{"title":"Extracorporeal Life Support Organization Registry Report 2022","authors":"P. Rycus, Christine M. Stead","doi":"10.1055/s-0042-1757394","DOIUrl":"https://doi.org/10.1055/s-0042-1757394","url":null,"abstract":"","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73638694","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}
N. Bansal, R. Magoon, Jaffrey Kalaiselvan, ItiShri ItiShri, Jasvinder K Kohli, R. Kashav
Abstract Pulmonary hypertension (PH) often complicates perioperative course following pediatric cardiac surgery, often presenting unique challenges to the attending cardiac anesthesiologist. Apart from difficult weaning from cardiopulmonary bypass, PH can often compound weaning from mechanical ventilation in this postoperative subset. From pathophysiological standpoint, the former can be attributed to concurrent detrimental cardiopulmonary consequences of PH as a multisystemic syndrome. Therefore, with an objective to address the affected systems, that is, cardiac and pulmonary simultaneously, we report combined use of inhaled milrinone (a pulmonary vasodilator) through high-frequency nasal cannula (oxygen reservoir and continuous positive airway pressure delivery device), purported to complement each other's mechanism of action in the management of PH, thereby hastening postoperative recovery. The article additionally presents a nuanced perspective on the advantages of combining the aforementioned therapies and hence proposing the same as a possible “ postoperative cardiopulmonary elixir .”
{"title":"Inhaled Milrinone via HFNC as a Postextubation Cardiopulmonary Elixir: Case Series and Review of Literature","authors":"N. Bansal, R. Magoon, Jaffrey Kalaiselvan, ItiShri ItiShri, Jasvinder K Kohli, R. Kashav","doi":"10.1055/s-0042-1759823","DOIUrl":"https://doi.org/10.1055/s-0042-1759823","url":null,"abstract":"Abstract Pulmonary hypertension (PH) often complicates perioperative course following pediatric cardiac surgery, often presenting unique challenges to the attending cardiac anesthesiologist. Apart from difficult weaning from cardiopulmonary bypass, PH can often compound weaning from mechanical ventilation in this postoperative subset. From pathophysiological standpoint, the former can be attributed to concurrent detrimental cardiopulmonary consequences of PH as a multisystemic syndrome. Therefore, with an objective to address the affected systems, that is, cardiac and pulmonary simultaneously, we report combined use of inhaled milrinone (a pulmonary vasodilator) through high-frequency nasal cannula (oxygen reservoir and continuous positive airway pressure delivery device), purported to complement each other's mechanism of action in the management of PH, thereby hastening postoperative recovery. The article additionally presents a nuanced perspective on the advantages of combining the aforementioned therapies and hence proposing the same as a possible “ postoperative cardiopulmonary elixir .”","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"46 1","pages":"190 - 194"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74738500","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}
Anand Prasoon, R. Singh, R. Anand, Sanjeev Kumar, Siddharth Singh, A. Singh
Context Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in mechanically ventilated patients. Curing and preventing effects of probiotics in promoting the growth of Bifidobacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of VAP are evident. Aims The purpose of this study was to evaluate the effects of administration of commercially available probiotics, that is, orodispersible probiotic sachets on VAP prevention and clinical outcomes in critically ill patients. Settings and Design Randomized control trials. Methods and Materials In this study, 120 mechanically ventilated patients were randomly divided into two groups (n = 60 per group). Group 1 was given orodispersible probiotic sachets by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were analyzed and clinical outcomes to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted. Statistical Analysis Used In this study, data were analyzed via SAS statistical software version 9.4, using Student's t-test, chi-squared test, repeated measure analysis of variance, and Wilcoxon test. Results There was a significant reduction in VAP diagnosed patients, as well as Clostridium difficile-associated diarrhea and some complications of mechanical ventilation, in group 1 in comparison to group 2. The improvement in VAP was significantly greater for group 1 as compared with group 2. However, the mortality rate was similar between two groups. Conclusions This study demonstrated that a daily diet with orodispersible probiotic sachets can be used as add-on therapy with other medications in the prevention of VAP. As a result, the use of orodispersible probiotic sachets in the treatment plan of patients undergoing long-term intubation is recommended.
