Terms Of Intensive Care Unit Research Articles

Neurological manifestations and complications of COVID-19 in patients admitted to a tertiary care center in Nepal during the second wave.

Neurological symptoms and signs of Coronavirus disease-19 (COVID-19) can accompany, follow, or precede respiratory symptoms and signs; hence, they are important in the diagnosis and management of COVID-19 patients. In this retrospective study conducted during the second wave of COVID-19, we included all patients diagnosed with COVID-19 using real-time polymerase chain reaction and admitted to the Tribhuvan University Teaching Hospital between June 2021 and October 2021. The patients were categorized into 2 groups: group A (with neurological manifestations or complications) and Group-B (without neurological manifestations or complications). The 2 groups were compared in terms of intensive care unit (ICU) admission, need for ventilatory support, length of hospital stay, and various outcomes. The study included 235 participants ranging in age from 13 to 102 years (mean age = 54 years, standard deviation = 18). Among the participants, 54.50% were male. The proportion of individuals in group A was higher (59.15%, N = 139) than that in Group-B (40.85%, N = 96). Notably, a significantly greater number of patients were admitted to the ICU in Group B than in Group A. However, there were no statistically significant differences in the need for ventilatory support or hospital stay between the 2 groups. Interestingly, group A showed a higher rate of improvement (Z = -3.1145, P = .00188, 95% CI), while Group-B had a higher rate of mortality (Z = 4.5562, P < .00001, 95% CI). Altered mental status and stroke have been specifically linked to poorer outcomes, whereas typical neurological manifestations, such as hyposmia, hypogeusia, dizziness, headache, and myalgia, are associated with better outcomes.

Are trauma victims with obesity lucky in penetrating trauma injuries?

We aimed to reveal the protective effect of body mass index (BMI) and subcutaneous adipose tissue thickness (SATT), together with scores covering the abdomen, in patients with penetrating abdominal trauma. The data of 234 abdominal penetrating trauma patients over the age of 16 who applied to the emergency general sur-gery unit of Istanbul Medipol Hospital between 2017 and 2021 were analyzed retrospectively. Sex, age, types of penetrating injuries, BMI, need for blood transfusion and intensive care unit (ICU), mortality, Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Flint Colon Injury Score (FCIS) were recorded. The patients were divided into two groups: Gunshot Wound (GW) and Stab Wound (SW).While there was no significant difference in all parameters examined in all patients and GW patients in terms of BMI, a statistically significant difference was found in terms of blood transfusion need in SW patients (p=0.035). As a result of the Receiver Operating Characteristic curve analysis for the SATT variable, the cutoff value between mortality (p=0.866) and SATT (mm) values in all patients was 11 mm for all patients and 12 mm for GW patients. A significant difference was found in all patients and separately in GW and SW groups in terms of ICU and blood transfusion need, length of stay, ISS, PATI, and FCIS scores in non-operated patients (p<0.05). When all patients were examined, a statistically significant difference was found in terms of mortality (p=0.002). It is the first study to evaluate penetrating abdominal injuries with both BMI and SATT comprehensively and with all abdominal scores. A cutoff value to be determined for SATT with larger and multicenter studies can take its place as a parameter in the penetrating trauma algorithm.

Reduction of Environmental Noise Impact on Preterm Babies in NICU by Using Ear Plugs

Objective − To determine if using ear plugs reduce the impact of noise on preterm babies admitted to neonatal intensive care units in terms of changes in their vital parameters and their discomfort level, assessed using the Neonatal Infant Pain Scale (NIPS) score.Materials and Methods − This is an interventional study conducted in a tertiary level neonatal intensive care unit (NICU) (Bangalore, India) over a period of 3 months, ranging from June 2022 to September 2022. This study included 20 preterm babies with different gestational ages and birth weights who were admitted to the NICU during that period. The babies’ response to noise, in terms of changes in heart rate, respiratory rate, blood pressure, oxygen saturation and discomfort level, were assessed with ear plugs and without ear plugs on alternate days and the results were recorded. Descriptive statistics were used for statistical analysis. Results − On days 1 and 3, mean heart rate and systolic blood pressure were lower in babies wearing ear plugs (141.55±2.42 SD and 60.1±11.58, respectively) than in the same babies without ear plugs (157.55±2.52 SD and 61.85±1.6 SD, respectively) on days 2 and 4. The mean oxygen saturation was higher in babies wearing ear plugs (96.7%±0.80 SD) than in the same babies without the intervention (93.75%±1.29 SD). The mean NIPS score was lower with the intervention (2.05±0.22) than without ear plugs (5.05±0.22 SD).Conclusion – Ear plugs were an effective alternative in situations where noise in the NICU cannot be consistently maintained at a lower level than the standard recommendation by the AAP of 45 decibels.

