adding carbon dioxide gap and the ratio of carbon dioxide gap divided by difference in arterial-venous oxygen content to lactate increased the accuracy of mortality prediction.
{"title":"Anaerobic Metabolism Markers as a Guide of Resuscitation Effort and Mortality Benefit in Septic Shock Among Egyptian Population","authors":"Walid K. M. Ahmed, Ramy Mohamed El Sayed Ibrahim Kishk, D. Ragab, M. Desouky","doi":"10.1097/EJ9.0000000000000002","DOIUrl":"https://doi.org/10.1097/EJ9.0000000000000002","url":null,"abstract":"Introduction: Venous-to-arterial carbon dioxide pressure and ratio of carbon dioxide gap divided by difference in arterial-venous oxygen content might be relevant in septic shock management. The aim of this study was to evaluate whether carbon dioxide gap and ratio of carbon dioxide gap divided by difference in oxygen content following septic shock resuscitation could predict mortality. Methods: Fifty septic shock patients were included in this study. Arterial and central venous blood gas samples were measured before and 6hours following fluid resuscitation and vasopressors. Results:Our study population was 61.6±7.4 years (31males). Thirty-three patients survived. Paired comparisons in nonsurvivors showed worsening hemodynamics, carbon dioxide gap, ratio of carbon dioxide gap divided by difference in oxygen content, and lactate clearance. Mortality prediction cutoffs for lactate (40mg/dl) with sensitivity (88.2%) and specificity (78.8%), carbon dioxide gap (6 mmHg) with sensitivity (94.1%) and specificity (63.6%) and ratio of carbon dioxide gap divided by difference in oxygen content (1.6) with sensitivity (88.2%) and specificity (60.6%). Combined lactate and the ratio of carbon dioxide gap divided by difference in oxygen content had sensitivity of 88.2% and specificity of 93.9%. Combined lactate and carbon dioxide gap had sensitivity of 82.4% and specificity of 90.9%. Discussion: Changes in carbon dioxide gap and ratio of carbon dioxide gap divided by difference in arterial-venous oxygen content during resuscitation of septic shock were related to in-hospital mortality. Adding carbon dioxide gap and the ratio of carbon dioxide gap divided by difference in arterial-venous oxygen content to lactate increased the accuracy of mortality prediction.","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43849051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-02DOI: 10.1097/EJ9.0000000000000004
Ahmad B. Elden, M. Abdelghany, Mostafa K. Ahmed, Dalia Tarek
Introduction: The aims of this study were to characterize the left ventricular dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the role of the echocardiographic and biochemical cardiac dysfunction indices in predicting clinical outcome. Materials andMethods: This prospective cohort study was carried out on 37 AECOPD patients. Demographic and routine laboratory data were recorded. Clinical data; arterial blood gases; brain natriuretic peptide (BNP); echocardiographic examination including left ventricular (LV) systolic function, mitral valve E wave, mitral valve septal e0, E/e0 ratio (E/e0 ratio as the study LV diastolic dysfunction Index), and tricuspid annular plane systolic excursion weremeasured on admission and on discharge. Patients’ standard spirometric reports were cited. The patients were followed up in the intensive care unit till discharge. Results: There were high E velocities and E/e0 ratios (>14) on admission with significant improvement on discharge, whereas there were insignificant changes in LV systolic function and internal dimensions. About 51.4% of participant had BNP level between 100 and 500 pg/mL. Multivariate analysis showed that both admission BNP and E/e0 ratio were independent predictor of length of stay (R=88.4% and P= .000, R=98.1% and P= .000), and E/é ratio and tricuspid annular plane systolic excursion were independent predictors of elevated BNP (R=0.930, P= .000, P= .009, respectively). None of the COPD obstructive values, admission hemodynamic parameters, and LV systolic indices had a significant impact. Reciever operating characteristic curve (ROC) analysis showed that BNP level >311 pg/mL and E/e0 ratio >15.3 were the significant predictive values for length of stay. Discussion:Most of the AECOPD patients had impaired LV diastolic function and elevated BNP levels that improved after control of the exacerbation. We recommend the use of BNP and E/e0 ratio to risk stratify the AECOPD patients.