{"title":"A Randomized Controlled Trial to Evaluate the Use of Probiotics in Prevention of Ventilator-Associated Pneumonia in Critically Ill ICU Patients","authors":"Anand Prasoon, R. Singh, R. Anand, Sanjeev Kumar, Siddharth Singh, A. Singh","doi":"10.1055/s-0042-1754161","DOIUrl":"https://doi.org/10.1055/s-0042-1754161","url":null,"abstract":"\u0000 Context Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in mechanically ventilated patients. Curing and preventing effects of probiotics in promoting the growth of Bifidobacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of VAP are evident.\u0000 Aims The purpose of this study was to evaluate the effects of administration of commercially available probiotics, that is, orodispersible probiotic sachets on VAP prevention and clinical outcomes in critically ill patients.\u0000 Settings and Design Randomized control trials.\u0000 Methods and Materials In this study, 120 mechanically ventilated patients were randomly divided into two groups (n = 60 per group). Group 1 was given orodispersible probiotic sachets by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were analyzed and clinical outcomes to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted.\u0000 Statistical Analysis Used In this study, data were analyzed via SAS statistical software version 9.4, using Student's t-test, chi-squared test, repeated measure analysis of variance, and Wilcoxon test.\u0000 Results There was a significant reduction in VAP diagnosed patients, as well as Clostridium\u0000 difficile-associated diarrhea and some complications of mechanical ventilation, in group 1 in comparison to group 2. The improvement in VAP was significantly greater for group 1 as compared with group 2. However, the mortality rate was similar between two groups.\u0000 Conclusions This study demonstrated that a daily diet with orodispersible probiotic sachets can be used as add-on therapy with other medications in the prevention of VAP. As a result, the use of orodispersible probiotic sachets in the treatment plan of patients undergoing long-term intubation is recommended.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91311708","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}
Postinfarction ventricular septal rupture (VSR) is a rare but dreaded mechanical complication of myocardial infarction. Moreover, patient develops cardiogenic shock or congestive heart failure requiring early surgical intervention. To optimize surgical repair, perioperative confirmation, determining location of VSR and adequacy of repair, is mandatory. Assessment can be obtained by the transesophageal echocardiography (TEE). Use of two- and three-dimensional TEE techniques clearly delineate size and shape of septal rupture and involvement of other cardiac structures. We report a patient presenting with postinfarction VSR for elective VSR repair and surgical revascularization and implication of TEE in perioperative management.
{"title":"Transesophageal Echocardiographic Illustration of Postinfarction Ventricular Septal Rupture","authors":"Devishree Das, M. Prakash, N. Makhija","doi":"10.1055/s-0042-1757368","DOIUrl":"https://doi.org/10.1055/s-0042-1757368","url":null,"abstract":"Postinfarction ventricular septal rupture (VSR) is a rare but dreaded mechanical complication of myocardial infarction. Moreover, patient develops cardiogenic shock or congestive heart failure requiring early surgical intervention. To optimize surgical repair, perioperative confirmation, determining location of VSR and adequacy of repair, is mandatory. Assessment can be obtained by the transesophageal echocardiography (TEE). Use of two- and three-dimensional TEE techniques clearly delineate size and shape of septal rupture and involvement of other cardiac structures. We report a patient presenting with postinfarction VSR for elective VSR repair and surgical revascularization and implication of TEE in perioperative management.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86257370","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}
S. Chandra, Aditi Narang, P. Choudhuri, Kapil Gupta
Abstract Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 has since resulted in more than 250 million cases worldwide and over 50 million deaths. Although treatment is mainly supportive, with oxygen therapy being the mainstay, various pharmacological treatment modalities have also been explored. In this review, we have evaluated the available evidence on airway management as well as medical management and highlighted the possible interventions that may be effective in care of critically ill patients.