Extracorporeal carbon dioxide removal compared to ventilation alone in patients with acute hypoxaemic respiratory failure: cost-utility analysis of the REST RCT.

Acute hypoxaemic respiratory failure requiring mechanical ventilation is a major cause of morbidity and mortality and has significant resource implications in terms of intensive care unit and hospital stay. To assess the cost-effectiveness of extracorporeal carbon dioxide removal compared to ventilation alone in patients with acute hypoxaemic respiratory failure. A cost-utility analysis embedded within a pragmatic, multicentre, allocation-concealed, open-label, randomised controlled trial. Four hundred and twelve (of a planned sample size of 1120) adult patients receiving mechanical ventilation for acute hypoxaemic respiratory failure, were recruited between May 2016 and December 2019 from 51 intensive care units in the UK. Participants were randomised (1 : 1) to receive extracorporeal carbon dioxide removal for at least 48 hours (n = 202) or standard care with ventilation alone (n = 210). Health-related quality of life via the EuroQol-5 Dimensions, five-level version, health resource use and associated costs were measured over the study period. The cost per quality-adjusted life-year was estimated at 12 months post randomisation. Mean EuroQol-5 Dimensions, five-level version utility scores were low and similar for each group. Quality-adjusted life-years were calculated for those patients with complete EuroQol-5 Dimensions, five-level version data (extracorporeal carbon dioxide removal n = 140, ventilation alone n = 143) and there was no discernible difference in quality-adjusted life-years at 12 months (mean difference -0.01; 95% confidence interval -0.06 to 0.05; 140). Total 12-month health resource use cost (including intervention costs) was calculated for those patients with complete cost data (extracorporeal carbon dioxide removal n = 125, ventilation alone n = 126) and costs were statistically significantly higher in the extracorporeal carbon dioxide removal group (mean difference £7668.76, 95% confidence interval 159.75, 15,177.77). Multiple imputation was used for missing total cost and quality-adjusted life-year data in the cost-utility analysis. Ventilation alone dominated extracorporeal carbon dioxide removal and there was 0% probability of extracorporeal carbon dioxide removal being cost-effective compared to ventilation alone for all willingness to pay thresholds per quality-adjusted life-year considered (£0-50,000). Extracorporeal carbon dioxide removal was associated with significantly higher costs, but no benefit in health-related quality of life. Given the data, extracorporeal carbon dioxide removal is not considered to be a cost-effective approach to treating patients with acute hypoxaemic respiratory failure. These included the absence of a baseline healthy utility score, minor data loss related to not obtaining complete intensive care unit readmission data for Scottish participants, and not estimating long-term cost-effectiveness due to the study closing early. Measuring baseline health-related quality of life in critical care studies is difficult; future economic evaluations in this setting should consider measuring health-related quality of life as soon as possible after the patients regain capacity. This trial is registered as NCT02654327 and ISRCTN 31262122. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 13/143/02.

Comparative Study Between the First and Second Wave of COVID-19 Deaths in India: A Single Center Study.

Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously evolving, and many mutant variants of the virus are circulating in the world. Recurrent waves of COVID-19 have caused enormous mortality all across the globe. Considering the novelty of the virus, it becomes crucial for healthcare experts and policymakers to understand the demographic and clinical attributes of inpatient deaths in the first and second waves of COVID-19. Methods This hospital record-based comparative study was conducted at a tertiary care hospital in Uttarakhand, India. The study included all COVID-19 RT PCR-positive patients admitted to the hospital during the first wave, from 1stApril2020to 31stJanuary2021, and the second wavefrom 1stMarch2021to 30thJune2021. Comparisons were made with respect to demographic, clinical, laboratory parameters, and course of hospital stay. Results The study exhibited 11.34% more casualties in the second wave, with the number of deaths being 424 and 475 for the first and second waves, respectively. A male preponderance of mortality was evident in both waves with significant differences(p=0.004). There was no significant difference in age between the two waves(p=0.809). The significantly different comorbidities were hypertension (p=0.003) and coronary artery disease (p=0.014). The clinical manifestations demonstrating a significant difference were cough (p=0.000), sore throat (p=0.002), altered mental status (p=0.002), headache (p=0.025), loss of taste and smell (p=0.001), and tachypnea (p=0.000). The lab parameters with a significant difference across both waves were lymphopenia (p=0.000), elevated aspartate aminotransferase (p=0.004), leukocytosis (p=0.008), and thrombocytopenia (p=0.004). During the hospital course of the second wave, in terms of intensive care unit stay, the need for non-invasive ventilation and inotrope support was higher. The complications manifesting in the form of acute respiratory distress syndrome and sepsis were observed more in the second wave. A significant difference was discerned in the median duration of hospital stay in both waves (p=0.000). Conclusion Despite being of shorter duration, the second wave of COVID-19 culminated in more deaths. The study demonstrated that most of the baseline demographic and clinical characteristics attributed to mortality were more common during the second wave of COVID-19, including lab parameters, complications, and duration of hospital stays. The unpredictable nature of COVID-19 waves calls for instituting a well-planned surveillance mechanism in place to identify the surge in cases at the earliest possible time and prompt response, along with developing infrastructure and capacity to manage complications.

Nutritional therapy for protein-energy malnutrition in children with sepsis

This review presents meta-analyses on nutrition in patients with critical illness using ASPEN/SCCM (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. The ESPNIC (2020) guideline, based on new evidence, complements most of the existing ASPEN (2017) guidelines for critical pediatrics. Childrens SSC (2020) did not find direct evidence and sufficient data to develop strong nutritional recommendations for children with sepsis/SS. Many issues remain unresolved, requiring systematic analysis. In the literature search, only a few randomized clinical trials have focused on the assessment and correction of protein-energy malnutrition in pediatric intensive care. Over the past decade, small and large pediatric studies have recommended nutritional therapy. However, given the heterogeneity of children admitted to intensive care units in terms of age, pathology, disease severity, presence of comorbidities, and nutritional status, it is unrealistic to expect that one nutrition strategy applies to all patients requiring intensive care. Therefore, most clinicians emphasize the need for an individualized approach to nutrition support in children, taking into account the pathology, severity, initial nutritional status, and riskbenefit ratio of different nutritional therapies. An extensive search of the literature on the problem did not reveal strong nutritional recommendations for children with sepsis/SS, which dictates the need for future research on the topic and correction of protein-energy malnutrition in children with sepsis/SS.

Predictive Value of Combination of Procalcitonin and Predisposition, Infection, Response, and Organ Dysfunction (PIRO) System in Septic Patients with Positive Blood Cultures in the Emergency Department.

PurposeProcalcitonin and predisposition, infection, response, and organ dysfunction (PIRO) system have high predictive value for the prognosis of critically ill patients. There are few studies on the predictive value of patients with positive blood cultures. The aim of the study was to evaluate risk stratification and sepsis-related mortality in patients with positive blood cultures via procalcitonin (PCT) combined with the PIRO system in emergency departments (ED).MethodsA total of 1074 patients with positive blood cultures were admitted to Beijing Chao-Yang Hospital ED from December 2017 to October 2020. Their serum PCT was recorded, along with a Sequential Organ Failure Assessment (SOFA) score, Mortality in Emergency Department Sepsis (MEDS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and PIRO score to predict the prognosis of septic patients with positive blood culture in terms of ICU (intensive care unit) admission, multiple organ dysfunction syndrome (MODS) development, and 28-day mortality. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to assess the prognostic value of the scoring systems.ResultsA total of 978 patients met the inclusion criteria. PCT, MEDS, APACHE II, and PIRO scores were found to independently predict ICU-admission, MODS development, and 28-day mortality (P<0.05), whereas SOFA did not. The AUC values of the PCT, MEDS, APACHE II, and PIRO scores for ICU-admission were 0.620, 0.740, 0.780, and 0.751, respectively. In the prediction of 28-day mortality, the AUC values of PCT, MEDS, APACHE II, and PIRO were 0.782, 0.745, 0.805, and 0.831, respectively. The AUC values combined PCT and PIRO system in predicting MODS and 28-day mortality were better than when predicting ICU-admission.ConclusionThis study indicates that PCT combined with the PIRO scoring system has a higher predictive value and is superior in predicting MODS and 28-day mortality in septic patients with positive blood cultures.

