Pub Date : 2020-04-01DOI: 10.4103/jtccm.jtccm_21_20
L. Moscote-Salazar, Amrita Ghosh, R. Pal, S. Raj, M. Rahman, A. Agrawal
Neurotoxicity has been an adverse effect described for almost all B-lactams; since its launch in 1994, there are numerous reports of patients treated with cefepime, covering a wide spectrum of clinical manifestations ranging from delirium to a nonconvulsive status epilepticus (NCSE), being the most of them reported in patients with decreased renal function, but also in patients with preserved renal function. We attempted to illustrate the clinical spectrum of cefepime neurotoxicity in relation to neurocritical care. We identified 13 publications describing neurotoxicity following cefepime administration from PubMed using search terms were cefepime, neurotoxicity, seizures, delirium, encephalopathy, NCSE, myoclonus, confusion, aphasia, agitation, coma, disability, and death. Two reviewers independently assessed identified articles for eligibility and used for this review writing. Most reports occur in elderly patients, although cases have been described in children and newborns. In general, patients recover soon after stopping beta-lactams or after reducing the dose or replacing them with another antibiotic; however, there is a likelihood of recurrence of symptoms after reintroducing Cefepime again at a dose low.
{"title":"Neurotoxicity Associated with Cefepime: An Update to Neurocritical Care: A Narrative Review","authors":"L. Moscote-Salazar, Amrita Ghosh, R. Pal, S. Raj, M. Rahman, A. Agrawal","doi":"10.4103/jtccm.jtccm_21_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_21_20","url":null,"abstract":"Neurotoxicity has been an adverse effect described for almost all B-lactams; since its launch in 1994, there are numerous reports of patients treated with cefepime, covering a wide spectrum of clinical manifestations ranging from delirium to a nonconvulsive status epilepticus (NCSE), being the most of them reported in patients with decreased renal function, but also in patients with preserved renal function. We attempted to illustrate the clinical spectrum of cefepime neurotoxicity in relation to neurocritical care. We identified 13 publications describing neurotoxicity following cefepime administration from PubMed using search terms were cefepime, neurotoxicity, seizures, delirium, encephalopathy, NCSE, myoclonus, confusion, aphasia, agitation, coma, disability, and death. Two reviewers independently assessed identified articles for eligibility and used for this review writing. Most reports occur in elderly patients, although cases have been described in children and newborns. In general, patients recover soon after stopping beta-lactams or after reducing the dose or replacing them with another antibiotic; however, there is a likelihood of recurrence of symptoms after reintroducing Cefepime again at a dose low.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"129 1","pages":"28 - 35"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87950941","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}
Pub Date : 2020-04-01DOI: 10.4103/jtccm.jtccm_13_20
Mafdy N. Basta
Myxedema coma is a rare life-threatening form of severe hypothyroidism with physiological decompensation. It occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by an acute event similar to infection, cerebrovascular accident, myocardial infarction, trauma, cold exposure, surgery, or drug therapy. Patients with myxedema coma are generally severely ill with hypothermia and depressed mental status. It is a medical emergency with a high mortality rate. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis. Patients with myxedema coma should be treated in an intensive care unit with continuous cardiac monitoring. Initial steps in management include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone assays. The following presentation is a case of postoperative myxedema coma that was successfully managed with multidisciplinary effort. The patient has had a complete recovery.