{"title":"COVID 19: Airway Management and Pharmacological Strategies","authors":"S. Chandra, Aditi Narang, P. Choudhuri, Kapil Gupta","doi":"10.1055/s-0042-1759862","DOIUrl":"https://doi.org/10.1055/s-0042-1759862","url":null,"abstract":"Abstract Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 has since resulted in more than 250 million cases worldwide and over 50 million deaths. Although treatment is mainly supportive, with oxygen therapy being the mainstay, various pharmacological treatment modalities have also been explored. In this review, we have evaluated the available evidence on airway management as well as medical management and highlighted the possible interventions that may be effective in care of critically ill patients.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"10 1","pages":"210 - 215"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82891424","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}
Many cardiac diseases, like coronary artery disease and some viral cardiomyopathy over a period of time, give rise to the condition calledheart failure (HF).More than2million Indians suffer from HF today. The first line of management includes lifestyle modifications, as well as medical therapy. The latter uses drugs such as beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptors/blockers aldosterone antagonists, diuretics, digoxin, and many others keep getting added with more research and research and development today. Salt and fluid restriction too plays a pivotal role. Patients with a wide QRS complex in their electrocardiogram and thosehavingamoderate to severe symptomsofHFneed to have a cardiac resynchronization therapy and a patient with fatal arrhythmias needs an implantable defibrillator inserted as therapy. So, use of advanced mechanical therapies is a necessity in HF patient. Most HF Indians have class III or class IV symptoms of dyspnea at rest of some duration or a recent origin. In this scenario of advanced mechanical support in HF patient, the two definitive therapies of nearly 6,000 in number and still on the increase are the use of ventricular assist devices (VAD) and heart transplant,which havemet with some success (►Box 1). This editorial briefly revises extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (►Figs. 1 and 2).
{"title":"ECMO and Ventricular Assist Devices as a Bridge to Transplant","authors":"P. Kapoor","doi":"10.1055/s-0042-1759861","DOIUrl":"https://doi.org/10.1055/s-0042-1759861","url":null,"abstract":"Many cardiac diseases, like coronary artery disease and some viral cardiomyopathy over a period of time, give rise to the condition calledheart failure (HF).More than2million Indians suffer from HF today. The first line of management includes lifestyle modifications, as well as medical therapy. The latter uses drugs such as beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptors/blockers aldosterone antagonists, diuretics, digoxin, and many others keep getting added with more research and research and development today. Salt and fluid restriction too plays a pivotal role. Patients with a wide QRS complex in their electrocardiogram and thosehavingamoderate to severe symptomsofHFneed to have a cardiac resynchronization therapy and a patient with fatal arrhythmias needs an implantable defibrillator inserted as therapy. So, use of advanced mechanical therapies is a necessity in HF patient. Most HF Indians have class III or class IV symptoms of dyspnea at rest of some duration or a recent origin. In this scenario of advanced mechanical support in HF patient, the two definitive therapies of nearly 6,000 in number and still on the increase are the use of ventricular assist devices (VAD) and heart transplant,which havemet with some success (►Box 1). This editorial briefly revises extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (►Figs. 1 and 2).","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"134 1","pages":"185 - 189"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89022442","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}
M. Sahu, Seshagiribabu Yagani, S. Singh, U. Singh, Dharmraj Singh, Shivam Panday
Background Normal saline (0.9% NS) is a common intravenous fluid used worldwide. Recent studies have shown that NS use is associated with increased incidence of acute kidney injury (AKI) and a need for renal replacement therapy (RRT). The practice is changing toward using balanced solutions to prevent AKI. Postcardiac surgery patients are more prone to develop AKI after cardiopulmonary bypass (CPB). We aim to study the type of fluid administrated, incidence of AKI, need for RRT, and overall outcome of these patients. Methods This prospective observational study was conducted in the cardiothoracic intensive care unit (cardiothoracic and vascular surgery intensive care unit) in a cohort of 197 adult patients who underwent on pump cardiac surgery in our hospital from July 2021 to October 2021 as a pilot study. Data was analyzed using SPSS 20.0 (IBM, Chicago, Illinois, United States). A p-value < 0.05 was considered significant. Results In our study, 58 (29.34%) patients developed AKI in the first three postoperative days and 16 (8.12%) patients required RRT. Incidence of AKI was found to be higher in patients who received NS only, as fluid of choice was 34.48% compared with other intravenous fluids. Patients with AKI had higher positive fluid balance (p < 0.001), longer CPB (p < 0.001), and aortic cross clamp (p = 0.006) times. Intensive care unit and hospital stay and mortality rates were higher in AKI patients than those without AKI (p < 0.001). Conclusion Our study demonstrated that NS was the commonly used crystalloid in our patients and was associated with increased incidence of AKI and RRT when compared with other balanced salts solutions.