A Cohort Study in Intensive Care Units: Health Decisions Related to Blood Transfusion during the COVID-19 Pandemic.

Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries was critical, as it was in Spain; according to the data published daily by the Ministry of Health on its website, during the period of this study, the occupancy rate of intensive care units (ICUs) by patients diagnosed with the novel coronavirus disease (COVID-19) rose to 23.09% in Spain, even reaching 45.23% at the end of January 2021. We aimed to analyze the changes observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic period regarding the effectiveness of Spanish ICUs in terms of mortality reduction. We present a cross-sectional study that compares two cohorts of patients admitted to ICUs across all autonomous communities of Spain with a diagnosis of polytrauma. Results: Only age was slightly higher at admission during the first wave of the pandemic (47.74 ± 18.65 vs. 41.42 ± 18.82 years, p = 0.014). The transfusion rate during the pandemic increased by 10.4% compared to the previous stage (p = 0.058). Regarding hemostatic components, the use of tranexamic acid increased from 1.8% to 10.7% and fibrinogen concentrates from 0.9% to 1.9%. In the case of prothrombin complex concentrates, although there was a slight increase in their use, there were no significant differences during the pandemic compared to the previous period. Conclusion: Mortality showed no difference before and during the pandemic, despite the observed change in the transfusion policy. In summary, the immediate and global implementation of patient blood management (PBM) based on clinical transfusion algorithms should be mandatory in all hospitals in our country.

Follow-up of Geriatric Patients with Pressure Ulcers by Plastic, Reconstructive and Aesthetic Surgery in Intensive Care Conditions

Objective: The aim of this study was to define the Follow-up results and the observation of relationship between the clinical features and woundconditions of geriatric patients with pressure ulcers treated in the intensive care unit by Plastic, Reconstructive and Aesthetic Surgery (PRAS)Methods: The research was carried out at Evliya Çelebi Training and Research Hospital of Kütahya University of Health Sciences betweenJanuary 2018 and January 2020. All pressure ulcers on set of our patients was observed during hospitalization. Study was conducted on 215patients hospitalized in neurology and general intensive care units. Ulcer diagnosis was performed by European Pressure Ulcer Advisory Panel(EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP). Patient data were collected and evaluated by surgical care nurse and PRC surgeontogether during the visit. The confidentiality and personal rights of each patient were respected.Results: There were 215 patients with pressure injuries, 45.6% were hospitalized in the neurology intensive care unit and 42.5% were with thediagnosis of cerebrovascular disease, 41.6% of patients state of consciousness was evaluated as confused. Gender prevalence were 52.2% werefemale with mean age 72.5 ± 2.4. There are 43.2% of the ulcers were in the sacral area, 52% were in stage 2, all patients had fecal / urinaryincontinence.Conclusion: Awareness and education of the care professionals working in intensive care units in terms of preventive measures can savepatients from pressure ulcers and avoid patients from the difficult and risky surgical interventions.

Comparison of direct laryngoscopy and video-assisted laryngoscopy in pediatric intensive care unit

Our objective was to compare video-assisted laryngoscopy (VAL) with direct laryngoscopy (DL) for glottic visualization in a pediatric intensive care unit in terms of the success rate in first attempts. Our study included patients aged from 1 month to 18 years who were admitted to the pediatric intensive care unit. We excluded patients with limited neck extension (C-spine immobilization, congenital abnormality), congenital anomalies (e.g., Pierre Robin syndrome, micrognathia, macroglossia), and recent airway surgery. Patients were premedicated before intubation. The time to intubation was defined as the time between the start of anesthesia and completion of intubation. The start of anesthetic induction was defined as the time the sedative was first administered. Completion of intubation was defined as the time that the end-tidal carbon dioxide tension was detected. We evaluated 120 of 135 intubations that met our inclusion criteria; 15 were excluded because in eight cases (53%) non-pediatric intensive care physicians made the initial attempts, and in seven cases (47%) the recorded intubation times were erroneous. We detected significantly higher POGO scores in the VAL group (p<0.001). VAL provided a fuller view of the glottis (Cormack and Lehane grade 1) than DL (p<0.001). Although the intubation attempts in the DL group were significantly higher (two or more attempts), no intubation failures occurred in either group.