{"title":"Postoperative Myxedema Coma: A Rare Presentation of Hypothyroidism","authors":"Mafdy N. Basta","doi":"10.4103/jtccm.jtccm_13_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_13_20","url":null,"abstract":"Myxedema coma is a rare life-threatening form of severe hypothyroidism with physiological decompensation. It occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by an acute event similar to infection, cerebrovascular accident, myocardial infarction, trauma, cold exposure, surgery, or drug therapy. Patients with myxedema coma are generally severely ill with hypothermia and depressed mental status. It is a medical emergency with a high mortality rate. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis. Patients with myxedema coma should be treated in an intensive care unit with continuous cardiac monitoring. Initial steps in management include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone assays. The following presentation is a case of postoperative myxedema coma that was successfully managed with multidisciplinary effort. The patient has had a complete recovery.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"60 1","pages":"41 - 45"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88512227","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}
Pub Date : 2020-04-01DOI: 10.4103/jtccm.jtccm_14_20
Angie Ching-Gonzalez, Christian Meza-Valle, Karen Muñoz-Báez, Juan Medrano-Carreazo, A. Agrawal, Rakesh Mishra, Adesh Shrivastava, Tariq Janjua, L. Moscote-Salazar
Severely ill neurosurgical patients are those who present with pathologies of the nervous system associated with either a high mortality or that which leaves significant sequelae in those who survive. Desmopressin is a synthetic analog of the antidiuretic hormone that is stored in neurohypophysis. Its function is to decrease urinary volume by increasing reabsorption of water in the convoluted tubules and nephron collectors, additionally increasing the expression of coagulation factor VII and the von Willebrand factor. For this reason, its usefulness in the management of various pathologies has been tested, from coagulopathies to posttraumatic and postsurgical diabetes insipidus. It contributes in improving hyponatremia and in maintaining the balance of fluids and electrolytes in traumatic brain injury and subarachnoid hemorrhage (SAH) patients. It has been additionally studied for its role in the risk of rebleeding in SAH patients and in those with coagulopathies, where its implicated mechanism of action is through platelet anti-aggregation.
{"title":"Desmopressin in Critically Ill Neurosurgical Patients: An Overview","authors":"Angie Ching-Gonzalez, Christian Meza-Valle, Karen Muñoz-Báez, Juan Medrano-Carreazo, A. Agrawal, Rakesh Mishra, Adesh Shrivastava, Tariq Janjua, L. Moscote-Salazar","doi":"10.4103/jtccm.jtccm_14_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_14_20","url":null,"abstract":"Severely ill neurosurgical patients are those who present with pathologies of the nervous system associated with either a high mortality or that which leaves significant sequelae in those who survive. Desmopressin is a synthetic analog of the antidiuretic hormone that is stored in neurohypophysis. Its function is to decrease urinary volume by increasing reabsorption of water in the convoluted tubules and nephron collectors, additionally increasing the expression of coagulation factor VII and the von Willebrand factor. For this reason, its usefulness in the management of various pathologies has been tested, from coagulopathies to posttraumatic and postsurgical diabetes insipidus. It contributes in improving hyponatremia and in maintaining the balance of fluids and electrolytes in traumatic brain injury and subarachnoid hemorrhage (SAH) patients. It has been additionally studied for its role in the risk of rebleeding in SAH patients and in those with coagulopathies, where its implicated mechanism of action is through platelet anti-aggregation.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"133 ","pages":"23 - 27"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72426862","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}
