Journal of Critical Care Medicine最新文献

Introduction: There is limited information about trends in mortality of intensive care unit (ICU) patients with Coronavirus Disease-2019 (COVID-19) throughout the entire pandemic period.

Aim: We compared the ICU mortality among the four consecutive waves of the pandemic, according to the virus variant predominance.

Methods: This is a retrospective study of prospectively collected data extracted from our COVID-19 clinical database. All adult patients with confirmed SARS-CoV-2 infection, consecutively admitted to our ICU from March 2020 through April 2022, were included. For the analysis we used the dates of the four periods of the pandemic, according to the predominance of different SARS-CoV-2 variants in Greece. Kaplan-Meier and Cox proportional hazards analyses were used.

Results: In total, 805 patients [median (IQR) age 67 (56-76) years, 68% males] were included. APACHE II, Charlson, and SOFA scores were 14 (11-19), 3 (2-5) and 7 (4-9), respectively; 674 (84%) patients required invasive mechanical ventilation. ICU length of stay was 15 (8-29) days, and mechanical ventilation duration was 11 (4-24) days. ICU and hospital mortality was 48% and 54%, respectively. Kaplan-Meier survival curves revealed no significant differences in ICU mortality among the four waves. Age, malignancy, chronic pulmonary disease and SOFA score were independent predictors of ICU mortality, but the pandemic waves themselves were not. Age had a significant impact on ICU mortality across all waves.

Conclusion: The effect of COVID-19 wave (and consequently of the SARS- CoV-2 variant) on ICU mortality seems to be trivial, and therefore our focus should be shifted to other risk factors, such as age and comorbidities. These findings along with those of other studies could be useful for modelling the evolution of future outbreaks.

Objective: We describe a peculiar combination of West Nile virus (WNV) and SARS-CoV-2 infection, suggesting crucial clinical implications for diagnosis and management.

Case report: We present a case of a 57-year-old woman with a past medical history of end-stage renal disease (ESRD), on chronic hemodialysis, and arterial hypertension. She was admitted to the hospital for a 5-day history of fever, headache, vomiting, psychomotor slowing, a diffuse tremor on the four limbs, and diarrhea. Evaluation revealed the presence of neutrophilic leukocytosis, hemoglobin level of 10.5g/dL, elevated C-reactive protein (60 mg/L), serum creatinine of 13.4 mg/dL with hyperkaliemia. Neurologic examination described the following findings: neck stiffness, confusion with motor aphasia, bradylalia, bradypsychia, global hyperreflexia, diffuse tremor, and unstable gait. Brain CT described a calcified temporo-lateral meningioma, CSF examination revealed colorless appearing, 560 leucocytes/3microL (97% lymphocytes), 848 mg/L proteins, glycorrhachia: 54 mg/dL (serum glucose: 101 mg/dL), and the multiplex Real-Time PCR test result was negative. On the second day of admission, the patient tested positive for COVID-19 and she was commenced on therapy with remdesivir, ceftriaxone, dexamethasone, and clexane. Adequate hemodialysis sessions were performed. On the eighth day of admission, the diagnosis of WNV infection was made based on the positive serological findings and the presence of IgM antibodies in the cerebrospinal fluid. After 15 days of hospitalization, the patient was discharged in good clinical condition, except for mild tremor in her limbs.

Conclusions: Periodic epidemic bursts of WNV infection have been reported in Mures County, but present coinfection is rare; the severity and prognosis of the disease are unforeseeable.

Objective: This study investigated whether incidental hyperglycemia serves as an independent risk factor for myocardial infarction (MI) among non-diabetic patients in the emergency department.

Methods: A retrospective case-control study analyzed data from one thousand non-diabetic patients aged 18-85 years who visited the emergency department during January through October two thousand twenty-four Patients were classified into two equal groups based on their random blood glucose levels: patients with glucose levels above 140 mg/dL formed the hyperglycemia group and patients with glucose levels below 140 mg/dL belonged to the normoglycemia group. The analysis employed logistic regression to assess how hyperglycemia related to MI while controlling for various demographic and clinical variables.

