Egyptian Journal of Critical Care Medicine最新文献

Background

No reliable data whether periprocedural myocardial necrosis (PPN) has same poor prognostic value as periprocedural myocardial infarction (PMI) or not. We aimed to assess the impact of PPN on short term clinical outcome.

Methods

100 patients admitted with non ST elevation acute coronary syndrome and underwent PCI were enrolled. Patients were grouped according to the occurrence of PPN into 2 groups, and were followed for 3 months. Patients with PMI were excluded.

Results

30 patients (30%) had PPN and were associated with higher risks of major adverse cardiac events (MACE) during the hospital and 3 months follow up (43.3% and 66.7% vs. 12.9% and 14.3% respectively; p < 0.001). PPN was more likely to occur in older, diabetic, previously infracted, and heart failure patients (p value: <0.05), in addition to patients who had lengthy and more complex lesions (p value 0.006 and <0.001 respectively). Each unit increase in Modified Gensini Score (MGS) increased odds of procedural complications 1.2 times, (P value 0.046), which in turn increased odds of short term MACE 5.7 times, (P value 0.003).

Conclusions

PPN are associated with poor short term prognosis. PPN occurs more in diabetic, heart failure, infracted patients and those who have complex lesions.

Background

Phosphorus (P) is an important electrolyte that plays a significant role in different physiological processes especially muscle contraction and adenosine triphosphate (ATP) high energy bonds. Low phosphorus level in blood may increase the exacerbation of chronic obstructive pulmonary disease (COPD), need, and duration of mechanical ventilation (MV).

Work aim

This study aims to examine and evaluate the effect of low serum phosphorus level on patients admitted with acute exacerbation of COPD regarding the need for ventilation, duration of ventilation and outcome.

Methods

We studied fifty patients with acute exacerbation of COPD admitted to chest department and respiratory ICU at Benha University hospital in the period between October 2014 and March 2015. A comparison was made between the group (A) with low phosphorus (<2.5 mg/dl) and group (B) with normal blood phosphorus (2.5–4.5 mg/dl), serum phosphorus was measured on admission. SIMV mode was the mode of MV in all patients.

Results

Sixty percent of the included patients had low levels of phosphorus while 40% had normal phosphorus level, 25 patients (83.3%) of hypophosphatemic group needed MV and 5 patients (16.7%) didn’t need MV, while in the normal phosphorus group, 11 patients (55%) needed MV and 9 patients (45%) didn’t need MV (P:0.032).

Regarding outcome, 18 patients (60%) with hypophosphatemia were discharged while 12 patients (40%) failed to wean and died. In normal phosphorus group, 14 patients (70%) discharged, but 6 patients (30%) failed to wean and died (P: 0.032), in patients with hypophosphatemia 10 patients had pneumonia with COPD, 5 patients of them needed MV and only one died, in patients with normal phosphorus level 7 patients had pneumonia, only one patient needed MV and died.

Conclusion

Hypophosphatemia may contribute to an increase in the COPD exacerbation, the need for ventilation, the duration of ventilation, and may contribute with other factors in increase in the rate of mortality. Therefore, monitoring and correcting its level is imperative.

Introduction

The association between anticardiolipin antibodies (aCL) and cardiac disease in the presence of systemic lupus erythematosus (SLE) has been reported in various clinical trials. However, the correlation between these auto-antibodies and right ventricular (RV) function has been inadequately investigated.

Objective

The present study investigated the possible correlation of the plasma anticardiolipin antibodies, as a marker of autoimmune phenomenon, with RV functions, assessed by right ventricular speckle tracking, in patients with systemic lupus erythematosus independent of significant pulmonary hypertension, systolic dysfunction or valvular disease.

Methods

Forty-six SLE patients and 20 healthy controls were enrolled in our study and submitted thorough history, complete clinical examination then clinical scoring according to SLEDAI-2K score and then laboratory investigations particularly plasma anticardiolipin Ig_G or Ig_M antibodies. Then echocardiography was done to assess cardiac dimensions, left ventricular systolic functions, right ventricular functions and lastly speckle tracking for assessment of the right ventricular systolic strain.

Results

Most of the study patients were young adult females with long-standing SLE (mean = 26 ± 3.1). All study patients had a high clinical SLE score (>6). All patients were normotensives and non-diabetics. No significant correlation was found between anticardiolipin titre and left ventricular dimensions or systolic functions. Significant negative correlation was found between RV strain and plasma level of both anticardiolipin Ig_M and Ig_G.

Conclusion

The present study identified that with the use of 2D speckle tracking in patients with SLE, right ventricular systolic function was significantly diminished with rising plasma titre of autoimmune (Ig_G or Ig_M) antibodies independent of cardiovascular risk factors.