{"title":"Cardiac Dysfunction Indices and Their Prognostic Value in Acute Exacerbation COPD Patients","authors":"Ahmad B. Elden, M. Abdelghany, Mostafa K. Ahmed, Dalia Tarek","doi":"10.1097/EJ9.0000000000000004","DOIUrl":"https://doi.org/10.1097/EJ9.0000000000000004","url":null,"abstract":"Introduction: The aims of this study were to characterize the left ventricular dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the role of the echocardiographic and biochemical cardiac dysfunction indices in predicting clinical outcome. Materials andMethods: This prospective cohort study was carried out on 37 AECOPD patients. Demographic and routine laboratory data were recorded. Clinical data; arterial blood gases; brain natriuretic peptide (BNP); echocardiographic examination including left ventricular (LV) systolic function, mitral valve E wave, mitral valve septal e0, E/e0 ratio (E/e0 ratio as the study LV diastolic dysfunction Index), and tricuspid annular plane systolic excursion weremeasured on admission and on discharge. Patients’ standard spirometric reports were cited. The patients were followed up in the intensive care unit till discharge. Results: There were high E velocities and E/e0 ratios (>14) on admission with significant improvement on discharge, whereas there were insignificant changes in LV systolic function and internal dimensions. About 51.4% of participant had BNP level between 100 and 500 pg/mL. Multivariate analysis showed that both admission BNP and E/e0 ratio were independent predictor of length of stay (R=88.4% and P= .000, R=98.1% and P= .000), and E/é ratio and tricuspid annular plane systolic excursion were independent predictors of elevated BNP (R=0.930, P= .000, P= .009, respectively). None of the COPD obstructive values, admission hemodynamic parameters, and LV systolic indices had a significant impact. Reciever operating characteristic curve (ROC) analysis showed that BNP level >311 pg/mL and E/e0 ratio >15.3 were the significant predictive values for length of stay. Discussion:Most of the AECOPD patients had impaired LV diastolic function and elevated BNP levels that improved after control of the exacerbation. We recommend the use of BNP and E/e0 ratio to risk stratify the AECOPD patients.","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46080719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-08DOI: 10.1097/EJ9.0000000000000007
Mohamed Ahmed, M. Abdelnabi, A. Almaghraby
Acute intermittent porphyria is an autosomal dominant inborn error characterized by decreased activity of porphobilinogen deaminase leading to increased levels of haem precursors, namely aminolevulinic acid and porphobilinogen. Posterior reversible encephalopathy syndrome is a clinical radiographic syndrome of heterogeneous etiologies characterized by headache, seizures, altered consciousness, and visual disorder associated with potentially reversible neuroradiological abnormalities predominantly in the parieto-occipital lobes. There are few previous reports of acute intermittent porphyria associated with posterior reversible encephalopathy syndrome, which are thought to result from peaks in hypertension.
{"title":"Acute Intermittent Porphyria, Posterior Reversible Encephalopathy Syndrome and Hypertensive Emergency, A Review of The Literature","authors":"Mohamed Ahmed, M. Abdelnabi, A. Almaghraby","doi":"10.1097/EJ9.0000000000000007","DOIUrl":"https://doi.org/10.1097/EJ9.0000000000000007","url":null,"abstract":"Acute intermittent porphyria is an autosomal dominant inborn error characterized by decreased activity of porphobilinogen deaminase leading to increased levels of haem precursors, namely aminolevulinic acid and porphobilinogen. Posterior reversible encephalopathy syndrome is a clinical radiographic syndrome of heterogeneous etiologies characterized by headache, seizures, altered consciousness, and visual disorder associated with potentially reversible neuroradiological abnormalities predominantly in the parieto-occipital lobes. There are few previous reports of acute intermittent porphyria associated with posterior reversible encephalopathy syndrome, which are thought to result from peaks in hypertension.","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44609790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-08DOI: 10.1097/EJ9.0000000000000005
W. Omar, A. Rabie, A. Battah, A. Moharram
Introduction: Contrast-induced acute kidney injury (CI-AKI) may complicate the course of percutaneous coronary intervention (PCI) and may be associated with adverse outcomes. The aim of this study was to compare the effect of ionic versus nonionic contrast media (CM) on the development of CI-AKI in patients undergoing primary PCI and to determine risk factors for CI-AKI. Methods: This prospective observational cohort study included 102 patients with ST elevation myocardial infarction who were subjected to primary PCI. They either received the ionic CM ioxitalamate (53 patients) or the nonionic CM iohexol (49 patients). The incidence of CI-AKI was compared between the 2 groups as well as different demographic data, risk factors, and clinical and procedural data. Daily serum creatinine was recorded for all patients in the first 72hours following the intervention and until discharge for patients who developed CI-AKI. CI-AKI was defined as a rise in serum creatinine by ≥0.3mg/dL or by more than 1.5 times baseline, or urine volume <0.5mL/kg/h for 6hours in the 72-hour period following primary PCI. Results: Overall, CI-AKI occurred in 17 patients (16.7%). There was no significant difference in the incidence of CI-AKI between the ionic and the nonionic groups. Univariate regression showed that CI-AKI had significant correlation with older age (61.8±8.0 years; P= .006), hypertension (P= .016), preexisting renal dysfunction (P= .025), hemodynamic instability (P= .03), complete revascularization (P= .031), and high contrast volumes exceeding the maximum allowed contrast dose (P= .027). After multivariable adjustment, old age and hypertension were still independent correlates of CI-AKI. CI-AKI was significantly associated with mortality (P< .001). Discussion: CI-AKI frequently complicates primary PCI and is associated with higher incidence of mortality. The incidence of CIAKI seems to be comparable between ionic and nonionic CM post-primary PCI. Optimizing periprocedural hemodynamic stability and using the least possible volume of CM can minimize the risk of CI-AKI.
