Duration Of ICU Research Articles

Predictors of length of hospital stay after pediatric Ebstein anomaly corrective surgery: a retrospective cohort study

BackgroundThe remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient’s hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA).MethodsWe conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event.ResultsA total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group.ConclusionWe identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.

Protective effects of fructose-1,6-bisphosphate postconditioning on myocardial ischemia-reperfusion injury in patients undergoing valve replacement：a randomized, double-blind, placebo-controlled clinical trial.

Pharmacological postconditioning can protect against myocardial ischaemia-reperfusion injury during cardiac surgery with extracorporeal circulation. The aim of this study was to observe the protective effects of fructose-1, 6-bisphosphate (FDP) postconditioning on myocardial ischaemia-reperfusion injury in patients undergoing cardiac valve replacement with extracorporeal circulation. Patients undergoing elective mitral valve replacement and/or aortic valve replacement were divided into normal saline postconditioning group (NS group) and FDP postconditioning group (FDP group). The primary outcome was the plasma concentration of creatine kinase-MB (CK-MB). The secondary outcomes were the plasma concentrations of lactate dehydrogenase (LDH), creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP), alpha-hydroxybutyrate dehydrogenase (α-HBDH) and cardiac troponin I (cTnI), the spontaneous cardiac rhythm recovery profile, the extracorporeal circulation time and duration of surgery, ICU and postoperative hospitalization. Forty patients were randomly assigned to receive intervention and included in the analysis. The serum concentrations of CK-MB, LDH, CK, cTnI, α-HBDH and hs-CRP at T1∼4 were lower in the FDP group than in the NS group (P < 0.001). Compared with the NS group, the dosage of dopamine administered 1∼90min after cardiac resuscitation, the spontaneous cardiac rhythm recovery time and the incidence of ventricular fibrillation were lower in the FDP group (P < 0.001, P < 0.001 and P = 0.040, respectively). The values of ST- changes were increased more significantly in the NS group than in the FDP group （median [standard deviation] 1.3 [0.3] mm vs 0.7 [0.2] mm）(P < 0.001). Compared with the NS group, the time of recovery of ST-segment deviations was shorter in the FDP group（50.3 [12.3] min vs 34.6 [6.9] min） (P < 0.001). The fructose-1, 6-bisphosphate postconditioning could improve both myocardial ischaemia-reperfusion injury and the spontaneous cardiac rhythm recovery during cardiac valve surgery with extracorporeal circulation.

A study of critically ill obstetric patients admitted to intensive care unit of a tertiary care hospital.

To evaluate characteristics, indications, complications and outcome of obstetric patients admitted to ICU of tertiary care hospital in KPK, Pakistan. This descriptive study was conducted in department of OBGYN of Lady Reading Hospital, Peshawar from January 2021 till December 2021. A total of 62 patients were enrolled into the study using nonprobability consecutive sampling technique. Their data were collected on a proforma. All patients were followed till their death or discharge home from hospital. The mean duration of ICU stay of patients, was 6.85 ± 4.82 days. Out of 62 patients 17 (27.41%) expired in ICU, while 45 (72.58%) patients survived and were discharged. Pre-eclampsia and Eclampsia was the commonest primary diagnosis, accounting for 28 cases (45.2%) with a case fatality rate of 25%, followed by 13 cases (21%) of primary postpartum hemorrhage (PPH) as the second commonest reason for ICU admission and a case fatality rate of 38%. The underlying primary diagnosis had no statistically significant association with outcome of the patient. Acute Renal failure had statistically significant association with outcome of the patient with adjusted OR 4.79, CI:1.17-19.66, p-0.02. Similar positive association with mortality existed for patients having DIC (aOR:6.59; CI:1.34-32.34, p-0.02). Pre-eclampsia/Eclampsia is the commonest reason for intensive care admission, however PPH has the highest case fatality rate. The outcome of critically ill obstetric patients is dependent on complications and not primary underlying diagnosis.

