Anesthesiology Clinics Research Articles

Systemic and regional cerebral perfusion in small infants undergoing minor lower abdominal surgery under awake caudal anaesthesia

Infants undergoing general anaesthesia have an increased risk of severe respiratory and cardiovascular critical events. Awake caudal anaesthesia is an alternative for small infants undergoing minor lower abdominal surgery. While clinical experience has shown stable intra-operative haemodynamic conditions, there are no studies evaluating systemic and regional cerebral perfusion during such a procedure. The purpose of this study was to evaluate the effects of awake caudal anaesthesia on systemic and regional cerebral perfusion in small infants. A prospective observational cohort study. Clinic of Anaesthesiology, University Children's Hospital, between November 2017 and June 2018. Twenty small infants (postmenstrual age 36 to 54 weeks, weight 1800 to 5700 g) scheduled for lower abdominal surgery under awake caudal anaesthesia were enrolled in this study. Standard monitoring was expanded to include cardiac index using electrical velocimetry and regional cerebral oxygen saturation using near infrared spectroscopy. The caudal block was performed with 0.3% ropivacaine 1 ml kg Hypotension was defined as mean arterial blood pressure (BP) less than 35 mmHg and regional cerebral desaturation as regional cerebral oxygen saturation less than 80% of baseline. Mean arterial BP, cardiac index and regional cerebral oxygen saturation parameters under awake caudal anaesthesia. Mean arterial BP, cardiac index and regional cerebral oxygen saturation remained above the predefined lower limits. No episodes of hypotension or regional cerebral desaturation were observed. Operation time was 35 ± 13 (range 20 to 71) min. The infants were discharged to the neonatal ward after the end of surgery, and milk was fed 22 ± 15 (range 6 to 55) min thereafter. Five preterm infants experienced self-limiting episodes of apnoea intra-operatively. The current study shows that awake caudal anaesthesia does not impair systemic and regional cerebral perfusion in small infants. German registry of clinical studies (DRKS-ID: 800015742).

Combating the COVID-19 battle with personal protective equipment (PPE) armamentarium.

Combating the COVID-19 battle with personal protective equipment (PPE) armamentarium.

The Results of Cardiac Surgery in Terms of Patient Blood Management in Our Hospital.

Clinic of Anaesthesiology and Reanimation, Türkiye Yüksek İhtisas Training and Research Hospital, beginning in 2014, the patient blood management (PBM) protocol is individualised based on patients' comorbidities, and the threshold for transfusion is 7 g dL-1 of haemoglobin for patients without comorbidities and 8-9 g dL-1 for patients with comorbidities. In this study, our aim was to compare patient outcomes, requirement for transfusion and the cost of transfusion between two different periods with and without PBM protocol. 229 and 283 patients who underwent open-heart surgery using cardiopulmonary bypass during the first 4 months of 2012 and the first 4 months of 2017, respectively, were included in this retrospective, cross-sectional study. There were no differences between the groups in preoperative data. Blood and blood product usage was observed to be significantly lower at the time of the PBM protocol. The use of packed red blood cells decreased from 2 units to 0and that of fresh frozen plasma decreased from 2 units to 0. In terms of postoperative mortality, there were no differences between the groups. According to the results of this study, the transfusion of unnecessary blood and blood products was reduced and the cost decreased with PBM protocol. Blood product usage did not affect 30-day mortality. It will be possible to achieve more valuable results if more patients are assessed, PBM protocol is implemented and postoperative results are evaluated in detail.

Low tetanus-diphtheria-acellular pertussis (Tdap) vaccine coverage among healthcare workers in a quaternary university hospital in São Paulo, Brazil: need for continuous surveillance and implementation of active strategies

IntroductionVaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. ObjectiveTo describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. MethodsA list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. ResultsThe study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. ConclusionsTdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.