DID WE NEED THOSE ANTIBIOTICS? OUTCOMES OF PATIENTS WITH COVID-19 TREATED FOR BACTERIAL SUPERINFECTION OF THE LUNGS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The COVID-19 pandemic has affected over half a billion people worldwide. Series report that up to 75% of hospitalized patients with COVID-19 receive broad-spectrum antibiotics;however, the incidence of bacterial coinfection is consistently reported to be low. The diagnosis of bacterial superinfection of the lungs (BSL) is clinical, which presents the possibility of overdiagnosis and overutilization of antibiotics. The aim of this study was to describe the outcomes of patients who were treated for a bacterial superinfection of the lungs (BSL) compared to those who were not. METHODS: We conducted a retrospective chart review of all consecutive patients with a diagnosis of COVID-19 hospitalized at our center. We defined BSL as a documented episode of pneumonia treated with antibiotics. We collected information on demographics, comorbidities, and microbiological markers. We compared patients with and without a diagnosis of BSL in terms of intensive care unit (ICU) stay, intubation, length on mechanical ventilation, length of hospital stay (LOS) and 7-day and 30-day mortality. RESULTS: Five hundred eighty-two patients had a diagnosis of COVID-19, of which 105 had BSL. Patients with BSL were older compared to those without BSL (mean age 74 vs 70 years) and more likely to be male (57% vs 47%), but they were similar in proportion of White patients (64 vs 63.6) and Charlson comorbidity index (5 vs 4). Patients with BSL had a higher likelihood of admission to the ICU (63% vs 19%) and higher intubation rates (31% vs 9%). BSL patients had longer mechanical ventilation (9 vs 3 days) and greater length of stay (13 vs 7). Only 17 BSL patients had sputum cultures, of which 10 were positive. None of the BSL patients had a positive Legionella urinary antigen or Streptococcus pneumoniae urinary antigen, and only 6/57 (10.5%) had a positive MRSA nasal screen. Seven-day and 30-day mortality were not statistically different between BSL and non-BSL patients (p=0.18, p=0.65 respectively). Interestingly, Cox proportional hazard analysis adjusted for age, sex, race, CCI and ICU stay yielded a significantly reduced mortality at 7 and 30-day among BSL patients (HR=0.2 CI [.1-0.7], p=.0106, HR=0.5 [CI.3-0.8], p=0.0101, respectively). CONCLUSIONS: Patients with BSL received more intense supportive care, and had a longer ICU stay, yet did not have a greater mortality. When adjusting for age, sex, race, CCI and ICU, there was a significant reduction in mortality. It is tempting to interpret these finding as an effect of antibiotics;however, we did not record COVID-19-specific treatments such as steroids, tocilizumab and remdesivir. It is likely that the BSL patients received more steroids, which have been associated with reduced mortality. In our population, microbiological testing was performed in a minority of patients, and it was therefore not a reliable marker of true infection. It is possible that many patients in the BSL group did not truly have a bacterial infection. CLINICAL IMPLICATIONS: Patients with a diagnosis of BSL were sicker, but we observed no difference in unadjusted mortality. Studies on the outcomes of the BSL among COVID-19 patients should account for the effect of concurrent COVID-19 specific therapy. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Ricardo Arbulu Guerra, source=Web Response No relevant relationships by NIRZARI PANDYA, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Mohamed Yassin, source=Web Response

Apneic Tracheostomy in COVID-19 Patients on Veno-Venous Extracorporeal Membrane Oxygenation.