Propofol vs Midazolam As the Initial Sedation Strategy for Mechanically Ventilated Patients: A Single-Center Experience From Saudi Arabia.

Background Propofol and midazolam are the most common sedative agents used in critical settings. Propofol and midazolam might have different mortality rates after sedation administration. Some studies mention that propofol is associated with a lower mortality rate than midazolam in mechanically ventilated patients, but other studies have contradicting results. This study aims to compare the 28-day mortality of propofol versus midazolam for patients undergoing mechanical ventilation in the National Guard Hospital Health Affairs (NGHA)-Western Region (WR). Methods A retrospective chart review was conducted at (NGHA-WR) from March 2016 to July 2022. The inclusion criteria were those mechanically ventilated patients aged 18 years or older who were admitted to ICU, where they were given either propofol or midazolam as the initial sedative agent. Those who signed DNR (Do Not Resuscitate) or were contraindicated to sedation, such as allergy, were excluded from the study. Data were retrospectively retrieved and obtained from the Hospital Information System (HIS-BestCare, Saudi-Korean Health Informatics Company, Riyadh, Saudi Arabia) and the Office of Data Intelligence. Results There is a significant difference between the type of sedation and the 28-day mortality rate. Midazolam was associated with higher rates of mortality - 104 (47.93%) when compared to propofol - three (14.29%). Also, patients who used midazolam had longer durations of ICU stay compared to propofol, with a mean number of 19.23 days vs 7.55 days, respectively. Conclusion There is a significant difference regarding the 28-day mortality between patients who were given propofol or midazolam as an initial sedative agent for mechanical ventilation ≥ 24 hours. Moreover, the use of propofol is associated with fewer days of being intubated or being in ICU when compared to midazolam.

Risk prediction and prognostic analysis of post-implantation syndrome after thoracic endovascular aortic repair

This study aimed to establish a predictive model for the risk of post-thoracic endovascular aortic repair (TEVAR) post-implantation syndrome (PIS) in type B aortic dissection (TBAD) patients, assisting clinical physicians in early risk stratification and decision management for high-risk PIS patients. This study retrospectively analyzed the clinical data of 547 consecutive TBAD patients who underwent TEVAR treatment at our hospital. Feature variables were selected through LASSO regression and logistic regression analysis to construct a nomogram predictive model, and the model's performance was evaluated. The optimal cutoff value for the PIS risk nomogram score was calculated through receiver operating characteristic (ROC) curve analysis, further dividing patients into high-risk group (HRG) and low-risk group (LRG), and comparing the short to midterm postoperative outcomes between the two groups. In the end, a total of 158 cases (28.9%) experienced PIS. Through LASSO regression analysis and multivariable logistic regression analysis, variables including age, emergency surgery, operative time, contrast medium volume, and number of main prosthesis stents were selected to construct the nomogram predictive model. The model achieved an area under the curve (AUC) of 0.86 in the training set and 0.82 in the test set. Results from calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) demonstrated that the predictive model exhibited good performance and clinical utility. Furthermore, after comparing the postoperative outcomes of HRG and LRG patients, we found that the incidence of postoperative PIS significantly increased in HRG patients. The duration of ICU stay and mechanical assistance time was prolonged, and the incidence of postoperative type II entry flow and acute kidney injury (AKI) was higher. The risk of aortic-related adverse events (ARAEs) and major adverse events (MAEs) at the first and twelfth months of follow-up also significantly increased. However, there was no significant difference in the mortality rate during hospitalization. This study established a nomogram model for predicting the risk of PIS in patients with TBAD undergoing TEVAR. It serves as a practical tool to assist clinicians in early risk stratification and decision-making management for patients.