Results: The incidence of MI was found in 61.4% of patients with hyperglycemia but only in 25.8% of patients with normoglycemia. Multivariable analysis revealed that incidental hyperglycemia increased the odds of MI by 2.42 times. The risk was higher among male patients and further increased when glucose levels exceeded 180 mg/dL.

Conclusions: Non-diabetic emergency department patients who experience incidental hyperglycemia show a high risk of developing MI. The evaluation of cardiovascular risk should begin with emergency physicians, who should consider elevated random blood glucose as a potential marker for identifying patients likely to benefit from early assessment and follow-up.

Introduction: COVID-19 pneumonia manifests with a wide range of clinical symptoms, from minor flu-like signs to multi-organ failure. Chest computed tomography (CT) is the most effective imaging method for assessing the extent of the pulmonary lesions and correlates with disease severity. Increased workloads during the COVID-19 pandemic led to the development of various artificial intelligence tools to enable quicker diagnoses and quantitative evaluations of the lesions.

Aim of the study: This study aims to analyse the correlation between lung lesions identified on CT scans and the biological inflammatory markers assessed, to establish the survival rate among patients.

Methods: This retrospective study included 120 patients diagnosed with moderate to severe COVID-19 pneumonia who were admitted to the intensive care unit and the internal medicine department between September 2020 and October 2021. Each patient underwent a chest CT scan, which was subsequently analysed by two radiologists and an AI post-processing software. On the same day, blood was collected from the patients to determine inflammatory markers. The markers analysed in this study include the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammatory index, systemic inflammation response index, systemic inflammation index, and serum interleukin-6 value.

Results: There were strong and very strong correlations between the derived inflammatory markers, interleukin-6, and the CT severity scores obtained by the AI algorithm (r=0.851, p<0.001 in the case of NLR). Higher values of the inflammatory markers and high lung opacity scores correlated with a decreased survival rate. Crazy paving was also associated with an increased risk of mortality (OR=2.89, p=0.006).

Conclusions: AI-based chest CT analysis plays a crucial role in assessing patients with COVID-19 pneumonia. When combined with inflammatory markers, it provides a reliable and objective method for evaluating COVID-19 pneumonia, enhancing the accuracy of diagnosis.

Introduction: Hyperglycemia and diabetes have been identified as risk factors for severe COVID-19 and death, with a high rate of reported de novo diabetes. We evaluated their incidence and relationship with adverse outcomes in critically ill COVID-19 patients.

Methods: Prospective single-center longitudinal cohort study in adults hospitalized in intensive care units for confirmed COVID-19. ROC curves for serum glucose and glycated hemoglobin were plotted in relation to 60-day mortality. A Cox proportional hazards model was used to assess the association of diabetes and de novo diabetes with 60-day mortality.

Results: 547 patients were included, with a mean age of 59.8 years; 133 (24.3%) had a history of diabetes, and 67 (12.2%) had de novo diabetes. At 60 days, 317 (57.9%) had died. For mortality, the AUC for glucose at admission was 0.55 (95% CI: 0.48 - 0.62) and 0.51 (95% CI: 0.41 - 0.62) for glycated hemoglobin. In the Cox model, diabetes had an HR of 0.888 (95% CI: 0.695 - 1.135, p: 0.344), history of DM had an HR of 0.881 (95% CI: 0.668 - 1.163, p: 0.371), and de novo diabetes had an HR of 0.963 (95% CI: 0.672 - 1.378, p: 0.835).

Conclusion: There was a high incidence of de novo diabetes in patients hospitalized in intensive care for COVID-19. Neither hyperglycemia, history of diabetes, nor de novo diabetes were associated with the development of complications or 60-day mortality.