Foreword

It is our great pleasure as Editor and Deputy Editor-in-Chief of the Journal of Head and Neck Anesthesia (JoHNA) to introduce you to the inaugural online issue of the Journal, presented in partnership between the Society for Head and Neck Anesthesia and Lippincott Williams & Wilkins (LWW) division of Wolters Kluwer Health. The Society for Head and Neck Anesthesia (SHANA, www.shanahq.com) is an award-winning, leading information resource in the rapidly expanding field of Head and Neck Anesthesia, and has over 600 members worldwide. LWW is a leading international health care publisher, with nearly 300 periodicals and 1500 books in more than 100 disciplines. Its extensive anesthesiology journal portfolio includes the renowned publications, such as Anesthesiology, Anesthesia and Analgesia, International Anesthesiology Clinics, European Journal of Anaesthesiology, Current Opinion in Anesthesiology, and others. The SHANA-LWW partnership represents an important advancement for JoHNA and the field of Head and Neck Anesthesia. The Journal will offer open access to publications important to our field, with the reprint of all prior editions of the Journal previously available on the web (www.shanahq.com). We have secured an editorial board comprising some of the leading experts in the field, to support JoHNA’s high-quality clinical and research publications. As the Journal develops with such a reputable publisher, we also anticipate accelerated indexing of JoHNA across the common databases for further dissemination of our work. We encourage submission of your important work to advance the field of Head and Neck Anesthesia for the benefit of the international anesthesia community. Submissions should be sent to the online editorial manager system, www.editorialmanager.com/johna/default.aspx. Clinical studies stand to answer important questions to advance the safe care of patients undergoing head and neck surgeries. For SHANA members, the selected manuscripts will have article-processing charges waived or discounted, depending on their submission. Manuscripts will be handled by the editorial board with a robust peer review process. The editorial management system will serve as an important tool to streamline the process, offer early decision-making, and provide manuscript-tracking features. Thank you for your interest in the Journal of Head and Neck Anesthesia. We look forward to working with you to disseminate your important contributions to the field. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report.

Analysis of the development of anesthesia care unit in China

Since the No. 1191 Medical Letters from the State Health Office in 2017, Notice of the General Office of the National the National Health and Family Planning Commission on the Establishment and Management of Anesthesiology Clinic and Nursing Units in Medical Institutions was issued, the establishment of anesthesia nursing posts has once again become a hotspot in the development history of anesthesia and nursing disciplines. By introducing the development model of anesthesia nursing in Wuxi People's Hospital and combining with literature analysis, this paper summarizes the development status of anesthesia nursing in China, and draws on the mature experience of developed countries in the development of anesthesia nursing, looks forward to the future direction of anesthesia specialized nursing in China, aiming at providing some ideas for standardizing and improving the cause of anesthesia nursing in China. Key words: Review; Anesthesia nursing; Anesthesia specialist nurse; Development status

Jeavons Syndrome, Eyelid Myoclonus with Absences (EMA) with Epileptic Status and Hypoactive Delirium

Abstract The evaluation of electroencephalogram (EEG) and the clinical picture of eyelid myoclonus (EM) with absences (EMA) using classical EEG signal evaluation and power spectral analysis currently presents a major challenge to predict further improvement, unsteady status, neurological defect outcomes in patients, or lethal termination in septic encephalopathy and acid-base imbalance due to kidney failure. At the Clinic of Anaesthesiology and Intensive Medicine (CAIM) of University Hospital in Martin (UHM) we clinically examined a patient N.J., a 58-year-old male with EMA. We used the Neuron-Spectrum-AM specialized software to measure the EEG signal visually and by means of power spectral analysis methods to quantitatively analyse the EEG record. The power spectral colour maps confirmed a disturbance of consciousness, approximating the depth of unconsciousness, affirmatively with a clinical disorder in absences, hypoactive delirium, and showed extinction of functional brain foci with the possibility of topical interpretation, and established an EEG correlate of impaired cognition, attention and lucidity of consciousness that were assessed by the clinical findings of the attending physician. The EMA syndrome was a final agonal condition with hypoactive delirium and was considered to be idiopathic epilepsy linked to severe metabolic-septic encephalopathy as an epileptic syndrome.