Predictive Value of Ultrasonic Diaphragm Thickening Fraction on Successful Weaning in Postoperative Cardiothoracic Surgery Patients with Chronic Obstructive Pulmonary Disease (COPD)

Abstract Background The diaphragm is the most important muscle of respiration and is largely responsible for the change in the intra thoracic pressure. In mechanically ventilated patients, the diaphragm can develop atrophy and weakness leading to prolonged duration of mechanical ventilation. Many studies reported a high prevalence of diaphragm dysfunction during weaning, and it was found to be associated with poorer clinical outcomes. Objective To assess the predictive value of diaphragm thickening fraction (DTF) by bedside ultrasound on successful weaning in postoperative cardiothoracic surgery patients with COPD. Subjects and Methods This prospective study was conducted on 40 subjects at cardiothoracic ICU unit at Elmaadi Military hospital during the period from (September,2021) to (July,2022) after approval of the research Ethical committee at faculty of medicine, Ain shams university. Results Regarding the relation between the two studied groups and diaphragmatic thickness, the thickness was decreased in the failed group than the successful group during inspiration, expiration and thickness fraction %, with significant difference between two groups as p-Value was &amp;lt;0.05. There was an increase in the duration of ICU stay &amp; mechanical ventilation in the failed group compared to the successful group, with significant difference between two groups as p-Value was &amp;lt;0.05. Regarding the correlation between ICU stay &amp; mechanical ventilation and diaphragmatic thickness, there were negative correlation between ICU stay &amp; MV duration and all parameters of the diaphragmatic thickness, with significant difference as p-Value was &amp;lt;0.05. Conclusion Weaning success in mechanically ventilated postoperative cardiothoracic surgery patients with COPD can be predicted by ultrasonography-based evaluation of diaphragm function by analyzing diaphragmatic thickness fraction. It is a practical, feasible, non-invasive technique that may be used at the bedside to rule out diaphragmatic dysfunction.

Comparative Study between High Caloric Nutrition and Net Caloric Nutrition and Their Correlation with Organs Failure and Mortality in Acute Respiratory Distress Syndrome Patients

Abstract Background Acute respiratory distress syndrome (ARDS) is an acute life threatening inflammatory lung injury manifested by hypoxia and stiff lungs due to increased pulmonary vascular permeability and almost always requiring mechanical ventilation support. ARDS represents an acute response to diverse provoking trigger factors and etiologies, resulting in bilateral lung opacities on radiography and hypoxemia. Objective To compare between high caloric nutrition and net caloric nutrition in ARDS patients regarding the mortality rates and the incidence of multiple organ failure. Patients and Methods This was a prospective, cohort, randomized, comparative study that was conducted on include adults’ patients with ARDS who was admitted to ICU Units in El Galaa Military Hospitals throughout 6 months. Results Regarding our primary outcomes, we found that there was no difference found between two groups regarding Hospital mortality, and there was statistically significant difference found between two groups regarding Survival at 60 days. While for the secondary outcomes in our study, we found that there was no difference found between two groups regarding infections, ICU mortality, ICU duration of stay and duration of hospital stay. Conclusion No difference was found between high caloric nutrition and net caloric nutrition in terms of the mortality rates and the incidence of multiple organ failure among ARDS patients.

The value of N-acetylcysteine bronchoalveolar lavage in patients with severe traumatic brain injury combined with ventilator-associated pneumonia

In order to improve the treatment of patients with ventilator-associated pneumonia (VAP) in severe traumatic brain injury (TBI) and to effectively suppress the inflammatory response and enhance blood oxygen indicators, we conducted an innovative bronchoalveolar lavage (BAL) treatment using N-acetylcysteine (NAC). To conduct this study, we divided patients with VAP in severe TBI into a control (CTRL) group and a BAL group. The control group received BAL with saline, while the BAL group received BAL with NAC in addition to standard care. We compared the clinical treatment, degree of inflammation, blood oxygen index, and safety of both groups pre- and post-BAL. The results showed that BAL with NAC was more effective in reducing the duration of antibiotic use, imaging uptake, fever reduction, mechanical ventilation, and ICU stay, as well as CPIS and APACHE II scores. Moreover, the BAL group demonstrated greater improvement in ventilation, as indicated by increased values of PaO2, SaO2, and OI, and a more substantial decrease in PaCO2. Furthermore, BAL treatment effectively suppressed the level of inflammatory response in the body and more significantly reduced TNF-α, CPR, PCT and MIP-1α levels. Adjuvant treatment with BAL effectively improved clinical outcomes and reduced mortality in severe TBI patients with VAP, while maintaining a high level of safety during the BAL operation. Therefore, BAL using NAC holds significant potential in the salvage of patients with severe TBI combined with VAP.