Pub Date : 2020-04-01DOI: 10.4103/jtccm.jtccm_9_20
P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels
{"title":"Severe Burns Complicated by Acute Kidney Injury: Some Nuances Regarding Risk Factors and Mortality Rate","authors":"P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels","doi":"10.4103/jtccm.jtccm_9_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_9_20","url":null,"abstract":"","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"20 1","pages":"46 - 46"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80192590","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}
Pub Date : 2020-01-01DOI: 10.4103/jtccm.jtccm_28_20
Bo Hu, Dawei Wang, Chang Hu, Ming Hu, Fangfang Zhu, Hui Xiang, Beilei Zhao, K. Kashani, Z. Peng
Objective: The information about the critically ill coronavirus disease 2019 (COVID-19) was limited and controversy. This study was to analyze the clinical feature and predictors for outcome in critically ill COVID-19. Design: This was a descriptive study from two hospitals. Setting: This study was conducted in intensive care units (ICUs) from university hospitals. Methods: Critically ill COVID-19 patients admitted in ICU from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8 to February 20, 2020, were screened. Interventions: None. Measurements and Main Results: Clinical, laboratory data were collected with management strategies and outcomes. Sixty-eight critically ill patients were enrolled. Their median age was 64 (interquartile range, 54–72) years, and 67.65% were male. In this cohort, 44 (65%) patients survived for 28 days. The invasive mechanical ventilator was used in 51 (75%) patients, with 20 of them requiring prone positioning, and 17 switched to extracorporeal membrane oxygenation. The compliance scores of lungs on the day of intubation among survivors were higher than those in nonsurvivors (25.00 [13.50–39.00] vs. 17.00 [12.00–22.00], P = 0.01). The blood interlukin-6 (IL-6) levels at the ICU admission were significantly higher in nonsurvivors compared to survivors (71.27 [51.48–144.15] vs. 18.15 [7.55–68.02] ng/ml, P = 0.025). The heart rates, lung injury scale, and positive end-expiratory pressure were constantly higher for 10 days in nonsurvivors. The frequency of vasopressor uses and neuromuscular blockers was higher in nonsurvivors from day 5 to day 10 (P < 0.05). In the whole cohort, the most common complications were acute respiratory distress syndrome (95.59%), shock (48.53%), arrhythmia (33.82%), acute cardiac injury (33.82%), and acute kidney injury (27.94%). Multivariate analysis indicated that lower lung compliance at the day of intubation and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) at ICU admission were related to higher mortality (P = 0.02 and 0.05, respectively). Conclusion: COVID-19-related critical illness predominantly affected old individuals and was characterized by severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies. High APACHE II scores and low lung compliance indicated poor outcomes.
{"title":"Clinical Features and Predictors for Outcome in Critically Ill Patients with COVID-19 Infection from Wuhan, China","authors":"Bo Hu, Dawei Wang, Chang Hu, Ming Hu, Fangfang Zhu, Hui Xiang, Beilei Zhao, K. Kashani, Z. Peng","doi":"10.4103/jtccm.jtccm_28_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_28_20","url":null,"abstract":"Objective: The information about the critically ill coronavirus disease 2019 (COVID-19) was limited and controversy. This study was to analyze the clinical feature and predictors for outcome in critically ill COVID-19. Design: This was a descriptive study from two hospitals. Setting: This study was conducted in intensive care units (ICUs) from university hospitals. Methods: Critically ill COVID-19 patients admitted in ICU from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8 to February 20, 2020, were screened. Interventions: None. Measurements and Main Results: Clinical, laboratory data were collected with management strategies and outcomes. Sixty-eight critically ill patients were enrolled. Their median age was 64 (interquartile range, 