Egyptian Journal of Critical Care Medicine最新文献

Objective

Synthetic cannabinoid drug abuse has been dramatically increasing among young individuals in many countries. There have been reports of serious side effects with SC abuse in these patients. Previous researches have exhibited that neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with mortality and morbidity in many chronic diseases. The aim of this study was to evaluate PLR and NLR in critical care patients with synthetic cannabinoid (bonzai) intoxication.

Materials and methods

One hundred and seven synthetic cannabinoid intoxication patients requiring intensive care and 40 healthy controls were included in the study. Patients characteristics and the complete blood count (CBC) variables, including white blood cell (WBC), hemoglobin (Hb), platelet count, NLR, PLR as well as AST, ALT, albumin total bilirubin, and other routine biochemical parameters were tested. Data analyses were conducted with SPSS-15 software (SPSS Inc., Chicago, Illinois, USA). Statistical significance was set at a p-value of <0.05.

Results

All participants were male, and the mean age of the patients was 21.74 ± 1.57 and healthy controls was 22.62 ± 2.9 years (p > 0.05). All the routine laboratory tests and inflammatory markers (Erythrocyte sedimentation rate and C-reactive protein) were similar between groups. As complete blood cell count; mean WBC values were 9.43 ± 3.27 × 10³/mm³ vs 7.05 ± 2.12 × 10³/mm³ (p < 0.001), mean platelet counts were 237.33 ± 60 × 10³/mm³ vs 263.90 ± 65.98 × 10³/mm³ (p = 0.022), NLR counts were 3.17 ± 1.95 vs 2.32 ± 1.27 (p = 0.003) and PLR values were 114.43 ± 36.39 vs 133.94 ± 45.27 (p = 0.008), in patients and controls, respectively. Cardiac side effects were observed among 36 patients but nobody was died.

Conclusion

Our results exhibited a significant increase of NLR values and decrease of PLR counts among critical care patients with synthetic cannabinoid (bonzai) intoxication. After at least 24 h of intensive care stay without side effects, the patients might transfer out to inpatient clinic for ongoing follow up period and psychiatric consultation.

Objective

The objective of the study was to compare Risk Assessment for Congenital Heart Surgery (RACHS-1), Aristotle Basic Complexity (ABC) and Society of Thoracic Surgeons – European Association for Cardiothoracic Surgery (STS-EACTS) complexity scoring models for predicting outcome after surgery for congenital heart disease.

Methods

This retrospective study included children <18 years. Procedures were categorized based on RACHS-1, ABC and STS-EACTS system. Outcome indicators were prolonged length of ICU stay (upper 25th percentile) and hospital mortality. The stratification models were tested for calibration using Hosmer‑Lemeshow modification of chi-square test and for discrimination using Receiver Operating Characteristic (ROC) curve. Area under the curve (AUC) of individual ROC curves was compared using z-statistics.

Results

The study included 920 patients. All 3 models showed good fit for both prolonged ICU stay and mortality on calibration. STS-EACTS outclassed RACHS-1 and ABC models with AUC of 0.759 for prolonged PLOS and 0.870 for hospital mortality. AUC of ROC curve for STS-EACTS was significantly higher than RACHS-1 model for both prolonged PLOS (p – 0.046) and hospital mortality (p – 0.015). No significant difference was observed between the AUC of ROC curves of other models.

Conclusion

Risk stratification for pediatric heart surgery is a useful tool to predict the outcome. STS-EACTS risk stratification model has the best discriminative power.

Recombinant Tissue Plasminogen Activator (rTPA) is the standard of care for treatment of acute ischemic stroke. Nevertheless, its widespread use in Egypt is hindered by many factors. We report on the first case of acute ischemic stroke to be treated with rTPA at our University hospitals. She received rTPA 4 h and 20 min after the onset of symptoms despite the occurrence of stroke inside the hospital and the availability of rTPA. The patient showed partial improvement after 3 months. We hope that public and medical staff awareness as well as our developing experience relative to treatment of acute ischemic stroke would improve over time allowing for avoidance of long-term suffering of these patients.