Combined Thoracoscopic Surgery and High-Frequency Ventilation Induce Severe Traumatic Brain Injury and Chest Trauma Recovery

Background: Traumatic injuries, especially combined injuries involving multiple body regions, have become a significant concern in industrialized nations due to their rising frequency and severity. Among these, chest injuries, particularly closed chest injuries, present critical challenges due to their high mortality rates and frequent occurrence in combined trauma cases. Effective management of such injuries is crucial to improving patient outcomes. Methods: This study analyzed the outcomes of 107 patients with combined severe traumatic brain injury (TBI) and chest trauma treated at the Russian Research Center for Emergency Medicine between 2017 and 2022. Patients were categorized based on respiratory support methods: Group I (52 patients) received artificial pulmonary ventilation (APV) with synchronized intermittent mandatory ventilation volume-controlled (SIMV VC), while Group II (55 patients) was managed with a combination of SIMV VC and high-frequency jet ventilation (sHFJV). Diagnostic and clinical assessments included neurological examinations, radiological imaging, and invasive monitoring. Surgical interventions involved video-assisted thoracoscopy (VATS) for managing chest injuries. Results: Initial assessments revealed severe conditions across both groups. After 12 hours of respiratory support, Group II patients exhibited significant improvements in oxygenation, blood gas parameters, and reduced pulmonary shunt compared to Group I. Group II also experienced shorter durations of respiratory support and ICU stays, and a lower mortality rate (5.45% vs. 17.3% in Group I). Thoracoscopic interventions were successfully performed with reduced postoperative complications and shorter hospital stays in Group II. Conclusion: The combination of SIMV VC and sHFJV significantly improves respiratory outcomes, reduces the duration of mechanical ventilation, and shortens ICU stays compared to SIMV VC alone. Thoracoscopic procedures prove effective for managing select cases of chest trauma. Careful patient evaluation is essential to ensure hemodynamic stability before opting for thoracoscopic interventions. This study underscores the importance of advanced diagnostic tools and minimally invasive techniques in optimizing the management of severe chest trauma and improving overall patient outcomes.

Nucleated red blood cells as a prognostic marker for mortality in patients with SARS-CoV-2-induced ARDS: an observational study

BackgroundThe presence of nucleated red blood cells (NRBCs) in the peripheral blood of critically ill patients is associated with poor outcome. Evidence regarding the predictive value of NRBCs in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS) remains elusive. The aim of this study was to evaluate the predictive validity of NRBCs in these patients.MethodsDaily NRBC values of adult patients with SARS-CoV-2-induced ARDS were assessed and their predictive validity for mortality was statistically evaluated.A cut-off level based on the patient’s maximum NRBC value during ICU stay was calculated and further specified according to Youden’s method. Based on this cut-off value, further analyses such as logistic regression models and survival were performed.Results413 critically ill patients with SARS-CoV-2-induced ARDS were analyzed. Patients who did not survive had significantly higher NRBC values during their ICU stay compared to patients who survived (1090/µl [310; 3883] vs. 140/µl [20; 500]; p < 0.0001). Patients with severe ARDS (n = 374) had significantly higher NRBC values during ICU stay compared to patients with moderate ARDS (n = 38) (490/µl [120; 1890] vs. 30/µl [10; 476]; p < 0.0001).A cut-off level of NRBC ≥ 500/µl was found to best stratify risk and was associated with a longer duration of ICU stay (12 [8; 18] vs. 18 [13; 27] days; p < 0.0001) and longer duration of mechanical ventilation (10 [6; 16] vs. 17 [12; 26] days; p < 0.0001). Logistic regression analysis with multivariate adjustment showed NRBCs ≥ 500/µl to be an independent risk factor of mortality (odds ratio (OR) 4.72; 95% confidence interval (CI) 2.95–7.62, p < 0.0001). Patients with NRBC values below the threshold of 500/µl had a significant survival advantage over those above the threshold (median survival 32 [95% CI 8.7–43.3] vs. 21 days [95% CI 18.2–23.8], log-rank test, p < 0.05).Patients who once reached the NRBC threshold of ≥ 500/µl during their ICU stay had a significantly increased long-term mortality (median survival 489 days, log-rank test, p = 0.0029, hazard ratio (HR) 3.2, 95% CI 1.2–8.5).ConclusionsNRBCs predict mortality in critically ill patients with SARS-CoV-2-induced ARDS with high prognostic power. Further studies are required to confirm the clinical impact of NRBCs to eventually enhance decision making.