54–72) years, and 67.65% were male. In this cohort, 44 (65%) patients survived for 28 days. The invasive mechanical ventilator was used in 51 (75%) patients, with 20 of them requiring prone positioning, and 17 switched to extracorporeal membrane oxygenation. The compliance scores of lungs on the day of intubation among survivors were higher than those in nonsurvivors (25.00 [13.50–39.00] vs. 17.00 [12.00–22.00], P = 0.01). The blood interlukin-6 (IL-6) levels at the ICU admission were significantly higher in nonsurvivors compared to survivors (71.27 [51.48–144.15] vs. 18.15 [7.55–68.02] ng/ml, P = 0.025). The heart rates, lung injury scale, and positive end-expiratory pressure were constantly higher for 10 days in nonsurvivors. The frequency of vasopressor uses and neuromuscular blockers was higher in nonsurvivors from day 5 to day 10 (P < 0.05). In the whole cohort, the most common complications were acute respiratory distress syndrome (95.59%), shock (48.53%), arrhythmia (33.82%), acute cardiac injury (33.82%), and acute kidney injury (27.94%). Multivariate analysis indicated that lower lung compliance at the day of intubation and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) at ICU admission were related to higher mortality (P = 0.02 and 0.05, respectively). Conclusion: COVID-19-related critical illness predominantly affected old individuals and was characterized by severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies. High APACHE II scores and low lung compliance indicated poor outcomes.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"8 1","pages":"10 - 17"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84289841","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}
Pub Date : 2020-01-01DOI: 10.4103/jtccm.jtccm_11_20
L. Moscote-Salazar, Tariq Janjua, A. Agrawal
century. Pediatr Res 2004;56:1-5. 3. Al Hajjar S, McIntosh K. The first influenza pandemic of the 21st century. Ann Saudi Med 2010;30:1-0. 4. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90. 5. Sharifi‐Razavi A, Karimi N, Rouhani N. COVID‐19 and intracerebral haemorrhage: Causative or coincidental? New Microbes New Infect 2020;35:100669. 6. Beal JC. Increased intracranial pressure in the setting of Enterovirus and other viral meningitides. Neurol Res Int 2017;2017:2854043. 7. Svedung Wettervik T, Kumlien E, Rostami E, Howells T, von Seth M, Velickaite V, et al. Intracranial pressure dynamics and cerebral vasomotor reactivity in coronavirus disease 2019 patient with acute encephalitis. Crit Care Explor 2020;2:e0197. 8. Noro F, Cardoso FM, Marchiori E. COVID-19 and benign intracranial hypertension: A case report. Rev Soc Bras Med Trop 2020;53:e20200325. 9. Bhaskar S, Bradley S, Israeli-Korn S, Menon B, Chattu VK, Thomas P, et al. Chronic neurology in COVID-19 era: Clinical considerations and recommendations from the REPROGRAM consortium. Front Neurol 2020;11:664. 10. Lawrenson JG, Buckley RJ. COVID-19 and the eye. Ophthalmic Physiol Opt 2020;40:383-8. 11. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 2007;24 Suppl 1:S37-44. Dear Editor,
世纪。儿科杂志2004;56:1-5。3.Al Hajjar S, McIntosh K. 21世纪的第一次流感大流行。安沙特阿拉伯医学2010;30:1-0。4. 毛磊，金辉，王敏，胡勇，陈生，何强，等。武汉2019冠状病毒病住院患者神经系统特征分析中华医学杂志，2020;77:683-90。5. Sharifi‐Razavi A, Karimi N, Rouhani N. COVID‐19与脑出血:是因果关系还是巧合?中国生物医学工程学报(英文版);2009;31(5):591 - 591。6. 比尔JC。肠病毒和其他病毒性脑膜炎患者颅内压升高。中华神经科杂志，2017;17(2):444 - 444。7. Svedung Wettervik T, Kumlien E, Rostami E, Howells T, von Seth M, Velickaite V，等。2019冠状病毒病合并急性脑炎患者颅内压动态及脑血管舒缩反应性中国生物医学工程学报(英文版);2020;29(1):391 - 391。8. Noro F, Cardoso FM, Marchiori E.。COVID-19与良性颅内高压1例报告。中国生物医学工程学报，2014;33(2):591 - 591。9. Bhaskar S, Bradley S, israel - korn S, Menon B, Chattu VK, Thomas P，等。COVID-19时代的慢性神经病学:REPROGRAM联盟的临床考虑和建议。中华医学杂志2020;11:664。10. 劳伦森JG，巴克利RJ。COVID-19和眼睛。中国眼科杂志，2020;40(3):388 - 388。11. 脑外伤基金会，美国神经外科医师协会，神经外科医师大会，神经外伤与重症监护联合分会，AANS/CNS, Bratton SL, Chestnut RM等。严重创伤性脑损伤处理指南。六、颅内压监测指征。中华神经科杂志(英文版);2009;31(1):337 - 344。亲爱的编辑,