{"title":"Postoperative Fluid Therapy in Adult Cardiac Surgical Patients and Acute Kidney Injury: A Prospective Observational Study","authors":"M. Sahu, Seshagiribabu Yagani, S. Singh, U. Singh, Dharmraj Singh, Shivam Panday","doi":"10.1055/s-0042-1755434","DOIUrl":"https://doi.org/10.1055/s-0042-1755434","url":null,"abstract":"\u0000 Background Normal saline (0.9% NS) is a common intravenous fluid used worldwide. Recent studies have shown that NS use is associated with increased incidence of acute kidney injury (AKI) and a need for renal replacement therapy (RRT). The practice is changing toward using balanced solutions to prevent AKI. Postcardiac surgery patients are more prone to develop AKI after cardiopulmonary bypass (CPB). We aim to study the type of fluid administrated, incidence of AKI, need for RRT, and overall outcome of these patients.\u0000 Methods This prospective observational study was conducted in the cardiothoracic intensive care unit (cardiothoracic and vascular surgery intensive care unit) in a cohort of 197 adult patients who underwent on pump cardiac surgery in our hospital from July 2021 to October 2021 as a pilot study. Data was analyzed using SPSS 20.0 (IBM, Chicago, Illinois, United States). A p-value < 0.05 was considered significant.\u0000 Results In our study, 58 (29.34%) patients developed AKI in the first three postoperative days and 16 (8.12%) patients required RRT. Incidence of AKI was found to be higher in patients who received NS only, as fluid of choice was 34.48% compared with other intravenous fluids. Patients with AKI had higher positive fluid balance (p < 0.001), longer CPB (p < 0.001), and aortic cross clamp (p = 0.006) times. Intensive care unit and hospital stay and mortality rates were higher in AKI patients than those without AKI (p < 0.001).\u0000 Conclusion Our study demonstrated that NS was the commonly used crystalloid in our patients and was associated with increased incidence of AKI and RRT when compared with other balanced salts solutions.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79366025","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}
Abstract Background Vitamin D deficiency is a very common occurrence in cardiac patients. It has been proved that cardiac surgery and cardiopulmonary bypass accelerate the deficiency further. The postoperative outcomes of patients deteriorate in the presence of vitamin D deficiency. Perioperative supplementation of vitamin D is the only solution to the problem. Hence, the present systematic review was conducted to derive the efficacy and safety of vitamin D supplementation on postoperative outcomes in cardiac surgery patients. Method Publications over duration of last 10 years was searched from different database and web sites. The data from full-text research articles were analyzed for the effect on different postoperative outcomes and side effects. Result Eight randomized control trials were retrieved on the effect of perioperative vitamin D supplementation in cardiac surgery patients and their postoperative outcomes. Six articles (75%) were found to be in favor of improvement in postoperative outcome. Two articles (25%) did not find any difference of outcome between the control and treatment group. All the studies observed the restoration of vitamin D to normal and no adverse effects from supplementation. Conclusion Perioperative vitamin D supplementation improves the postoperative outcomes after cardiac surgery. It is effective and safe to supplement vitamin D in cardiac surgery patients.