Intensive care unit-acquired weakness and mechanical ventilation: A reciprocal relationship

Intensive care unit-acquired weakness (ICU-AW; ICD-10 Code: G72.81) is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause. The risk factors for ICU-AW include hyperglycemia, parenteral nutrition, vasoactive drugs, neuromuscular blocking agents, corticosteroids, sedatives, some antibiotics, immobilization, the disease severity, septicemia and systemic inflammatory response syndrome, multiorgan failure, prolonged mechanical ventilation (MV), high lactate levels, older age, female sex, and pre-existing systemic morbidities. There is a definite association between the duration of ICU stay and MV with ICU-AW. However, the interpretation that these are modifiable risk factors influencing ICU-AW, appears to be flawed, because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW. Prevention strategies must be based on other risk factors. Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.

Outcomes in pediatric extracorporeal cardiopulmonary resuscitation: A single-center retrospective study from 2007 to 2022 in China

ObjectiveWe aimed to investigate the prognostic factors of pediatric extracorporeal cardiopulmonary resuscitation (ECPR). MethodsThe retrospective study included a total of 77 pediatric cases (7 neonates and 70 children) who underwent ECPR after in-hospital and out-of-hospital cardiac arrest between July 2007 and December 2022. Primary endpoints were complications, while secondary endpoints included all-cause in-hospital mortality. ResultsAmong the 45 cases experiencing complications, 4 neonates and 41 children had multiple simultaneous complications, primarily neurological issues in 25 cases. Additionally, organ failure occurred in 11 cases, and immunodeficiency was present in two cases. Furthermore, 9 cases experienced bleeding events, and 13 cases showed thrombosis. Patients with complications had lower weight, shorter ECMO durations, and longer CPR durations. Non-survivors had longer CPR durations and shorter durations of ECMO, ICU stay, and mechanical ventilation compared to survivors. Complications were more prevalent in non-survivors, particularly organ failure and bleeding events. ConclusionWeight, CPR duration, and ECMO duration were associated with complications, suggesting areas for treatment optimization. The higher occurrence of complications in non-survivors underscores the importance of early detection and management to improve survival rates. Our findings suggest clinicians consider these factors in prognostic assessments to enhance the effectiveness of ECPR programs.