{"title":"Optic Nerve Ultrasonography for Noninvasive Monitoring of Intracranial Pressure in COVID-19 Patients","authors":"L. Moscote-Salazar, Tariq Janjua, A. Agrawal","doi":"10.4103/jtccm.jtccm_11_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_11_20","url":null,"abstract":"century. Pediatr Res 2004;56:1-5. 3. Al Hajjar S, McIntosh K. The first influenza pandemic of the 21st century. Ann Saudi Med 2010;30:1-0. 4. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90. 5. Sharifi‐Razavi A, Karimi N, Rouhani N. COVID‐19 and intracerebral haemorrhage: Causative or coincidental? New Microbes New Infect 2020;35:100669. 6. Beal JC. Increased intracranial pressure in the setting of Enterovirus and other viral meningitides. Neurol Res Int 2017;2017:2854043. 7. Svedung Wettervik T, Kumlien E, Rostami E, Howells T, von Seth M, Velickaite V, et al. Intracranial pressure dynamics and cerebral vasomotor reactivity in coronavirus disease 2019 patient with acute encephalitis. Crit Care Explor 2020;2:e0197. 8. Noro F, Cardoso FM, Marchiori E. COVID-19 and benign intracranial hypertension: A case report. Rev Soc Bras Med Trop 2020;53:e20200325. 9. Bhaskar S, Bradley S, Israeli-Korn S, Menon B, Chattu VK, Thomas P, et al. Chronic neurology in COVID-19 era: Clinical considerations and recommendations from the REPROGRAM consortium. Front Neurol 2020;11:664. 10. Lawrenson JG, Buckley RJ. COVID-19 and the eye. Ophthalmic Physiol Opt 2020;40:383-8. 11. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 2007;24 Suppl 1:S37-44. Dear Editor,","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"9 1","pages":"21 - 21"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76352097","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}
Pub Date : 2020-01-01DOI: 10.4103/jtccm.jtccm_12_20
J. Prakash, Rashmi Kujur, R. Kharwar, Amit Gupta
Acute pulmonary embolism is an uncommon complication after pacemaker insertion. This report describes, in view of multiple finding, we found the exact cause of the present scenario of the patient which is rare and successfully managed.
{"title":"Acute Pulmonary Embolism Secondary to Pacemaker Insertion","authors":"J. Prakash, Rashmi Kujur, R. Kharwar, Amit Gupta","doi":"10.4103/jtccm.jtccm_12_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_12_20","url":null,"abstract":"Acute pulmonary embolism is an uncommon complication after pacemaker insertion. This report describes, in view of multiple finding, we found the exact cause of the present scenario of the patient which is rare and successfully managed.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"66 1","pages":"18 - 20"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74129306","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}
Pub Date : 2020-01-01DOI: 10.4103/jtccm.jtccm_1_20
D. De Backer, M. Van Hove, P. Foulon, J. Kadou, Grégoire Michiels, S. Giglioli
Circulatory shock is characterized by a decrease in oxygen delivery to the tissues associated with impairment in oxygen metabolism and tissue hypoxia. Clinical and biological signs of impaired tissue perfusion and tissue hypoxia are used as bedside to detect circulatory failure and trigger resuscitation procedures. The most popular signs of tissue hypoperfusion include mean arterial pressure, capillary refill time and mottling score, central venous oxygen saturation (ScvO2), veno-arterial difference in PCO2 (PvaCO2), microcirculation assessment, and lactate. Both the severity and duration of the alterations in any of these variables are associated with a poor outcome so that it sounds logical to trigger therapy based on these. Using these variables as target for therapy is much more complex. Some of the limits for using some of these variables as targets include an incertitude about the target to reach (should we aim at normalizing or improving the variable, and by how much?) and the time lag between resolution of impaired tissue perfusion/hypoxia and normalization of the variable. The ideal target variable should have a well-defined end point and a rapid response time. Interestingly, hemodynamic resuscitation targeting these variables gave variable results. In this review, we will discuss the interest and limitations of the above-mentioned indices of tissue perfusion and hypoxia as trigger as well as end point of resuscitation in critically ill patients.