Management of Tracheal Agenesis with Esophageal Intubation Can Save Lives: A Reminder for Anaesthesiologist and Neonatologist

Introduction: Tracheal agenesis (TA) is a rare congenital anomaly presenting at birth with respiratory distress and difficult airway management. Polyhydramnios and premature labor are often pathologies associated with these pregnancies, which makes patient management more difficult. TA is often associated with other organ system anomalies (such as cardiovascular, renal and limb anomalies). Hereby, we report a case of tracheal agenesis who is presenting to our pediatric surgery and anesthesiology clinics. Case Presentation: An 30 weeks’ premature infant was transferred to our neonatal intensive care unit, with the diagnosis of tracheal agenesis. He had failed attempts at intubations because of failing to visualize the vocal cords. It was learned that immediately, his respiratory tract was secured via cervical oesophagostomy using long tracheostomy cannula and the infant was subsequently stabilized by gently ventilated. The diagnosis was confirmed on CT scan. It was performed distal oesophageal banding at the upper gastroesophageal junction with gastrostomy. On postoperative day 12 in intensive care unit, the baby further got complicated with a developing cyanosis and circulatory insufficiency. Cardiorespiratory arrest was developed and the infant died after 40 minutes after resuscitation. Conclusions: Successful approach at tracheal agenesis depends on, either prenatal diagnosis or recognition of this situation immediately after birth. In recent years, long time survival has been reported in tracheal agenesis through various surgical approaches. Therefore, it should be remembered that early esophageal ventilation is a life-saving alternative.

Perioperative standards for the treatment of coagulation disorders and usage of blood products in patients undergoing liver transplantation used in the Clinic for Transplant Surgery in Wrocław.

Coagulation system disorders in liver transplantation (ltx) patients are considered a serious issue. Liver cirrhosis leads to decreased synthesis of clotting factors and decreased elimination of waste products, including coagulation proteins. Platelet sequestration and dysfunction in an enlarged spleen additionally worsen these conditions. The resulting state, the most common pathology of the coagulation system, involves the reduction of clotting potential and hyperfibrinolysis. Tackling the problem of impaired hemostasis is a dynamic process. Throughout the whole procedure, consisting of the preanhepatic, the anhepatic and the neohepatic phases, consecutive pathomechanisms disrupt the very balance that anesthesia aims to preserve. Rotational thromboelastometry (ROTEM), having been introduced in the Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland, enables the efficient and early diagnosis of clotting disorders. An additional major problem which occurs during ltx, namely blood loss, could be solved using a cell separator. In this study, we present the standards introduced to the Transplantology Department of the Vascular Surgery Clinic, Wroclaw Medical University, Poland, that describe blood treatment during ltx procedures. We conclude that thromboelastometric examination and the use of a cell separator have significantly increased the safety of ltx procedures at our clinic. The introduction of thromboelastometry (TEM) and the implementation of the cell separator recovery method have enabled us to perform the dangerous and complicated surgical procedure of ltx in a much more stable and much safer manner than in the past.

Preoperative Evaluation of Internet Usage Characteristics of Patients in an Anesthesiology Clinic: A Survey of 1000 Patients

Preoperative Evaluation of Internet Usage Characteristics of Patients in an Anesthesiology Clinic: A Survey of 1000 Patients

The diagnostics of sepsis in pregnant women and during postpartum period: the controversial questions of surviving sepsis campaign (International Guidelines for Management of Sepsis and Septic Shock), updated in 2016