Introduction

Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a known complication, where postoperative (PO) Cystatin C (Cys C) has been shown to be an earlier marker than the relatively late appearing creatinine (Cr). We sought to evaluate the reliability of preoperative (pre-OP) Cys C as a predictor for CSA-AKI in patients with normal renal functions.

Methodology

Our study included consecutive patients undergoing on-pump cardiac surgery from July 2011 to April 2012. Pre-OP and PO Cystatin C and renal profiles were compared in AKI (GP I) and non-AKI (GP II) patients. RIFLE and AKIN criteria were calculated at baseline and daily during the successive three PO days.

Results

Out of 40 patients (16 males; mean age = 59 years), 20 developed AKI. Both Pre-and PO Cys C were significantly higher in GP I, and positively correlated with PO Cr. (r: 0.38 P; 0.01; r: 0.68, p 0.04 respectively). Using ROC curve, a cutoff value of 1.8 mg/l and 1.88 (sensitivity 50 and 80%; specificity 90 and 65%) for Pre-OP and PO Cys C respectively in predicting AKI. Multivariate analysis showed the Pre-OP Cys C and cardiopulmonary bypass time were independent predictors for AKI.

Conclusion

In patients with apparently normal renal functions, preoperative Cys C may be a predictor of post cardiac surgery AKI. In those patients, especially diabetics, Cys C may uncover subtle nephropathy which makes them more prone to AKI posed by stresses of cardiac surgery.

Background: Relatives often lack important information about intensive care unit patients. Research on ways to improve family satisfaction in the ICU has become a crucial point in ICU quality improvement research. Objective: The aim of this study is to develop and analyze a list of commonly asked questions from relatives of patients in the intensive care unit in Arabic countries. This list might help families to determine which questions they want to ask and help them in decision-making process in emergency situations of their critically ill relatives. Methods: This study was a prospective double center study. It took place in the ICUs of two hospitals in Arabic countries: Egypt and Kingdom of Saudi Arabia. Alexandria University Main Hospital in Egypt and the ICU of King Fahad specialist Hospital in Dammam in Saudi Arabia. Data collection was done by reporting of Questions asked by the relatives of ICU patients during daily interview. The list of questions generated was checked to identify questions that could be eliminated. The remaining questions were categorized into 9 different groups: diagnosis, treatment, prognosis, comfort, patient interaction, family, mortality, post-ICU management and other questions. WE ranked the questions in the preliminary list through ICU staff, patients families and the patient themselves. Results: 115 Health care professional (34 physicians and 81 nurses) participated in the data collection, the questions recorded were 2240 questions. It was found that about 1750 questions (78.12%) were duplicated or not clear. The remaining 490 questions were classified into different categories. The same 115 Health care professional (34 physicians and 81 nurses) who shared in the collection of data also shared in the ranking of the questions. 128 first degree relatives shared in the evaluation of the relevance of questions as well as 62 patients after they have been cured and before their discharge from ICU.A list was created including the most important 12 questions which got a score of 3 or more from all the 3 categories who did the assessment (the patients, their relatives and health care professional). Conclusion: This study could provide a real help and guide to the physicians in the ICU and the patients families in the preparation for the families – physicians meetings, save the time lost in poor communication, decrease conflict, increase family satisfaction and help in decision-making process.

Early identification of sepsis and its differentiation from non-infective SIRS are important for sepsis outcome. We intended to evaluate the use of presepsin in differentiating sepsis from noninfectious SIRS and its prognostic value compared to CRP. We included 31 patients (median age 60 year old, 16 males) admitted with SIRS to El-Sahel Teaching Hospital, Egypt after excluding 21 patients with preadmission corticosteroids therapy, blood transfusion, immunosuppressive illness, and ICU length of stay (ICU-LOS) less than 24-hours. Patients were classified into non-infective SIRS group (13 patients) and sepsis group (18 patients). Presepsin, CRP and SOFA score were measured on admission and on days 2 and 4 of admission. The outcome parameters studied were ICU-LOS and in-hospital survival. Apart from temperature and AST which were significantly higher in sepsis group, the two groups were comparable. All the presepsin levels and CRP on days 2 and 4 were significantly higher in sepsis than in SIRS groups. The ICU-LOS was positively correlated with all the presepsin levels and with the CRP levels on days 2 and 4. All presepsin values were significantly higher in survivors while none of the CRP levels were significantly different in survivors and non-survivors. The decrease of presepsin over time was significantly associated with better survival. It was found to be 70% sensitive and 91% specific for predicting survival in SIRS patients. This relation was not found in CRP levels. We concluded that the presepsin can be used for early differentiation between sepsis and non-infectious SIRS and predict higher mortality.