Damage Control Resuscitation and Damage Control Surgery

Trauma triggers complex physiological responses with primary and secondary effects vital to understanding and managing trauma impact. "Damage Control" (DC), a concept adapted from naval practices, refers to abbreviated initial surgical care focused on controlling bleeding and contamination, critical for the survival of severely compromised patients. This impacts anaesthesia procedures and intensive care. "Damage Control Resuscitation" (DCR) is an interdisciplinary approach aimed at reducing mortality in severely injured patients, despite potentially increasing morbidity and ICU duration. Current medical guidelines incorporate DC strategies.DC is most beneficial for patients with severe physiological injury, where surgical trauma ("second hit") poses greater risks than delayed treatment. Patient assessment for DC includes evaluating injury severity, physiological reserves, and anticipated surgical and treatment strain. Inadequate intervention can worsen trauma-induced complications like coagulopathy, acidosis, hypothermia, and hypocalcaemia.DCR focuses on rapidly restoring homeostasis with minimal additional burden. It includes rapid haemostasis, controlled permissive hypotension, early blood transfusion, haemostasis optimization, and temperature normalization, tailored to individual patient needs."Damage Control Surgery" (DCS) involves phases like rapid haemostasis, contamination control, temporary wound closure, intensive stabilization, planned reoperations, and final wound closure. Each phase is crucial for managing severely injured patients, balancing immediate life-saving procedures and preparing for subsequent surgeries.Intensive care post-DCS emphasizes stabilizing patients hemodynamically, metabolically, and coagulopathically while restoring normothermia. Decision-making in trauma care is complex, involving precise patient assessment, treatment prioritization, and team coordination. The potential of AI-based decision support systems is noted for their ability to analyse patient data in real-time, aiding in decision-making through evidence-based recommendations.

A perioperative predictive model of early mortality in acute cervical spinal cord injury: A prospective cohort study

BackgroundTraumatic cervical spine injury is common among spinal cord injury which requires an intensive, multidisciplinary approach which can affect the immediate postoperative hospital survival rate. By identifying the risk factors leading to early mortality in cervical spine trauma patients, the prognosis of patients with TCSCI can be better predicted. ObjectiveThe study aims to analyze the variables influencing in-hospital mortality in cervical spine trauma patients treated at a Level I trauma Center. MethodsProspective study was conducted on subaxial cervical spine injuries from July 2019 to March 2022. Patients were divided into two groups: Group A, with in-hospital mortality, and Group B, who got discharged from hospital, and mortality predictors were reviewed and analyzed for as potential risk factors for in-hospital mortality. ResultsOut of 105 patients, 83.8 % were male with mean age of 40.43 ± 12.62 years. On univariate analysis, AIS (p-value: <0.01), ICU stay (p-value: <0.01), level of injury (p-value: <0.01), and MRI parameters like the extent of Parenchymal damage (p-value: <0.01), MSCC (p-value: <0.01), and MCC (p-value: <0.01) were potential risk factors for in-hospital mortality. On multivariate regression analysis AIS at presentation (p-value: 0.02) was the only significant independent parameter for in-hospital mortality. ConclusionsAIS grading at presentation, duration of ICU stay, level of injury, rate of tracheostomy, and MRI parameters like the extent of parenchymal damage, MCC, and MSCC influence and predicts in-hospital mortality, whereas AIS is the only independent risk factor.

Benefits of Rib Fixation Utilizing Low-Cost Materials: A Randomized Pilot Trial

IntroductionSurgical stabilization of rib fractures (SSRF) using standard rib plating systems has become a norm in developed countries. However, the procedure has not garnered much interest in low–middle-income countries, primarily because of the cost. MethodsThis was a single-center pilot randomized trial. Patients with severe rib fractures were randomized into two groups: SSRF and nonoperative management. SSRF arm patients underwent surgical fixation in addition to the tenets of nonoperative management. Low-cost materials like stainless steel wires and braided polyester sutures were used for fracture fixation. The primary outcome was to assess the duration of hospital stay. ResultsTwenty-two patients were randomized, 11 in each arm. Per-protocol analysis showed that the SSRF arm had significantly reduced duration of hospital stay (22.6 ± 19.1 d versus 7.9 ± 5.7 d, P value 0.031), serial pain scores at 48 h and 5 d (median score 5, IQR (3-6) versus median score 7, IQR (6.5-8), P value 0.004 at 48 h and median score 2 IQR (2-3) versus median score 7 IQR (4.5-7) P value 0.0005 at 5 d), significantly reduced need for injectable opioids (9.9 ± 3.8 mg versus 4.4 ± 3.4 mg, P value 0.003) and significantly more ventilator-free days (19.9 ± 8.7 d versus 26.4 ± 3.2 d, P value 0.04). There were no statistically significant differences in the total duration of ICU stay (median number of days 2, IQR 1-4.5 versus median number of days 7, IQR 1-14, P value 0.958), need for tracheostomy (36.4% versus 0%, P value 0.155), and pulmonary and pleural complications. ConclusionsSSRF with low-cost materials may provide benefits similar to standard rib plating systems and can be used safely in resource-poor settings.