Sepsis and septical shock clinical criteria were agreed in Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016. Despite the imperfections of SIRS criteria (low specificity), their sensitivity reaches 100%. According to modern ideas, sepsis is a systemic inflammatory response to infection (Systemic Inflammatory Response Syndrome – SIRS) always associated with the presence of infectious agent in the body. Clinical and metabolical manifestations of sepsis are similar to symptoms and criteria of system inflammatory response syndrome. Physiological features of pregnant women are making adjustments to the classical picture of diagnosis and treatment. In the first trimester of pregnancy 15% of women are suffering from dyspnea. Increased heart rate is normal manifestation of the third mechanism of regulation of cardiac output (volume of circulating blood – first, the contractile ability of the myocardium – second). Increase in the number of leukocytes in peripheral blood of pregnant/postpartum women is a physiological process and creates difficulties in diagnostic process. The aim of study was to determine peculiarities of sepsis and septical shock in pregnant and postpartum women according to instructions of Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. The problem of sepsis is currently very severe in obstetrics. In now days, infections occupy third place in the structure of maternal mortality and make up about 15%. Systemic manifestations of sepsis/septical shock in pregnant/postpartum women (including the development of multiple organ dysfunction) can significantly outpace local changes of purulent source. If the primal source of infection is located in the uterus, the development of septical shock is not always accompanied by symptoms of “classical” metroendometritis, making it difficult to diagnose. It also detains radical sanation of the infectious source contributing to progression of multiple organ dysfunction. In 2001 E.P. Rivers et al. published an article in highly ranked journal N Eng J Med, which is cited by various authors until now. The whole algorithm of infusion and inotropic therapy was developed on its basis for patients with sepsis and septic shock. Despite this, in present time many authors doubt in expediency of achieving CVP 8-13 mmHg (J.H.Boyd et al 2011; M.Cessoni et al 2011; Marik P.E. et al 2008)., sodium ions accumulate in the extracellular space (interstitial and intravascular) in pregnant; as a result tissues become hydrophilic and tissue “phisiological edema” develops. Given the presence of capillary loss syndrome in pregnant/ postpartum women (preeclampsia / eclampsia) controversial is the question of the qualitative composition of the infusion therapy. There are no safe antibiotics for pregnant women according to Food and Drug Administration – FDA (USA). Therefore, the problem of antibiotic therapy in these patients also have its own features. Physiological features of pregnant woman are making adjustments to the classical picture of diagnosis and treatment of sepsis/septical shock in this group of patients. The aim of study was to determine peculiarities of sepsis and septical shock in pregnant and postpartum women according to instructions of Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. The problem of sepsis is currently very severe in obstetrics. In now days, infections occupy third place in the structure of maternal mortality and make up about 15%.In this article we have discussed the results of the diagnosis and treatment of 14 pregnant /postpar tum women with sepsis, who came to the clinic of anesthesiology and intensive care of the Lviv Regional Hospital from 2010 to 2016.Chorioamnionitis and endometritis were the main reasons of peritonitis and sepsis. Intensive therapy (volemic resuscitation, cardio-respiratory support, antibiotic therapy) and surgical intervention (eliminating the causes of peritonitis, sanitation and drainage of the abdominal cavity) were conducted to all the patients. The patient’s general condition was evaluated by APACHE II scale at 14,5 ± 1,5 points and multiple organ dysfunction was evaluated at 5,0 ± 1 points by SOFA scale.

Pain Management, An Issue of Anesthesiology Clinics

Pain Management, An Issue of Anesthesiology Clinics

The current level of shared decision-making in anesthesiology: an exploratory study

BackgroundShared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients’ preferences and best available evidence. SDM seems readily applicable in anesthesiology.We aimed to determine the current level of SDM among preoperative patients and anesthesiology clinicians.MethodsWe invited 115 consecutive preoperative patients, visiting the pre-assessment outpatient clinic of the department of Anesthesiology at the Academic Medical Center of Amsterdam. Inclusion criteria were patients who needed surgery in the arms, lower abdomen or legs, and in whom three anesthesia techniques were feasible. The SDM-level of the consultation was scored objectively by independent observers who judged audio-recordings of the consultation using the OPTION5-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and CollaboRATE questionnaires) and clinicians (SDM-Q-Doc questionnaire). Objective and subjective SDM-levels were assessed on five-point and six-point Likert scales, respectively. Both scores were expressed as percentages.ResultsData of 80 patients could be analysed. Objective SDM-scores were low (30.5%). Subjective scores of the SDM-Q-9 and CollaboRATE were high among patients (91.7% and 96.3%, respectively) and among clinicians (SDM-Q-Doc; 84.3%). Apparently, they appreciated satisfaction rather than SDM, being poorly aware of what SDM entails.ConclusionThe level of SDM in an outpatient anesthesiology clinic where preoperative patients receive information about various possible anesthesia options, was found to be low. Thus, there is room for improving the level of SDM. Some suggestions are given how this can be achieved.