{"title":"Effect of Ionic Versus Nonionic Contrast Media on the Development of Contrast-Induced Acute Kidney Injury in Patients Undergoing Primary Percutaneous Coronary Intervention","authors":"W. Omar, A. Rabie, A. Battah, A. Moharram","doi":"10.1097/EJ9.0000000000000005","DOIUrl":"https://doi.org/10.1097/EJ9.0000000000000005","url":null,"abstract":"Introduction: Contrast-induced acute kidney injury (CI-AKI) may complicate the course of percutaneous coronary intervention (PCI) and may be associated with adverse outcomes. The aim of this study was to compare the effect of ionic versus nonionic contrast media (CM) on the development of CI-AKI in patients undergoing primary PCI and to determine risk factors for CI-AKI. Methods: This prospective observational cohort study included 102 patients with ST elevation myocardial infarction who were subjected to primary PCI. They either received the ionic CM ioxitalamate (53 patients) or the nonionic CM iohexol (49 patients). The incidence of CI-AKI was compared between the 2 groups as well as different demographic data, risk factors, and clinical and procedural data. Daily serum creatinine was recorded for all patients in the first 72hours following the intervention and until discharge for patients who developed CI-AKI. CI-AKI was defined as a rise in serum creatinine by ≥0.3mg/dL or by more than 1.5 times baseline, or urine volume <0.5mL/kg/h for 6hours in the 72-hour period following primary PCI. Results: Overall, CI-AKI occurred in 17 patients (16.7%). There was no significant difference in the incidence of CI-AKI between the ionic and the nonionic groups. Univariate regression showed that CI-AKI had significant correlation with older age (61.8±8.0 years; P= .006), hypertension (P= .016), preexisting renal dysfunction (P= .025), hemodynamic instability (P= .03), complete revascularization (P= .031), and high contrast volumes exceeding the maximum allowed contrast dose (P= .027). After multivariable adjustment, old age and hypertension were still independent correlates of CI-AKI. CI-AKI was significantly associated with mortality (P< .001). Discussion: CI-AKI frequently complicates primary PCI and is associated with higher incidence of mortality. The incidence of CIAKI seems to be comparable between ionic and nonionic CM post-primary PCI. Optimizing periprocedural hemodynamic stability and using the least possible volume of CM can minimize the risk of CI-AKI.","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44223950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-25DOI: 10.1097/EJ9.0000000000000001
W. Omar, A. Mokhtar, K. Abdelaziz, Hatem Alazizi
Introduction: Endothelial dysfunction plays a major role in the pathophysiology of septic shock and organ dysfunction, and has been suggested to be a predictor of mortality in sepsis. Ultrasound measurement of brachial artery reactivity indices in response to transient ischemia provides indirect estimates of endothelial dysfunction. The aim of this study was to assess whether brachial artery reactivity indices could be used for prognostic assessment of patients with sepsis or not. Methods: Fifty patients with diagnosis of sepsis were subjected to flow-mediated dilatation (FMD) of brachial artery within 24 hours from ICU admission. Measurements were compared in sepsis survivors versus nonsurvivors and correlated with clinical severity scoring systems (acute physiology and chronic health evaluation II and sequential organ failure assessment scores). Another 30 volunteers without acute illness were taken as a control group to determine a normal reference range for FMD. Results: Hyperemic velocity was significantly lower in sepsis group versus control group (71.77±18.67 versus 81.64±9.84, P= .003). FMDwas significantly lower in sepsis group compared to control group (3.72±2.22 versus 5.29±1.74, P= .001). Change in velocity was significantly lower in sepsis group compared to control group (19.53±10.80 versus 31.25±6.72, P< .001). Twenty percent of enrolled patients died within 28 days of hospital admission. Change in velocity was significantly lower in nonsurvivors versus survivors (7.82±2.26 versus 22.45±10.08, P= .001). Change of velocity of 12 cm/cardiac cycle was the cut point in predicting mortality in sepsis with sensitivity of 89.7% and specificity of 100% with a total accuracy of 92% and area under the curve (AUC) of 0.936 (CI 0.866–1.0). Discussion: Brachial artery hyperemic change in blood velocity was a noninvasive indicator of microvascular function that independently predicted mortality in sepsis. In contrast, brachial artery FMD was not associated with mortality in our sepsis cohort.
