Anestezjologia intensywna terapia [journal]
- Fever treatment with a catheter-based heat exchange system in the neurointensive care unit. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2016 Jun 7.
- 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 Jun 1.
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 May 31.
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 May 30.
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), 2nd Simplified Acute Physiology Score (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.
- Hypoalbuminaemia at admission predicts the poor outcomes in critically ill children. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2016 May 20.
Hypoalbuminaemia at admission is a common finding in patients admitted to the Paediatric Intensive Care Unit (PICU) and it is thought that this may predict morbidity and mortality.s: A retrospective study was conducted in the tertiary hospital. The medical records of critically ill children were reviewed. The data were analyzed for the prevalence and outcomes.Two hundred and two patients were included in the analysis. The incidence of hypoalbuminaemia at admission was 57.9%. These patients had a mortality rate 4 times greater (adjusted odds ratio 3.8; 95% CI: 1.4-10.0), a longer length of PICU stay (8.6 vs. 6.7 days, P = 0.04) and a longer period on a ventilator (5.9 vs. 3.9 days, P = 0.04) than patients with normal albumin levels.s: Hypoalbuminaemia at admission was a predictive factor of poor outcome in critically ill children. It is associated with a higher mortality, a longer length of stay in the PICU, as well as longer ventilator use.
- Efficiency of goal-directed oxygen delivery in ICU patients. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2016 May 18.
Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO₂ objectives. We evaluated the efficiency of a strategy based on goal-directed O₂ delivery in the ICU.A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3). The delivery of oxygen was goal-directed on SpO₂ measurement: 88-94% for Group 1 and 90-96% for others. The time spent with an SpO₂ below, within and above the prescribed limits was collected.The mean time spent within the prescribed range was for Groups 1, 2 and 3, respectively as follows: 61.9% [60.5-63.2], 63.7% [62.3-65] and 56.4% [55.3-57.6] (P < 0.001 for each group). A history of chronic obstructive pulmonary disease was not correlated with better results (P = 0.11), while invasive ventilation was related to the time spent out of the prescribed range (P < 0.001; OR 1.3 [1.22-1.28]) especially in hyperoxaemia (40.7% [39.6-41.8] P < 0.001). Efficiency seems unrelated to nurse burden or night team exhaustion (r = -0.09, P = 0.77).Goal-directed oxygen delivery based on SpO₂ objectives in ICU patients ensures that in only approximately 64% of the time, SpO₂ stays within the prescribed range.