Cases of acute mercury poisoning by mercury vapor exposure during the demolition of a fluorescent lamp factory

BackgroundIn 2015, workers dismantling a fluorescent lamp factory in Korea were affected by mercury poisoning from exposure to mercury vapor.Case presentationEighteen out of the 21 workers who participated in the demolition project presented with symptoms of poisoning and, of these, 10 had persistent symptoms even at 18 months after the initial exposure to mercury vapor. Early symptoms of 18 workers included a general skin rash, pruritus, myalgia, sleep disturbance, and cough and sputum production. Following alleviation of these initial symptoms, late symptoms, such as easy fatigue, insomnia, bad dreams, and anxiety disorder, began to manifest in 10 out of 18 patients. Seven workers underwent psychiatric care owing to sleep disturbance, anxiety disorder, and depression, and three workers underwent dermatologic treatment for hyperpigmentation, erythematous skin eruption, and chloracne-like skin lesions. Furthermore, three workers developed a coarse jerky movement, two had swan neck deformity of the fingers, and two received care at an anesthesiology clinic for paresthesia, such as burning sensation, cold sensation, and pain. Two workers underwent urologic treatment for dysfunction of the urologic system and impotence. However, symptomatic treatment did not result in satisfactory relief of these symptoms.ConclusionAwareness of the perils of mercury and prevention of mercury exposure are critical for preventing health hazards caused by mercury vapor. Chelation therapy should be performed promptly following mercury poisoning to minimize damage.

NEUROMARKERIŲ S100B IR NSE REIKŠMĖ VERTINANT PACIENTŲ, PATYRUSIŲ GALVOS SMEGENŲ TRAUMĄ, MIRTINGUMO IR BAIGČIŲ PROGNOZĘ

Įvadas. Galvos smegenų trauma (GST) ‒ tai heterogeninė patologinė būklė, pasireiškianti plačiu klinikinių simptomų spektru. Pacientų, patyrusių GST, prognozės vertinimas tampa neatsiejama klinikinės priežiūros dalimi, dėl didelės tokių pacientų baigčių įvairovės. Klinikinėje praktikoje žinomi keli smegenims specifiški biocheminiai žymenys, tačiau daugiausia naudojami ir ištirti žymenys S100B baltymas ir NSE (neuronų specifinė enolazė), kurie ir pasirinkti nustatyti pacientų, patyrusių GST, mirtingumo ir baigčių prognozę. Pagrindinis šio tyrimo tikslas buvo įvertinti žymenų S100B ir NSE prognostines galimybes, vertinant mirtingumą ir ilgalaikį išgyvenamumą pacientams po GST. Metodika. Prospektyvinis stebėjimo tyrimas atliktas Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose, Anesteziologijos klinikoje, tiriant Neurochirurgijos klinikos pacientus, kurie pateko į ligoninę dėl galvos smegenų traumos nuo 2013 iki 2017 metų. Tiriamųjų grupę sudarė 183 suaugę pacientai, kuriems reikėjo atlikti skubią operaciją dėl GST. Neuromarkerių ištyrimui pacientų kraujo mėginiai buvo imami keturis kartus: iš karto pacientui patekus į ligoninę (N1), po stacionarizavimo praėjus 24 val. (N2), 48 val. (N3) ir 72 val. (N4). Visos p reikšmės < 0,05 laikomos statistiškai reikšmingomis. Rezultatai. Kiekvieno tiriamosios grupės paciento kraujo mėginiuose buvo matuojamos ir lyginamos tarpusavyje abiejų neuromarkerių S100B baltymo ir NSE vidutinės koncentracijos. Taip pat abiejų neuromarkerių koncentracijos visuose keturiuose kraujo mėginiuose buvo lyginamos tarp išgyvenusiųjų po GST ir mirusiųjų ligoninėje pacientų. Išmatavus neuromarkerių NSE ir S100B koncentracijas N3 (praėjus 48 val. po stacionarizavimo) ir N4 (praėjus 72 val. po stacionarizavimo) gauti statistiškai reikšmingi abiejų neuromarkerių skirtumai, o N2 (praėjus 24 val. po stacionarizavimo) mėginiuose statistiškai reikšmingas skirtumas gautas tik S100B. Abiejų neuromarkerių koncentracijos visuose keturiuose mėginiuose statistiškai reikšmingai skyrėsi tarp išgyvenusiųjų ir tiriamųjų, kurie mirė, grupėse. ROC kreivės analizė buvo naudojama išskirti tam tikras neuromarkerių koncentracijos ribas kiekvieno matavimo atveju. Neuromarkerių koncentracijos buvo lyginamos tarp mirusiųjų ligoninėje ir išgyvenusiųjų po GST pacientų. Išvada. S100B ir NSE žymenys yra patikimi ilgalaikio išgyvenamumo prognostiniai veiksniai pacientams, patyrusiems GST, nors žymuo S100B yra patikimesnis vertinant pacientų mirtingumo ligoninėje prognozę.