COVID-19 creates an impressive burden for intensive care units in terms of need for advanced respiratory care, with a huge number of acute respiratory distress syndromes (ARDS) requiring prolonged mechanical ventilation. In some cases, this proves to be insufficient, with a refractory respiratory failure calling for an extracorporeal approach (veno-venous ECMO). In this scenario, most of these patients need an early tracheostomy procedure to be carried out, which creates the risk of distribution of aerosol particles, possibly leading to personnel infection. The use of apneic tracheostomy has been proposed for COVID-19 patients, but in case of ECMO it may produce lung derecruitment, severe hypoxemia, and sudden worsening of respiratory mechanics. We developed an apneic tracheostomy technique and applied it in over 32 patients supported by veno-venous ECMO. We present data showing the safety and feasibility of this technique in terms of patient care and personnel protection. Gas exchange and pH did not show statistically significant changes after the tracheostomy, nor did respiratory mechanics data or the need for inspiratory pressure and FiO2. The use of apneic tracheostomy was a safe option for patient care during ECMO and reduced the possibility of virus spreading.

A 5G-powered robot-assisted teleultrasound diagnostic system in an intensive care unit

BackgroundTeleultrasound provides an effective solution to problems that arise from limited medical resources, a lack of local expertise, and scenarios where the risk of infection is high. This study aims to explore the feasibility of the application of a 5G-powered robot-assisted teleultrasound diagnostic system in an intensive care unit.MethodsIn this study, the robot-assisted teleultrasound diagnostic system MGIUS-R3 was used. Using 5G network technology, the doctor manipulates the robotic arm to perform teleultrasound examination. The doctor can adjust parameters via the teleultrasound control panel, and real-time transmission of audio, video and ultrasound images can facilitate simultaneous communication between both parties. All patients underwent robot-assisted teleultrasound examination and bedside ultrasound examination of the liver, gallbladder, pancreas, spleen, kidney, as well as assessment for pleural effusion and abdominal effusion. We evaluated the feasibility of the application of the robot-assisted teleultrasound diagnosis system in the intensive care unit in terms of consultation duration, image quality, and safety. We also compared diagnostic consistency and differences.ResultsApart from one patient who was excluded due to severe intestinal gas interference and poor image quality, a total of 32 patients were included in this study. Every patient completed all relevant examinations. Among them, 20 patients were male; 12 were female. The average age of the patients was 61 ± 20 years. The average duration of teleultrasound diagnosis was 17 ± 7 min. Of the 32 patients, 26 had positive results, 6 had negative results, and 5 had inconsistent diagnoses. The overall diagnostic results were basically the same, and there were no differences in diagnostic levels between the two. The overall average image quality score was 4.73 points, which represented a high-quality image. After robot-assisted teleultrasound examination, no significant changes were observed in the vital signs of patients as compared to before examination, and no examination-related complications were found.ConclusionThe 5G-powered robot-assisted teleultrasound diagnostic system was associated with the benefits of clear images, simple operation, relatively high levels of consistency in terms of diagnostic results, higher levels of safety, and has considerable application value in the intensive care unit.

Use of Anti-Cytokine Therapy in Kidney Transplant Recipients with COVID-19.

In the context of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to evaluate the impact of anti-cytokine therapies (AT) in kidney transplant recipients requiring hospitalization due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This is an observational retrospective study, which included patients from March to May 2020. An inverse probability of treatment weighting from a propensity score to receive AT was used in all statistical analyses, and we applied a bootstrap procedure in order to calculate an estimation of the 2.5th and 97.5th percentiles of odds ratio (OR). outcomes were measured using an ordinal scale determination (OSD). A total of 33 kidney recipients required hospitalization and 54% of them received at least one AT, mainly tocilizumab (42%), followed by anakinra (12%). There was no statistical effect in terms of intensive care unit (ICU) admission, respiratory secondary infections (35% vs. 7%) or mortality (16% vs. 13%) comparing patients that received AT with those who did not. Nevertheless, patients who received AT presented better outcomes during hospitalization in terms of OSD ≥5 ((OR 0.31; 2.5th, 97.5th percentiles (0.10; 0.72)). These analyses indicate, as a plausible hypothesis, that the use of AT in kidney transplant recipients presenting with COVID-19 could be beneficial, even though multicenter randomized control trials using these therapies in transplanted patients are needed.

National survey revealed variable practices in paediatric procedural sedation and patient monitoring.