Background

Preexisting hyperglycemia worsens the clinical outcome of acute stroke. Do non-diabetic patients with stress hyperglycemia have a similar outcome to those with diabetes mellitus (DM)?

We aimed to assess the glycemic status after acute stroke and its role on stroke outcome.

Methods

61 consecutive patients with acute stroke were included. 41 had hyperglycemia (20 diabetics and 21 non diabetics) and 20 were control. Admission blood glucose level, CT brain and NIHSS were performed. 30 days mortality was the study endpoint.

Results

60.7% males with mean age of 62.9 ± 10.5 years. Compared to control, patients with hyperglycemia had a higher incidence of posterior circulation affection (19.5% vs. 0%, P = .03). The NIHSS was statistically higher than control (14.9 ± 5.9 vs.7.8 ± 3.5, p = .000). The mortality rate and the hospital length of stay were higher than control (65.9% vs. 5.0%, P < .001 and 12.5 ± 9.1 vs. 3.0 ± 4.2 days, P < .001 respectively). NIHSS score, and 30 days mortality were higher in stress hyperglycemia compared to diabetics (17 ± 5.1 vs. 12.7 ± 6.1, P = .018, and 85.7% vs. 45%, P = .006 respectively). Predictors of 30 days mortality were: history of hypertension (P = .04), NIHSS ≥ 10 (sensitivity 91% and specificity 100%) and admission blood glucose ≥ 223 mg/dL (sensitivity 63% and specificity 96%).

Conclusions

Hyperglycemia is associated with poor outcomes after acute stroke. History of HTN, admission glucose level ≥ 223 mg/dL and NIHSS ≥ 10 were predictors of worse stroke outcome.

Background

Cuff leak test (CLT) has been proposed as a simple method of predicting post-extubation stridor (PES), however due to different cut-off point of cuff-leak volume between previous studies, the laryngeal ultrasonography (US) including measurement of air column width was used to predict PES. The aim of the present study was to evaluate the value of laryngeal US versus cuff leak test in predicting PES.

Methods

The study included fifty patients admitted to the Critical Care Department, Cairo University Hospitals from the period of November 2014 to January 2016, intubated for at least 24 h and examined prior to extubation using CLT and laryngeal ultrasound.

Results

Four cases developed PES. CLT identified PES patients with a sensitivity of 75%, with PPV of 50% for leakage volume of 132.5 ml. Laryngeal ultrasound showed a sensitivity of 50% for those patients with air column width before deflation less than 10.955 mm and air column width difference (ACWD) of 0.905 mm with PPV of 11.8% and 14.3% for both respectively.

Conclusion

Both CLT and laryngeal US might have low sensitivity and PPV in predicting PES and should be used with caution in prediction of PES.

Background

The potential benefit of intensive care unit (ICU) admission of hematologic cancer patient requiring mechanical ventilation (MV) still controversial especially with increased cost of needed life support measures.

Objective

To seek clinical predictors of ICU mortality in hematologic cancer patients requiring (MV) during the first day of admission to the ICU.

Design, Setting, Participants: 448 patients were included in this prospective observational cohort study, between May 2014 and May 2016 at the oncology center of Mansoura university hospital.

Measurements and Main Results

ICU mortality was (350 out of 448 patients). Indications of (MV) were sepsis (42%), airway/ pulmonary invasion by tumor (33%), cardiopulmonary arrest (3%), coma (16%) and pulmonary embolism (5%). The independent risk factors for mortality were performance status 3–4(odds ratio, 2.49; 95% confidence interval [1.35:4.60]); cancer recurrence/ progression (odds ratio, 9.31;95% confidence interval, [4.18:21.24]); pao2/ fio2 ratio < 150 (odds ratio, 2.47; 95% confidence interval, [1.344:4.68]); airway/ pulmonary involvement by tumor as a cause of M.V. (odds ratio, 6.73; 95% confidence interval, [2.2:10.05]); sequential organ failure assessment score(excluding respiratory points, each 4 points; odds ratio 2.14; 95% confidence interval, [1.16:3.133]); use of vasopressors (odds ratio, 3.39; confidence interval, [1.73:6.44]).