Choice of Anesthesia for Cesarean Delivery: An Analysis of the National Anesthesia Clinical Outcomes Registry.

Neuraxial anesthesia use in cesarean deliveries (CDs) has been rising since the 1980s, whereas general anesthesia (GA) use has been declining. In this brief report we analyzed recent obstetric anesthesia practice patterns using National Anesthesiology Clinical Outcomes Registry data. Approximately 218,285 CD cases were identified between 2010 and 2015. GA was used in 5.8% of all CDs and 14.6% of emergent CDs. Higher rates of GA use were observed in CDs performed in university hospitals, after hours and on weekends, and on patients who were American Society of Anesthesiologists class III or higher and 18 years of age or younger.

The preoperative cardiology consultation: indications and risk modification.

BackgroundThe cardiologist is regularly consulted preoperatively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear.MethodsThis is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for elective non-cardiac surgery, which resulted in 273 (1%) referrals to the cardiologist for further preoperative evaluation. Medical charts were reviewed for patient characteristics, main reason for referring, requested diagnostic tests, interventions, adjustment in medical therapy, 30-day mortality and major adverse cardiac events.ResultsThe most common reason for consultation was the evaluation of a cardiac murmur (95 patients, 35%). In 167 (61%) patients, no change in therapy was initiated by the cardiologist. Six consultations (2%) led to invasive interventions (electrical cardioversion, percutaneous coronary intervention or coronary artery bypass surgery). On average, consultation delayed clearance for surgery by two weeks.ConclusionIn most patients referred to the cardiologist after being screened at an outpatient anaesthesiology clinic, echocardiography is performed for ruling out specific conditions and to be sure that no further improvement can be made in the patient’s health. In the majority, no change in therapy was initiated by the cardiologist. A more careful consideration about the potential benefits of consulting must be made for every patient.

Comparison of Neuroendocrine Responses in Open and Laparoscopic Appendectomies in Children: A Randomized Controlled Trial

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si Serkan Arslan, MD, Dicle University Faculty of Medicine, Department of Pediatric Surgery, Diyarbakir, Turkey Phone: +90 533 633 07 74 E-mail: drserkanarslan@hotmail.com Re cei ved/Ge lis ta ri hi: 16.02.2016 Ac cep ted/Ka bul ta ri hi: 20.05.2016 This study was 7th European Congress of Pedaitric Anesthesia for Pediatric Anesthesiology, Polond, 2009 published as a poster at a congress. 1Kagithane State Hospital, Clinic of Anesthesiolog and Reanimation, Istanbul, Turkey 2Dunya Goz Hospital, Clinic of Anesthesiology and Reanimation, Istanbul, Turkey 3Sisli Memorial Hospital, Clinic of Anesthesiolog and Reanimation, Istanbul, Turkey 4Sisli Etfal Training and Research Hospital, Clinic of Anesthesiology and Reanimation, Istanbul, Turkey 5Dicle University Faculty of Medicine, Department of Pediatric Surgery, Diyarbakir, Turkey Aysel Erdem Salkaya1, Ozgur Ozbagriacik2, Alp Akay3, Sibel Oba4, Serkan Arslan5 J Pediatr Res 2016;3(3):144-8 DO I: 10.4274/jpr.41713