Therapeutic strategy for totally thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation

Objective: To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass. Methods: This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People's Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period. Results: The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of (M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation (OR=11.424, 95%CI: 1.477 to 144.564, P=0.033) and excessive rewarming (OR=15.249, 95%CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions: The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Impact of Cardiac Pacemaker Implantation in Patients With Acute Traumatic Cervical Spinal Cord Injury.

Cardiac pacemaker implantation may be indicated in patients with refractory bradycardia following a cervical spinal cord injury (CSCI). However, evidence about the impact of this procedure on outcomes is lacking. We planned a study to assess whether the implantation of a pacemaker would decrease mortality and hospital resource utilization in patients with CSCI. Adult patients with CSCI in the Trauma Quality Improvement Program (TQIP) database between 2016 and 2019 were retrospectively analyzed. Patients were divided into "pacemaker" and "non-pacemaker" groups, and their baseline characteristics and clinical outcomes were analyzed. A total of 6774 cases were analyzed. The pacemaker group showed higher in-hospital rates of cardiac arrest, myocardial infarction, and longer duration of mechanical ventilation and ICU stay than the non-pacemaker group. Nevertheless, pacemaker placement was associated with a significant decrease in mortality (4.2% vs 26.0%, P < .01). Patients with CSCI requiring a pacemaker placement had better survival than those treated without a pacemaker. Pacemaker implantation should be highly considered in patients who develop refractory bradycardia after CSCI.

Single-Lung Ventilation in Infants for Surgical Repair of Coarctation of The Aorta Without Cardiopulmonary Bypass.

To investigate the effect of improving the operative field and postoperative atelectasis of single-lung ventilation (SLV) in the surgical repair of coarctation of the aorta (CoA) in infants without the use of cardiopulmonary bypass (CPB). This was a retrospective cohort study. The clinical data of 28 infants (aged 1 to 4 months, weighing between 4.2 and 6 kg) who underwent surgical repair of CoA without CPB from January 2019 to May 2022 were analyzed. Fourteen infants received SLV with a bronchial blocker (Group S), and the other 14 infants received routine endotracheal intubation and bilateral lung ventilation (Group R). In comparison to Group R, Group S exhibited improved exposure of the operative field, a lower postoperative atelectasis score (P<0.001), reduced prevalence of hypoxemia (P=0.01), and shorter durations of operation, mechanical ventilation, and ICU stay (P=0.01, P<0.001, P=0.03). There was no difference in preoperative information or perioperative respiratory and circulatory indicators before SLV, 10 minutes after SLV, and 10 minutes after the end of SLV between the two groups (P>0.05). Intraoperative bleeding, intraoperative positive end-expiratory pressure (PEEP), and systolic pressure gradient across the coarctation after operation were also not different between the two groups (P>0.05). This study demonstrates that employing SLV with a bronchial blocker is consistent with enhanced operative field, reduced operation duration, lower prevalence of intraoperative hypoxemia, and fewer postoperative complications during the surgical repair of CoA in infants without the use of CPB.