{"title":"Effect of Vitamin D Supplementation on Postoperative Outcomes in Cardiac Surgery Patients: A Systematic Review","authors":"Sambhunath Das, Punyatoya Bej","doi":"10.1055/s-0042-1759822","DOIUrl":"https://doi.org/10.1055/s-0042-1759822","url":null,"abstract":"Abstract Background Vitamin D deficiency is a very common occurrence in cardiac patients. It has been proved that cardiac surgery and cardiopulmonary bypass accelerate the deficiency further. The postoperative outcomes of patients deteriorate in the presence of vitamin D deficiency. Perioperative supplementation of vitamin D is the only solution to the problem. Hence, the present systematic review was conducted to derive the efficacy and safety of vitamin D supplementation on postoperative outcomes in cardiac surgery patients. Method Publications over duration of last 10 years was searched from different database and web sites. The data from full-text research articles were analyzed for the effect on different postoperative outcomes and side effects. Result Eight randomized control trials were retrieved on the effect of perioperative vitamin D supplementation in cardiac surgery patients and their postoperative outcomes. Six articles (75%) were found to be in favor of improvement in postoperative outcome. Two articles (25%) did not find any difference of outcome between the control and treatment group. All the studies observed the restoration of vitamin D to normal and no adverse effects from supplementation. Conclusion Perioperative vitamin D supplementation improves the postoperative outcomes after cardiac surgery. It is effective and safe to supplement vitamin D in cardiac surgery patients.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"1 1","pages":"195 - 200"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88592336","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}
Armaanjeet Singh, R. Kashav, R. Magoon, Iti Shri, Jasvinder K Kohli
In the December 2021 issue of the Journal of Cardiac Critical Care, we proposed a promising prognostic index, shock index (SI) for risk-stratifying the patients ailing from coronavirus disease 2019 (COVID-19).1 While it is indeed gratifying to witness an increasing research interest in the subject,2–5 the elucidation of nuances of the accruing literature would be of potential interest to the readers of the Journal. Reiterating the basics of the classically described prognostic index, SI is computed as the ratio of heart rate (HR) to systolic blood pressure (SBP).6 Alongside being conducive to the prediction of hemodynamic instability in patients with myocardial infarction and sepsis, the former has also been propounded as a prognostic marker for the in-hospital mortality prediction.7 Notably, a normal SI (0.5–0.7) along with the absence of an elevated lactate level has been associated with a very low risk for severe sepsis at presentation.8 Talking specifically of SI-based prognostication in COVID-19, there have been four studies that analyzed the merit of SI among patients with COVID-19 over the past 2 years of the pandemic. The first study by Doğanay et al provided results in favor of the mortality predictive value of SI.2 In a retrospective evaluation of 489 COVID-19 patients using CHAID (Chi-Square Automatic Interaction Detection Technique" is a statistical tool used for comparing relationship between variables) analysis, they highlighted SI as the factor with the highest predictive value within any given age group with a cutoff of 0.93. They also noted an increase in the association of SI and mortality with advanced age (mortality in patients with SI>0.93 and age<56 years old1⁄426.9%, 56–77 years1⁄480.5%,>77 years1⁄491.4%). These results were corroborated by Kurt et al in their efforts to investigate the mortality predictive potential of SI and modified SI (HR/mean arterial pressure).3 Using the data of 464 patients evaluated retrospectively, they noted a higher predictive power of modified SI compared with SI (DeLong’s test, AUC difference1⁄4–0.020, p1⁄40.003). Similarly, a research endeavor by Ak et al compared various threshold values of SI (0.7, 0.8, 0.9, and 1.0) in 364 COVID-19 cases to assess the predictive performance in terms of intensive care unit (ICU) admission and mortality rate.4 A pre-hospital SI>0.9 was found to be predictive of a higher ICU admission and mortality rate. While these studies show a beneficial aspect of employing SI in risk stratification of COVID-19 patients, van Rensen et al could not elicit a similar result in their study. Their retrospective analysis of 411 patients revealed no discernible discriminative potential of SI for ICU admission and mortality in COVID-19 patients.5 Being a purely hemodynamic parameter, SI emerges as a useful metric for physiological status monitoring.9 At the same time, the inclusion of other vital-system monitoring parameters in SI can buttress the subsequent prognostic potential.