The Incidence and Risk Factors of Nosocomial Infections in ICU

AbstractIntroduction: The increased incidence of nosocomial infections in intensive care units, with frequent occurrence of multiresistant pathogens increase mortality and often raises therapeutic problems.Objectives: to assess the incidence of nosocomial infections, and risk factors.Methods: The study includes 125 patients hospitalized in the Clinic of Anesthesiology and Intesive Care in the Emergency County Hospital and Cardiovascular Surgery Targu Mures. The patients were divided into two groups: the control group (n = 99), patients who did not develop infections during hospitalization in the ICU and the group with infection (n = 26).Results: The incidence of nosocomial infections in our intensive care unit was 19.1%, the most common pathogen being Acinetobacter baumanii. There were no significant differences between the two groups regarding demographic data, the most important risk factor was chronic alcohol consumption. SAPS II. and SOFA scores showed higher values in the group with infection on the day of admission. This group showed lower levels of arterial blood oxygen (Horowitz index), lower sodium level, and higher number of platelets compared to the control group. The mortality in the group with infection was 47.65% compared to the control.Conclusions: Nosocomial infections in critically ill patients are associated with hypoxemia, thrombocytopenia, hyponatremia and a bad outcome.

Abstract PR142

Background & Objectives: Measurement of neuromarkers is easy but not widely used diagnostic method. The value of neuromarkers for predicting the outcome of traumatic brain injury (TBI) is not clear enough. The aim of this study was to evaluate the value of S100B and NSE for prediction of in-hospital mortality for patients with severe TBI. Materials & Methods: A prospective study was held in Lithuanian University of Health Sciences Kaunas Clinics, Anesthesiology clinic. Serum of 46 patients with severe TBI was analyzed for S100B and NSE neuromarkers. Neuromarkers were measured at hospital admission (N1) and after 24 (N2), 48 (N3) and 72 (N4) hours. Outcomes were analyzed at hospital discharge and the influence of neuromarkers for in-hospital mortality was evaluated using ROC curves. Patients with absence of measurements were excluded from the study. Nonparametric tests were used for statistical analysis at p ≤ 0.05. Approval of Regional bioethics committee was obtained before study initiation. Results: 46 patients were involved into the study. There were 11 women and 35 men. The average age was 55.33 ± 16.8 years and there was no significant difference between women and men. Statistically significant differences were found comparing N1-N3, N1-N4, N2-N4, N3-N4 measurements of S100B and N1-N2, N1-N3, N1-N4, N2-N4 measurements of NSE. Using ROC curves analysis specific values of breaking points were found for in-hospital mortality prediction. In-hospital mortality was significantly higher when S100B was N1 >22.5 pg/ml (incidence of mortality (IoM) 33.3%), N2 >128.5 pg/ml (IoM 75%), N3 >27.04 pg/ml (IoM 46.7%), N4 >112.06 pg/ml (IoM 75%) and NSE was N2 >7.97 µg/l (IoM 36.4%), N3 >5.8 µg/l (IoM 45%), N4 >28.6 µg/l (IoM 50%). N1 measurement of NSE had no statistically significant difference. Statistically significant difference among the survivors and in-hospital mortality was found in N1, N2, N3 of S100B measurements and in N2, N3 of NSE measurements. Moreover, S100B values N2 >128.5 pg/ml and N3 >27.04 pg/ml increased the risk of in-hospital mortality 18.174 and 7.67 times respectively as well as NSE N2 >7.97 µg/l and N3 >5.8 µg/l increased the risk 5.4 and 21. 671 times respectively. Conclusion: S100B and NSE can be used for prediction of in-hospital mortality for severe TBI patients. However, the maximum value for prediction can be obtained if neuromarkers are measured after 24 and 48 hours after hospital admission.