Paediatric procedures requiring sedation are increasingly being performed off site, but there are no national guidelines for paediatric procedural sedation in Finland or studies on it. Therefore, the aim of this survey was to assess national practices for paediatric procedural sedation outside operation rooms and intensive care units in terms of indications, sedative medication, treatment facilities, patient safety and training of the personnel. An online survey including single- and multiple-choice questions and open-ended questions was sent to Finnish paediatricians, paediatric surgeons and paediatric anaesthesiologists via the electronic mailing lists of national societies in December 2019. A total of 71 responses were received. Lumbar puncture (41%), intra-articular injections (38%) and MRI (17%) were the most common procedures that required routine sedation. Benzodiazepines were the most frequently used sedatives during both painful procedures (80%) and imaging (61%). Pulse oximetry monitoring was reported by 75% of the respondents, but other physiological parameters were rarely monitored (ECG 28%; blood pressure 39%; respiratory rate 34%). The level of sedation was not objectively assessed. Adrenaline (72%) and equipment for managing adverse respiratory outcomes (supplemental oxygen 98%; ventilation equipment 92%) were available in most facilities in which sedation was performed. Only one-third of the respondents had undergone training for paediatric procedural sedation, and only 39% of the hospital units compiled statistical data on sedation-related adverse events. The paediatric procedural sedation practices vary across hospitals. National guidelines for patient monitoring and training of personnel could improve treatment quality and patient safety.

In What Ways Has the COVID-19 Crisis Been a Challenge for Caregivers in Intensive Care Units in Terms of Their Relationship with Their Patients’ Relatives?

Background: The intensive care unit (ICU) is a technical environment where patients’ lives are at risk. The COVID-19 pandemic has led to for visitors of patients hospitalised in ICUs.Methods: A qualitative study including 10 semi-directive interviews with caregivers working in an ICU. Results: The COVID-19 crisis disrupted the inclusion of patients’ relatives in the ICU. Their inclusion had been established by various means before the crisis: 24-hour visits, participation in mortuary toilets, pets’ visits, logbooks, family lounges, and volunteer visits. These options led to better inclusion in the ICU, even if there were still difficulties: involving the patients’ loved ones during the acute phase, communicating with the visitors, waiting for care, choosing a healthcare proxy, and coping with restricted visiting hours. The COVID-19 crisis added barriers: the initial closure of all the wards in which the interviewed caregivers worked, followed by their partial reopening; a fear of the virus; equipment related constraints; exacerbated communication difficulties; and an extreme lack of medical time. The caregivers tried to implement new means of including relatives in this context: videoconferencing, virtual logbooks, and regular telephone interviews. However, the global context of the pandemic made it difficult for hospital professionals to accommodate the patients’ loved ones, thus deteriorating caregivers’ relationships with relatives, resulting in negative experiences for both relatives and caregivers.Conclusion: The COVID-19 crisis has made it challenging for caregivers to accommodate the relatives of hospitalised patients. Despite the means implemented to maintain a link between caregivers and family members, face-to-face relationships are necessary for humane patient care.Funding: None to declare.Declaration of Interest: None to declare. Ethical Approval: This study was approved by an IRB. It did not request any further approval according to French law

Role of fiberoptic bronchoscopy in patients with respiratory complications in multispecialty intensive care units

Introduction: To determine the contribution and safety profile of flexible fiberoptic bronchoscopy in intensive care units in terms of therapeutic outcome in lung collapse patients. Methodology: Patients with respiratory complications from various speciality intensive care units were enrolled. After clinical and radiological evaluation, if conservative management fails, bronchoscopic intervention was considered. Bronchoscopy was performed according to British Thoracic Society guidelines after informed consent. Swivel-T-Tube adapter was used for the patients in mechanical ventilation. Data such as chest radiograph, arterial blood gas, Bacterial culture of tracheal and BAL secretions between before and after brochcoscopy (6 & 24 hrs) were analysed using standard SPSS software. Results: In our study 63 patients were enrolled, Most of the patients were in mechanical ventilation 85% (n=54/63). In our study, the indications for bronchoscopy were suspected atelectasis 57.1% (n=36), persistent pulmonary infiltrates 30% (n=27). In suspected atelectasis cases(n=36) bronchoscopic findings were mucous plug in 61%(n=22), blood clot in 11%(n=4) and purulent secretions 22% (n=8) and mucoid secretions in 5% ( n=2). Post brochoscopic chest radiograph of suspected ateletasis showed partial resolution in 38.8% (n=14) and complete resolution in 47.2% (n=17). Conclusion: In our study contribution of bronchoscopy played a vital role in therapeutic outcome. Patients had good response to bronchoscopy 85% improvement when intervened within 5 days of admission in ICU. No life threatening complications were encountered; hence bronchoscopy is safe in critically ill patients, if basic precautions are taken. Keywords: BAL and VAP; Fiberoptic bronchoscopy in intensive care units; Lung atelectasis in ICU; Safety of FOB in ICU.