内皮功能障碍在脓毒症休克和器官功能障碍的病理生理中起着重要作用，并被认为是脓毒症死亡率的预测因子。超声测量臂动脉反应性指数对短暂性缺血的反应提供了内皮功能障碍的间接估计。本研究的目的是评估臂动脉反应性指标是否可以用于脓毒症患者的预后评估。方法:对50例确诊为脓毒症的患者在入院后24小时内行肱动脉血流介导扩张术(FMD)。比较脓毒症幸存者和非幸存者的测量结果，并与临床严重程度评分系统(急性生理和慢性健康评估II和序贯器官衰竭评估评分)相关。另外30名无急性疾病的志愿者作为对照组，以确定口蹄疫的正常参考范围。结果:脓毒症组血充血速度明显低于对照组(71.77±18.67 vs 81.64±9.84,P= 0.003)。脓毒症组fmdp(3.72±2.22)明显低于对照组(5.29±1.74,P= .001)。脓毒症组的流速变化明显低于对照组(19.53±10.80 vs 31.25±6.72,P< 0.001)。20%的患者在入院后28天内死亡。非幸存者的速度变化明显低于幸存者(7.82±2.26比22.45±10.08,P= .001)。12 cm/心动周期速度变化是预测脓毒症死亡率的切入点，敏感性为89.7%，特异性为100%，总准确率为92%，曲线下面积(AUC)为0.936 (CI 0.866-1.0)。讨论:肱动脉充血速度变化是微血管功能的无创指标，可独立预测败血症的死亡率。相反，在我们的败血症队列中，肱动脉FMD与死亡率无关。
{"title":"Predictive Value of Brachial Artery Reactivity in Sepsis","authors":"W. Omar, A. Mokhtar, K. Abdelaziz, Hatem Alazizi","doi":"10.1097/EJ9.0000000000000001","DOIUrl":"https://doi.org/10.1097/EJ9.0000000000000001","url":null,"abstract":"Introduction: Endothelial dysfunction plays a major role in the pathophysiology of septic shock and organ dysfunction, and has been suggested to be a predictor of mortality in sepsis. Ultrasound measurement of brachial artery reactivity indices in response to transient ischemia provides indirect estimates of endothelial dysfunction. The aim of this study was to assess whether brachial artery reactivity indices could be used for prognostic assessment of patients with sepsis or not. Methods: Fifty patients with diagnosis of sepsis were subjected to flow-mediated dilatation (FMD) of brachial artery within 24 hours from ICU admission. Measurements were compared in sepsis survivors versus nonsurvivors and correlated with clinical severity scoring systems (acute physiology and chronic health evaluation II and sequential organ failure assessment scores). Another 30 volunteers without acute illness were taken as a control group to determine a normal reference range for FMD. Results: Hyperemic velocity was significantly lower in sepsis group versus control group (71.77±18.67 versus 81.64±9.84, P= .003). FMDwas significantly lower in sepsis group compared to control group (3.72±2.22 versus 5.29±1.74, P= .001). Change in velocity was significantly lower in sepsis group compared to control group (19.53±10.80 versus 31.25±6.72, P< .001). Twenty percent of enrolled patients died within 28 days of hospital admission. Change in velocity was significantly lower in nonsurvivors versus survivors (7.82±2.26 versus 22.45±10.08, P= .001). Change of velocity of 12 cm/cardiac cycle was the cut point in predicting mortality in sepsis with sensitivity of 89.7% and specificity of 100% with a total accuracy of 92% and area under the curve (AUC) of 0.936 (CI 0.866–1.0). Discussion: Brachial artery hyperemic change in blood velocity was a noninvasive indicator of microvascular function that independently predicted mortality in sepsis. In contrast, brachial artery FMD was not associated with mortality in our sepsis cohort.","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43608292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.1016/j.ejccm.2018.12.018
M. Abouelwafa, Alia Abdelfattah, Waheed Radwan, Akram Bary, M. Khaled, Wael Samy, M. Yousry, A. Saed, Mahmood Saad
Stress induced cardiomyopathy complicated by refractory cardiogenic shock is challenging as treatment by inotropes and vasopressors may be ineffective. We present a case of female patient presented with cardiogenic shock after rupture globe operation, patient presented on mega doses of vasopressors and inotropes, peripheral percutaneous VA ECMO was instituted, IABP was put to deload leftventricle, 2 days later patient was shifted to VAV ECMO. After 4 days of ECMO run patient recovered left ventricular function and patient was weaned from all mechanical support devices. But patient developed septic shock refractory to vasopressors therapy and patient died.
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