Journal of Critical Care Medicine最新文献

Objective: To analyze the frequency and types of postoperative complications and risk factors for in-hospital mortality.

Methods: This retrospective longitudinal study included adult patients who underwent surgical procedures and were admitted to the intensive care unit of a university hospital between March and July 2022. Study variables included sociodemographic, clinical, and epidemiological data; postoperative complications and hospital outcomes. The significance level was set at 5%.

Results: We analyzed 202 patients, with a median age of 67 years (IQR 55-74) and a predominance of males (62.4%). Inhospital mortality was 26.2%. Postoperative complications occurred in 84.7% of patients, with cardiovascular (53.4%), infectious (49.5%), and gastrointestinal (48.5%) complications being the most frequent. Early postoperative feeding was initiated in 34.2% of cases, and a delay was associated with a higher risk of complications. Nausea and vomiting prophylaxis were administered to most patients-intraoperatively in 61.9% and postoperatively in 96%. In logistic regression analysis, female sex, urgent surgery, and higher SAPS 3 scores were identified as independent risk factors for death.

Conclusions: Postoperative complications were highly prevalent and associated with an increased risk of death. Intra-operative nausea and vomiting prophylaxis and early postoperative feeding were associated with a lower frequency of complications. Identified risk factors for mortality included female sex, higher SAPS 3 scores, and urgent surgeries.

Introduction: The use of selective digestive decontamination (SDD) in critically ill patients remains controversial. The impact of antimicrobial resistance varies according to multiple factors attributed to the type of patient and the characteristics of intensive care units (ICU).

Aim of the study: to describe the effect of the implementation of a selective digestive decontamination protocol on the incidence of nosocomial infections and colonization of multidrug-resistant organisms (MDRO) in an intensive care unit.

Materials and methods: Prospective observational study in a general ICU of a University Hospital. All patients admitted for 2 years (divided into 1-year periods) before and after the implementation of the SDD were included. This intervention was performed in all patients who received invasive mechanical ventilation in the second period. Incidence density rates were determined for all nosocomial infections (per days of stay) and device-associated infections (per days of use), and risk ratio (RR) were calculated with 95% confidence intervals. Microbiological surveillance of the colonization status of patients was performed on admission and on a weekly basis. A univariate analysis was performed for comparison between groups. A p<0.05 was considered significant.

Results: A total of 1532 patients were included in the pre-intervention period (pre-SDD) and 1734 in the post-intervention period (post-SDD). The incidence of all infections decreased [9.21 vs 6.54 per days of stay; RR: 0,71 (0,428 - 1,172), p=0,16], although not significantly. Both catheter-related bacteremias and all catheter-related bacteremias together (primary and secondary) were significantly reduced [4.49 vs 0.71 per 1000 days of use; RR: 0,157 (0,017 - 0,723), p=0,006]. The colonization rates by MDRO also decreased (3.26% vs 2.36%), but not significantly.

Conclusions: Implementation of SDD significantly decreased the number of catheter-related bacteraemias, without an increase in MDRO colonization.

Acute Respiratory Distress Syndrome [ARDS] is a critical condition characterized by severe respiratory failure due to widespread lung inflammation, which can arise from various causes including trauma, infections, and systemic diseases. Among the rare causes is infection with Ascaris lumbricoides, a helminth typically affecting the gastrointestinal tract but capable of causing severe respiratory complications. We present the case of a 41-year-old woman with acute respiratory distress and negative viral and bacterial tests, who was ultimately diagnosed with Ascaris lumbricoides-induced ARDS. Her management included mechanical ventilation, antimicrobial therapy, corticosteroids, and eventually anthelmintic treatment after discovering the parasite. Despite initial deterioration and severe hypoxemia, the patient improved significantly following anthelmintic therapy, allowing extubation on day 8 and ICU discharge on day 12. Helminth-induced ARDS, though rare, should be considered in critically ill patients, especially in endemic regions. Early identification and appropriate therapy can dramatically improve outcomes.

Objective: Nurses in closed hospital wards, such as Intensive Care and isolation units, play a pivotal role in identifying potential donors and supporting families during sensitive decision-making moments. However, gaps in knowledge or negative attitudes among nurses can hinder donation efforts. This study aims to explore the knowledge and attitudes of closed-ward nurses regarding organ donation and transplantation, providing insights to enhance education, advocacy, and clinical practices in these critical settings.

Methods: Modern analysis was performed on the data collected from questionnaires distributed to nurses of … General Hospital. The study involved 108 nurses. The questionnaire used to collect the data was provided by the Department of Social Work of the … University and distributed in electronic form to hospital nurses.

Results: After analyzing the nurses' responses, it emerged that 85.19% of nurses are positive about the idea of organ donation and declare themselves willing to become donors, motivated by their will to really help their fellow human beings. In contrast, 5.56% said they would not be willing to donate. The main cause of their refusal seems to be fear and the prejudices they have, but also the fact that there is no trust in the organizations responsible for transplants. Finally, regarding the knowledge of the nurses who participated in the survey, the average knowledge score on the scale 0-100 is 72.

Conclusions: There is a clear need for specialized training for nurses managing organ donation. The emotional burden and responsibilities they face are significant. Enhanced training supports their well-being and ensures a more compassionate, efficient process for donors and families, ultimately improving the experience for all involved.

Objective: This study aimed to investigate the prevalence and genetic relatedness of multidrug-resistant Gram-negative bacilli, particularly those resistant to carbapenems, in patients admitted to intensive care units. It also sought to explore associations between bacterial colonization or infection and clinical outcomes, including comorbidities, treatment regimens, and mortality.

Methods: Between November 2022 and December 2023, screening and pathological samples were collected from patients at a tertiary hospital. Screening samples included rectal and pharyngeal swabs, while pathological samples comprised respiratory tract secretions. Bacterial identification and antibiotic susceptibility testing were performed using standard microbiological methods. Genetic similarity among isolates was assessed using a molecular fingerprinting technique to detect potential clonal spread.

Results: A total of 62 carbapenem-resistant strains were identified, with Acinetobacter baumannii and Klebsiella pneumoniae being the most prevalent. Pathological isolates exhibited higher resistance levels than screening isolates. Most patients had multiple comorbidities, with cardiac, renal, and pulmonary conditions being the most common. A significant association was found between prolonged intensive care unit stay and increased mortality. However, no significant correlation was observed between the number of comorbidities or antibiotic classes used and mortality. Molecular analysis revealed clonal clusters of Acinetobacter and Klebsiella strains, suggesting nosocomial transmission.

Conclusions: The findings underscore the importance of early screening, molecular surveillance, and stringent infection control measures in intensive care settings.

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.