Challenges to delivering family‐centred care during the Coronavirus pandemic: Voices of Italian paediatric intensive care unit nurses

Challenges to delivering family‐centred care during the Coronavirus pandemic: Voices of Italian paediatric intensive care unit nurses

COVID-19 associated variations in liver function parameters: a retrospective study

BackgroundCharacteristics of laboratory findings of COVID-19 patients are of great significance for diagnosis and treatment. Studies that have analysed the variations in hepatic profile in correlation with the inflammatory markers...

Anaesthesia for robot-assisted thoracic surgery: our experience

Introduction Robot-assisted thoracic surgery (RATS) has emerged as a minimal-invasive surgical approach, but little is known about anaesthetic and analgesic management and postoperative complications (1). Methods Retrospective, single-centre, observational study including 50 patients operated by RATS between January-October 2019. Exclusion criteria were loss of data and surgical technique reconversion. Demographic data, length of stay in intensive care unit (ICU) and in hospital, acute postoperative pain assessed by numerical rating scale (NRS: 0-10), postoperative nausea and vomiting (PONV), and major complications was collected. Statistical analysis was performed with STATA/IC15.1® and Kruskal-wallis test was used. Categorical data are presented as n (%) and continuous data as mean [standard deviation (SD)]. Results Mean age was 61.6 years (SD 13.6) with 27 (54%) men and 23 (46%) women. 35 (70%) patients corresponded to ASA classification I-II whereas 15 (30%) corresponded to III-IV. Thymectomy was performed in 18 (36%) patients, and lung resection in 32 (64%), including 21 (42%) lobectomies and 11 (22%) wedge resections. 43 (86%) patients underwent general anaesthesia with sevoflurane and 7 (14%) with propofol infusion. Lung isolation was performed with a double-lumen tube in all patients. In 26 (52%) subjects invasive arterial blood pressure was monitored. Central lines were not inserted in any patient while urinary catheter in 29 (58%). Regional analgesia techniques were intercostal infiltration in 30 (60%) patients, ultrasound-guided serratus anterior plane (SAP) block in 16 (32%) and both techniques in 4 (8%). SAP and combined techniques groups received less fentanyl intraoperatively than intercostal infiltration group (p=0.028) (table 1). No epidural nor paravertebral catheters were placed. Multimodal analgesia was performed in all patients (table 2). All patients were extubated in operating theatre; 32 (64%) were admitted to ICU with an average stay of 19.8 (SD 3.7) hours with no readmissions, and 18 (36%) subjects were transferred to the ward. Mean hospitalization length was 3.2 (SD 2.2) days. 2 thymectomized patients were discharged home same day of procedure Mean postoperative pain at 1, 24 and 48 hours was 2.6 (SD 2.5), 1.5 (SD 1.8) and 0.9 (SD 1.3). In ICU, pain was treated with intravenous morphine boluses in 28 (56%) patients and morphine patient-controlled analgesia in 8 (16%), in addition to paracetamol and NSAIDs. 14 (28%) patients developed PONV in first 24 hours. Four cases of pneumothorax in operated lung were reported as major complications. Discussion This study seems to reflect a trend towards less invasive surgical technique and also anaesthetic approach. RATS seems to be feasible in our population with encouraging results in terms of ICU and hospital length of stay and low acute postoperative pain. Performing SAP block as analgesic technique could reduce intraoperative consumption of opioids, but further larger prospective trials may be considered.