{"title":"Evolution of a Parsimonious Prognostic Index in COVID-19","authors":"Armaanjeet Singh, R. Kashav, R. Magoon, Iti Shri, Jasvinder K Kohli","doi":"10.1055/s-0042-1750197","DOIUrl":"https://doi.org/10.1055/s-0042-1750197","url":null,"abstract":"In the December 2021 issue of the Journal of Cardiac Critical Care, we proposed a promising prognostic index, shock index (SI) for risk-stratifying the patients ailing from coronavirus disease 2019 (COVID-19).1 While it is indeed gratifying to witness an increasing research interest in the subject,2–5 the elucidation of nuances of the accruing literature would be of potential interest to the readers of the Journal. Reiterating the basics of the classically described prognostic index, SI is computed as the ratio of heart rate (HR) to systolic blood pressure (SBP).6 Alongside being conducive to the prediction of hemodynamic instability in patients with myocardial infarction and sepsis, the former has also been propounded as a prognostic marker for the in-hospital mortality prediction.7 Notably, a normal SI (0.5–0.7) along with the absence of an elevated lactate level has been associated with a very low risk for severe sepsis at presentation.8 Talking specifically of SI-based prognostication in COVID-19, there have been four studies that analyzed the merit of SI among patients with COVID-19 over the past 2 years of the pandemic. The first study by Doğanay et al provided results in favor of the mortality predictive value of SI.2 In a retrospective evaluation of 489 COVID-19 patients using CHAID (Chi-Square Automatic Interaction Detection Technique\" is a statistical tool used for comparing relationship between variables) analysis, they highlighted SI as the factor with the highest predictive value within any given age group with a cutoff of 0.93. They also noted an increase in the association of SI and mortality with advanced age (mortality in patients with SI>0.93 and age<56 years old1⁄426.9%, 56–77 years1⁄480.5%,>77 years1⁄491.4%). These results were corroborated by Kurt et al in their efforts to investigate the mortality predictive potential of SI and modified SI (HR/mean arterial pressure).3 Using the data of 464 patients evaluated retrospectively, they noted a higher predictive power of modified SI compared with SI (DeLong’s test, AUC difference1⁄4–0.020, p1⁄40.003). Similarly, a research endeavor by Ak et al compared various threshold values of SI (0.7, 0.8, 0.9, and 1.0) in 364 COVID-19 cases to assess the predictive performance in terms of intensive care unit (ICU) admission and mortality rate.4 A pre-hospital SI>0.9 was found to be predictive of a higher ICU admission and mortality rate. While these studies show a beneficial aspect of employing SI in risk stratification of COVID-19 patients, van Rensen et al could not elicit a similar result in their study. Their retrospective analysis of 411 patients revealed no discernible discriminative potential of SI for ICU admission and mortality in COVID-19 patients.5 Being a purely hemodynamic parameter, SI emerges as a useful metric for physiological status monitoring.9 At the same time, the inclusion of other vital-system monitoring parameters in SI can buttress the subsequent prognostic potential.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84657348","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}
Minati Choudhury, J. Narula, M. Hote, S. Mohapatra
Permanent pacemaker implantation in low birthweight (LBW) babies with congenital complete heart block is extremely challenging due to a paucity of appropriate pulse generator placement pocket sites. The development of infection following an implantation procedure can pose a life-threatening risk to the patients. With more patients in the younger group receiving these devices than ever before and the rate of infection increasing rapidly, a closer look at the burden of infection and its impact on outcome of these patients is warranted. We report mucormycosis infection at the abdominal pacemaker pocket site of an infant requiring pacemaker explantation and re-insertion into the intrapleural space.
{"title":"Mucormycosis: An Uncommon Cutaneous Infection at Permanent Pacemaker-Implanted Site in a Very Low-Birthweight Baby","authors":"Minati Choudhury, J. Narula, M. Hote, S. Mohapatra","doi":"10.1055/s-0041-1739522","DOIUrl":"https://doi.org/10.1055/s-0041-1739522","url":null,"abstract":"Permanent pacemaker implantation in low birthweight (LBW) babies with congenital complete heart block is extremely challenging due to a paucity of appropriate pulse generator placement pocket sites. The development of infection following an implantation procedure can pose a life-threatening risk to the patients. With more patients in the younger group receiving these devices than ever before and the rate of infection increasing rapidly, a closer look at the burden of infection and its impact on outcome of these patients is warranted. We report mucormycosis infection at the abdominal pacemaker pocket site of an infant requiring pacemaker explantation and re-insertion into the intrapleural space.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91236979","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}
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