Conclusion

Poor performance status, cancer status, severity of acute organ failure, use of vasopressors and airway/pulmonary involvement by tumor were the main predictors of mortality. Making use of such clinical data may help to provide intensive care for patients with a potential chance of survival.

Premature Ventricular Contractions is one of the manifestations of ischemic heart disease. Moreover, nitroglycerin is a standard anti-ischemic agent. So why don’t use it as anti-arrhythmic in like our case?

Background

The role of oral hygiene in the intensive care unit is indisputable. Several studies were carried out in different pediatric intensive care units using different oral hygiene regimes. Chlorhexidine preparations are widely used in oral care regimes.

Aim

This study was conducted in the pediatric intensive care unit of Children’s Hospital of Mansoura University, Egypt to unravel the effect of adoption of an oral hygiene protocol using 0.12% chlorhexidine solution on the outcome of mechanically ventilated patients.

Methods

The study comprised 50 patients admitted in the period from January 2013 to August 2016. The sample was analyzed as follow: intervention group (28 patients) and control group (22 patients). The intervention group received a 0.12% chlorhexidine based oral hygiene protocol while the control group received usual oral care without chlorhexidine. Mann-Whitney and Chi-square tests were used.

Results

Duration of mechanical ventilation and length of stay were significantly reduced in the intervention group (p =.003 and .007 respectively). Statistically insignificant difference in development of ventilation-associated pneumonia and mortality between both groups was shown (p = .068 and .208 respectively).

Conclusions

Adoption of a 0.12% chlorhexidine based oral hygiene regime was associated with improved outcome in pediatric intensive care unit.

Background

Ventilator-associated pneumonia (VAP) remains a common cause of intensive care unit (ICU) and hospital morbidity and mortality despite advances in diagnostic techniques and management. We aimed to determine the prevalence, possible complications and in-hospital prognosis of VAP in mechanically ventilated patients.

Methods

This prospective observational, case-control study, was carried out from September 2012 to August 2013. Forty-eight adult patients maintained on mechanical ventilation for more than 48 h in our ICU were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and, at least two of following: (1) fever of ≥38.3 °C, (2) leukocytosis of ≥12,000⧹mm³, and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples of suspected cases were collected and processed as per standard protocols.

Results

The primary underlying diagnosis was acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 25 patients, congestive heart failure in 10, pneumonia in 6, post-operative in 5, neurological diseases in 2 patients. VAP developed in 17 patients (35.4%), gram-negative agents were the major offending pathogen (Pseudomonas aeruginosa accounting for 22.9%). The length of ventilation (LOV) and the length of ICU stay (LOS_ICU) were significantly higher in the VAP group (P = 0.001, 0.0001 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), atelectasis, and infection with multi-drug resistant organisms were more common in the VAP group. Conclusion: Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.

Prediction of fluid status and survival by electrical cardiometry in septic patients with acute circulatory failure.

Background

Septic hemodynamic instability imposes challenges to critical care physician in deciding fluid management to optimize preload dependency state.

Methods

Thirty patients with severe sepsis and hypotension (Mean arterial pressure i.e. MAP < 65 mmHg) and evidence of tissue hypotension i.e. lactate level ≥4 mmol/L were enrolled in our study. Fluid resuscitation (30 ml/kg) was administered. Fluid response was defined as MAP ≥ 65 mmHg with lactate level <4 mmol/L cardiac output (CO), measured by electrical cardiometry, in guiding fluid therapy.

Results

The study included 13 males (43.3%) with age 47.8 ± 19.7. Paired comparison showed significant change in MAP readings (P value < 0.001). ROC curve showed cutoff 12.5% for delta CO to predict fluid responsiveness with Area under Curve (AUC) 0.927, sensitivity 90.0%, and specificity 70.0%. ROC also showed delta CO cutoff 12.5% to predict survival with AUC 0.756, sensitivity 66.7% and specificity 66.7%.

Conclusion

Delta change in cardiac output, measured by electric cardiometry could be used to predict fluid response and survival in acute circulatory failure in septic critically ill patients.