Acute respiratory distress syndrome (ARDS) is a severe inflammatory reaction in the lungs caused by sudden pulmonary and systemic injuries. Clinically, this diverse syndrome is marked by sudden hypoxemic respiratory failure and the presence of bilateral lung infiltrates visible on a chest X-ray. ARDS management remains largely supportive, with a focus on optimizing mechanical ventilation strategies and addressing the underlying causes of lung injury. The current pharmacological approach for ARDS primarily focuses on corticosteroids, neuromuscular blocking agents, and beta-2 agonists, however, none has been definitively proven to be consistently effective in improving clinical outcomes. This review summarizes the latest evidence regarding the effectiveness and limitations of these pharmacological interventions, identifying key areas where further research is needed.

Systolic anterior motion (SAM) of the mitral valve refers to the unusual movement of the anterior and sometimes the posterior mitral valve leaflets toward the left ventricular outflow tract (LVOT) during systole. This phenomenon is most frequently associated with the asymmetric septal variant of hypertrophic cardiomyopathy (HCM), but it can also occur in conditions like acute myocardial infarction, diabetes mellitus, hypertensive heart disease, after mitral valve repair, and even in asymptomatic individuals during dobutamine stress tests. We present a case of transient SAM induced by a junctional rhythm along with high doses of dobutamine and nitroglycerin in an intensive care unit (ICU) setting. Transesophageal echocardiography (TEE) played a crucial role in detecting SAM and showed that transitioning from a junctional rhythm to a ventricular paced rhythm led to an improvement in the SAM condition.

Background: Numbers of elderly patients who are being admitted to the intensive care unit (ICU) are increasing; Among ICU patients, elderly patients represent a particular subgroup, with a proportion of up to 50% for patients aged 65 years and over, and on average about 35% of admissions for patients older than 70-75 years. Also, those aged 80 years and older represent around 15% of total ICU population. In Egypt, a study conducted in seven regions found that geriatric patients represent around 48.5% of total ICU admission. Elderly individuals are more susceptible to anemia due to multiple comorbidities and age related changes. Anemia is a common problem among critically ill elderly patients with serious consequences. It is recognized as an independent risk factor for increased mortality and morbidity. In fact, anemia is the most prevalent hematologic disorder in the ICU. The prevalence of anemia among critically ill patients admitted to the ICU ranges from 60 to 66%. Approximately 60% of critically ill patients are anemic at admission, and an additional 40-50% develop anemia during their ICU stay. The condition is particularly common among older patients. Low hemoglobin (Hb) concentrations are associated with prolonged ICU and hospital stays, as well as increased mortality rates. Therefore, anemia is consequently a significant public health issue from the medical and economic perspectives.

Aim: To compare outcomes between anemic and non-anemic critically ill elderly patients admitted to the Geriatric ICU at Ahmed Shawky geriatric Hospital, Ain Shams University hospitals.

Subjects and methods: A Prospective cohort study was conducted on two hundred sixteen elderly patients of both sexes aged 60 years old or older. It was carried out in the geriatric ICU at Ahmed Shawky geriatric Hospital, Ain Shams University Hospitals. Data collection included participants demographics, medical history, full labs assessment and anemia evaluation based on hemoglobin level, Severity of illness was assessed by validated scoring systems, including the Sequential organ failure assessment (SOFA score) on the first day of admission, as well as Acute physiology and chronic Health Evaluation (APACHE II, APACHE IV). Additionally, the Mortality Probability Model Score (MPM0-III) was applied at first day of admission, 48hours and 72 hours following ICU admission. Anemia management strategies were documented, including the use of blood transfusions, iron therapy and other supportive treatments. Clinical outcomes assessed included ICU length of stay, Site of discharge, in-hospital Mortality and the incidence of Hospital acquired infections.

Results: On admission 172(79.6%) of studied subjects were anemic, (90)41.7% had mild anemia, 56(25.9%) had moderate anemia and 26(12%) had severe anemia. Anemic patients showed significantly higher SOFA, MPM 24hrs, MPM 48hrs, MPM 72hrs, APACHE4, SAPSII