Procalcitonin and C-Reactive Protein in Critically Ill Patients with Sepsis and Septic Shock Admitted in an ICU of a Tertiary Care Hospital in Bangladesh

Background: Early intervention and predicting outcome has become a cornerstone in the treatment of sepsis as this may ensure the difference between survival and mortality. Both C-reactive protein and Procalcitonin have long been identified as good diagnostic markers of sepsis but their prognostic value is still a matter of debate. This study aims to find this particular point out. Objectives: Objective of this current study is to see the relationship of Procalcitonin and C-reactive protein respectively with the outcome of the patients with sepsis and septic shock and to compare their usefulness as predictors of outcome. Methods: This study was carried out in Intensive Care Unit of BIRDEM General Hospital, Shahbag, Dhaka for a period of one year. All consecutive patients with sepsis and septic shock were enrolled as study subjects during this period according to selection criteria. At the time of diagnosis that is at zero hour of development of sepsis or septic shock both C-reactive protein and Procalcitonin were measured and it was repeated at 24 hours. Data were collected in preformed data collection sheet and analyzed by the SPSS. Results: In this study, total 170 patients were enrolled as a case of sepsis or septic shock. The mean age was 59.5 ± 15.8 with a range between 20-96 years. Fifty seven (34%) patients had septic shock either during admission or during the first 24 hour of ICU stay and 46 (27.1%) patients did not survive their illness. The mean SOFA score was 6.30±2.18, mean duration of ICU stay 5.5.±2.98 days and mean MAP was 83.73±24.49 mmHg and 98 patients (57.65%) patients were ventilated during their admission. Diabetes mellitus had majority among co-morbidities with 147 (86.4%) patients having diabetes mellitus. Finally after calculating the cut off values from Youden’s index C-reactive protein was found to be more sensitive and Procalcitonin more specific as predictors of outcome. Conclusion: This study concludes that both Procalcitonin and C-reactive protein can individually predict outcome in sepsis and septic shock and one is not inferiorto the other.The dynamic changes of both these biomarkers over first 24 hours were also strongly associated with outcome. It was noted that while C-reactive protein was more sensitive, Procalcitonin was more specific. Bangladesh Crit Care J March 2024; 12 (1): 4-10

Outcome of Acinetobacter baumannii Ventilator Associated Pneumonia in Upper Egypt: does the resistance profile play a role?

Abstract Background Ventilator-associated pneumonia (VAP) due to drug resistant Acinetobacter baumannii (A. baumannii) is a challenging nosocomial problem associated with increased morbidity and risk of mortality. Objective This study aimed to investigate plasmid mediated quinolone resistance genes (PMQR) as a mechanism of resistance transmission, risk factors and outcome of A. baumannii VAP. Methods This prospective cohort study included 100 VAP patients between October 2020 and December 2022. Microbiological confirmation of A. baumannii. was done and PMQR genes were exposed by polymerase chain reaction (PCR). Pneumonia severity index (PSI), risk factors for developing drug resistant A. baumannii VAP, and the outcome were studied. Results The proportions of drug sensitive (DS), multidrug (MDR), extensive drug (XDR), and pan drug (PDR) resistant A. baumannii were 14%, 35%, 50%, and 1%, respectively. Majority of PSI classes IV and V showed XDR (66%) and PDR (100%) isolates. Detection of qnrA, qepA and aac(6′)-Ib-cr genes was predominant in PSI classes IV and V. The in-hospital mortality for MDR, XDR, and PDR was 22.7%, 70.5%, and 2.3%, respectively. ICU duration, prior use of carbapenems and use more than 2 antibiotics prior to VAP were risk factors for developing MDR A. baumannii while septic shock, multilobar chest radiography (CXR) infiltration and PSI class were predictors of in-hospital mortality. Conclusions VAP caused by MDR, XDR and PDR isolates of A. baumannii which harbors qnrA, qepA and aac(6’)-Ib-cr PMQR genes showed higher PSI classes and increased in-hospital mortality. The number of PMQR genes in A. baumannii isolates, ICU days, use of more than 2 antibiotics, and use of carbapenem prior to VAP, were independent risk factors for the development of drug resistant A. baumannii VAP.