Anestezjologia intensywna terapia [journal]
- Vitamin D in critically ill patients. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(3):201-7.
Vitamin D deficiency is a commonly observed global phenomenon, both in the general population and in hospitalized patients, including critically ill patients. Vitamin D deficiency is associated with multiple adverse health outcomes, including increased morbidity and mortality in the general population and in critically ill patients. Vitamin D is a fatsoluble vitamin that plays an important role in bone metabolism. However, Vitamin D is also a steroid hormone that exerts multiple pleiotropic effects. Vitamin D regulates immunity, inflammation, cell proliferation, differentiation, apoptosis, and angiogenesis. There is growing evidence of a close relationship between vitamin D insufficiency and various systemic disorders, i.e., type II diabetes, certain types of cancer, obesity, and cardiovascular morbidities. The purpose of this article is to present the current knowledge on the relationship between vitamin D status and critical illness.
- Risk factors of acute kidney injury requiring renal replacement therapy based on regional registry data. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(3):185-90.
Acute kidney injury (AKI) is a common problem in critically ill patients treated in the intensive care unit (ICU) and is associated with high mortality, particularly when renal replacement therapy (RRT) is required. Our aim was to investigate the risk factors for AKI requiring RRT (AKI-RRT).In our retrospective, multi-centre, observational study, we analysed 14,672 consecutive AKI-RRT patients hospitalized in ICUs in the Silesian Region (Poland) between October 2011 and December 2014. Demographic and clinical data were derived from the Silesian Registry of Anaesthesiology and Intensive Care Departments. Logistic regression was used to select final risk factors for AKI-RRT. The ROC method was used to analyse the value of clinical parameters to predict the risk of AKI-RRT.Of a total of 14,672 patients, 1,234 (8.4%) developed AKI requiring RRT. Overall 59% of patients were males and the median age in the group was 66 (IQR 55-76) years. There were 16 variables that modified the risk of AKI-RRT. The AUROC for the test scored 0.845 (95% CI: 0.84-0.85; P < 0.0001).We found multiple factors that modified the risk of AKI requiring RRT. Chronic kidney disease (CKD) and cardiogenic shock increased, whereas neurological disorders decreased the risk. Measures directed towards AKI prevention should be aimed specifically at patients with cardiological disorders and CKD.
- Fever treatment with a catheter-based heat exchange system in the neurointensive care unit. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(3):208-10.
- Ultrasound and fibreoptic-guided percutaneous tracheostomy in patient with deviated trachea. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(2):148-9.
- Pulmonary artery embolism during the course of colitis ulcerosa - the constant diagnostic challenge of invasive fungal infection. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(2):146-8.
- Outcome of patients of chest trauma suffering from chronic obstructive pulmonary disease - experience at level 1 trauma centre. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(3):162-5.
The outcome of chest trauma depends on many factors, one of which includes comorbidities. Nowadays, as the elderly population is on the rise, more and more trauma victims are being admitted with chronic obstructive pulmonary disease as a comorbidity in trauma centre intensive care units. However, there are hardly any studies describing the outcome of such patients with chest trauma and chronic obstructive pulmonary disease, both being respiratory problems. The aim was to study the outcomes and various complications in patients of chest trauma with COPD admitted to our ICU over a given time period.A detailed review of charts of patients with chest trauma and chronic obstructive pulmonary disease admitted over one and a half years was performed and various parameters noted, including as follows: demographic data; various scores; the number of days on a ventilator and in the ICU. Moreover, complications, such as ventilator associated pneumonia, catheter related bloodstream infections, as well as outcomes, were noted.During the study period, 19 patients were admitted, out of which 4 died. The APACHE scores were higher for those who died and all had ventilator-associated pneumonia as a complication. All those who had undergone the placement of an epidural and were managed with non-invasive ventilation initially did not require invasive ventilation.Chest trauma patients with chronic obstructive pulmonary disease are prone to develop ventilator-associated pneumonia which may be the source of increased mortality among such patients. Epidural placement reduces the risk of invasive ventilation if a patient can be managed with non-invasive ventilation.
- Validity of low-efficacy continuous renal replacement therapy in critically ill patients. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(3):191-6.
The 1980s saw the use of continuous arteriovenous hemofiltration whose intensity hemofiltration rate was only 3 or 4 mL kg⁻¹ h⁻¹. With the installation of a blood pump, this dose went up to 8 or 10 mL kg⁻¹ h⁻1, and continued to increase, reaching about 20 mL kg⁻¹ h⁻¹ by the year 2000. Some studies found that a higher dose could be beneficial, and the world rapidly followed the trend, increasing the dose up to 35 mL kg⁻¹ h⁻¹. Then, two randomized control trials, namely the VA/NIH Acute Renal Failure Trial Network study and the RENAL study, came along in succession which changed the Kidney Disease: Improving Global Outcomes (KDIGO) recommendation to 20 to 25 mL kg⁻¹ h⁻¹. However, no good evidence exists to support this. Our recent multicenter retrospective studies from the JSEPTIC CRRT database show that the Japanese continuous renal replacement therapy dose of (14.3 mL kg⁻¹ h⁻¹) does not seem to have worse outcomes when compared with a higher dose.
- Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis. [Journal Article]
- Anaesthesiol Intensive Ther 2016; 48(3):175-9.
Scoring systems in critical care patients are essential for predicting of the patient outcome and evaluating the therapy. In this study, we determined the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scoring systems in the prediction of mortality in adult patients admitted to the intensive care unit (ICU) with severe purulent bacterial meningitis.We retrospectively analysed data from 98 adult patients with severe purulent bacterial meningitis who were admitted to the single ICU between March 2006 and September 2015.Univariate logistic regression identified the following risk factors of death in patients with severe purulent bacterial meningitis: APACHE II, SAPS II, SOFA, and GCS scores, and the lengths of ICU stay and hospital stay. The independent risk factors of patient death in multivariate analysis were the SAPS II score, the length of ICU stay and the length of hospital stay. In the prediction of mortality according to the area under the curve, the SAPS II score had the highest accuracy followed by the APACHE II, GCS and SOFA scores.For the prediction of mortality in a patient with severe purulent bacterial meningitis, SAPS II had the highest accuracy.