{"title":"Indices of Tissue Perfusion: Triggers of Targets of Resuscitation?","authors":"D. De Backer, M. Van Hove, P. Foulon, J. Kadou, Grégoire Michiels, S. Giglioli","doi":"10.4103/jtccm.jtccm_1_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_1_20","url":null,"abstract":"Circulatory shock is characterized by a decrease in oxygen delivery to the tissues associated with impairment in oxygen metabolism and tissue hypoxia. Clinical and biological signs of impaired tissue perfusion and tissue hypoxia are used as bedside to detect circulatory failure and trigger resuscitation procedures. The most popular signs of tissue hypoperfusion include mean arterial pressure, capillary refill time and mottling score, central venous oxygen saturation (ScvO2), veno-arterial difference in PCO2 (PvaCO2), microcirculation assessment, and lactate. Both the severity and duration of the alterations in any of these variables are associated with a poor outcome so that it sounds logical to trigger therapy based on these. Using these variables as target for therapy is much more complex. Some of the limits for using some of these variables as targets include an incertitude about the target to reach (should we aim at normalizing or improving the variable, and by how much?) and the time lag between resolution of impaired tissue perfusion/hypoxia and normalization of the variable. The ideal target variable should have a well-defined end point and a rapid response time. Interestingly, hemodynamic resuscitation targeting these variables gave variable results. In this review, we will discuss the interest and limitations of the above-mentioned indices of tissue perfusion and hypoxia as trigger as well as end point of resuscitation in critically ill patients.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"32 1","pages":"1 - 9"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86822599","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}
Pub Date : 2020-01-01DOI: 10.4103/jtccm.jtccm_8_20
P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels
{"title":"Procalcitonin to Facilitate Early Detection of Co-Infection during Flu in Critically Ill Immunosuppressed Patients: We Are Not Sure","authors":"P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels","doi":"10.4103/jtccm.jtccm_8_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_8_20","url":null,"abstract":"","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"22 1","pages":"22 - 22"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90500704","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}
Pub Date : 2019-10-01DOI: 10.4103/jtccm.jtccm_6_20
Vijay Singh, R. Datta, S. Sasidharan, Lalit Tomar, M. Babitha
Introduction: The characteristics for the planned ICU admissions were not surprising. However, the reasons for unplanned ICU admission are multi-factorial and may be beyond the scope of the anaesthesiologist's role in patient care. Unplanned intensive care admission may be a useful indicator of the quality of the overall process of peri-operative care. With this background, this study was undertaken to do a prospective evaluation, analysis of post-op admissions in the Intensive Care Unit of a tertiary care hospital. Material and Methods: The present observational study was conducted in the Intensive Care Unit of a defence Tertiary Care Hospital for a period of one-year wef 1Apr 18 to 31 March 19 and all the post-operative patients were divided into two groups: Group 1 – Planned Admissions: This included those patients where surgeon and/or the anaesthesiologist had decided pre-operatively for post-op ICU admission. Group 2 – Unplanned Admissions and Emergency admission: This included those patients, whose admissions were not anticipated pre-operatively, however, due to some unexpected peri-op complications arising within 48 hours of surgery led them to ICU admission. This group also comprised of patients who were admitted after forty-eight hours of primary surgery for post-operative complications. Result: In one year, the total operated patients (excluding paediatric, cardiac) in various OTs were 18157 and out of which, 261 patients were admitted to ICU. In planned group, maximum patients were of ASA III and in unplanned/emergency admissions ASA II patients were predominant. Post-operative gastrointestinal surgery patients formed a substantial percentage of the ICU admissions in both planned (94/211; 44.55%) and unplanned admission (20/50; 40.00%). GA with endotracheal intubation was technique of anaesthesia in both planned and unplanned admission. The predominant reason for unplanned ICU admission was post-operative care and treatment following unanticipated intra-operative complications. Conclusion: Thorough pre-operative evaluation and pre-operative optimization of patients whenever possible can reduce the incidence of unplanned admission to ICU. Early recognition of complications, timely intervention and timely intensive care and monitoring are essential to improve outcomes.
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