Background

Urinary NGAL is a novel biomarker that is rapidly released after AKI.

Purpose

To study the value of urinary NGAL/creatinine ratio in predicting AKI in the recipient of LDLT.

Methods

A total of 30 recipients of LDLT were included in a prospective, randomized, two center study. All patients were subjected to a measurement of urinary NGAL/creatinine ratio and the serum creatinine at fashioned time intervals to assess which can predict early renal impairment; accordingly, these data were applied on mortality and hospital stay.

Results

Urinary NGAL/creatinine ratio was significant in detecting renal impairment as early as 3, 18, and 24 h post induction of anesthesia (p = 0.001 for all), while it was not significant preoperatively (p = 0.817). Serum creatinine was not significant during the 1st and 2nd days (p = 0.748 and 0.157 respectively), but began to be significant during the 3rd and 4th days (p < 0.001 for both). Urinary NGAL/creatinine ratio was correlated with ICU stay (r = 0.758 with p < 0.001) and mortality during 3, 18, and 24 h postoperative (p < 0.001, <0.001 and 0.005 respectively). The most sensitive in detecting mortality was urinary NGAL/creatinine ratio after 3 h of the operation with a sensitivity of 100% and a specificity of 95.5%.

Conclusion

Urinary NGAL/creatinine ratio may be used as a test for the early prediction of adverse outcome of LDLT recipient patients at ICU admission.

Background

The significance of reciprocal ST segment depression during acute myocardial infarction has been an area of debate, whether it is a sign of multivessel disease, ischemia at a distance or merely a benign electrical phenomenon.

Objective

To study the relation between the presence of reciprocal ST segment depression in ST elevation myocardial infarction, extent of coronary artery disease & left ventricular systolic function.

Patients and methods

A prospective, controlled study involving 200 ST elevation myocardial infarction patients (100 inferior, 100 anterior), each group was sub-grouped into 2 subgroups according to the presence of reciprocal ST segment depression or absence: in anterior STEMI group we had subgroup A1 with RSTD (41 patients) and subgroup A2 without RSTD (59 patients) while in inferior STEMI group each subgroup (B1 and B2) consisted of 50 patients. Echocardiography & coronary angiography were done for all patients.

Results

Patients with reciprocal ST segment depression showed a significant lower mean Left ventricular ejection fraction compared to those without (37 + 3% vs 53 + 5% P < 0.001, anterior ST elevation myocardial infarction subgroups) & (47 + 4% vs 60 + 3% P < 0.001, inferior ST elevation myocardial infarction subgroups). Higher incidence of multivessel disease was found in subgroups with reciprocal ST segment depression (80.5% vs 49.2%, P < 0.001 in anterior ST elevation myocardial infarction) & (60% vs 20%, P < 0.001 in inferior ST elevation myocardial infarction). The mean modified gensini score was higher in subgroups with reciprocal ST segment depression (64.2 + 12.6 vs 30.2 + 6.6, P < 0.001 in anterior infarction group) & (36.2 + 10.6 vs 20.4 + 4.2, p < 0.001 in inferior infarction group).

Conclusion

Reciprocal ST segment depression in acute myocardial infarction was associated with significant LV systolic dysfunction & greater extent of coronary artery disease.

Objectives

The aim of this study is to compare degree of left ventricular dyssynchrony as assessed with phase analysis from Gated myocardial perfusion SPECT (GMPS) to that assessed with Echocardiographic Tissue Doppler Imaging (TDI) in patients with left ventricular EF <35%, QRS complex >120 ms.

Patients & methodology

30 patients were included, all scheduled for CRT. TDI was measured as standard deviation of time to peak systolic velocity in 6 basal segments. Gated SPECT TC-99m sestamibi acquisition was performed, software phase analysis parameters is histogram bandwidth which include 95% of the element of the phase distribution. Study population was divided into two groups: responders and non-responders according to increase of at least 15% of LVEF after 3 months.

Results

ROC analysis was done to reveal that Phase analysis parameter acted in better way to predict CRT response with histogram bandwidth 55.5° Area Under Curve (AUC) 68.9% sensitivity 87% specificity 42.9% positive predictive value (PPV) 83.3% negative predictive value (NPV) 50% compared to TDI sensitivity 52.25%, specificity 71.4% PPV 85.7% NPV 31.3% When applying histogram bandwidth cutoff 55.5° dyssynchrony was illustrated in 20 (87%) patients in comparison to 14 (60%) patients with Echo TDI, there was significant difference in sensitivity of histogram bandwidth compared to TDI with p value 0.043.

Conclusion

Histogram bandwidth of GMPS Tc^99m sestamibi may be more predictive of significant response to CRT as compared to TDI.