Monitoring In Intensive Care Unit Research Articles

Post traumatic disruption of the trachea: About three adolescents’ cases with literature review

Introduction: Tracheal lesions are rare but potentially serious and can cause significant morbidity and mortality. Early diagnosis is essential for optimal management. We report 3 cases of adolescents who were victims of external cervicothoracic trauma. All three patients presented with neck pain, inspiratory dyspnea, and polypnea with subcutaneous cervical emphysema in clinical examination. Nasofibroscopy showed normal appearance and mobility of the vocal cords. Cervical and thoracic CT scan with contrast enhancement was carried out in all our patients that showed tracheal breach in various localizations. The first patient underwent surgical exploration of the penetrating wound in the cervical area. The surgical exploration revealed no damage to the anterior and lateral faces of the trachea. In this case, a sagittal discontinuity on the posterior wall of the trachea was revealed using a rigid bronchoscope. All patients were admitted to the intensive care unit for monitoring and follow-up for 24 to 72 hours and received antibiotics and corticosteroids for 10 days. The patient's symptoms improved throughout the evolution. Conclusion: Early diagnosis is necessary to prevent complications. The gold standard for diagnosis is bronchoscopy. Conservative management is recently considered the best therapeutic choice which also allows the morbidity of surgical treatment to be avoided

POST-OPERATIVE PROTOCOL FOR BRAIN TUMOR SURGERY IN INTENSIVE CARE UNIT: A LITERATURE REVIEW

Background: Brain tumors represent a diverse group of neoplasms arising from intracranial tissues, posing significant clinical challenges and impacting public health globally. With primary brain tumors having an annual incidence of around 14 per 100,000 individuals and secondary brain tumors being even more prevalent, the burden on healthcare systems is substantial. Postoperative care, particularly in the intensive care unit (ICU), plays a crucial role in monitoring patients for early detection of complications and maintaining neurological and systemic homeostasis. This study aims to serve a literature review to examine post operative management in brain surgery operation in the ICU in literatures. Result and Discussion: Protocols for ICU management post-brain tumor surgery are essential, with factors such as patient status, surgical site, and anticipated postoperative needs guiding decisions regarding ICU admission and monitoring. Neuroprotective strategies encompass physiological and pharmacological interventions aimed at mitigating adverse outcomes, with a multifaceted approach necessary for optimal neuroprotection. Conclusion: A comprehensive understanding of the surgical and postoperative management of brain tumors along with the implementation of evidence-based protocols for ICU care are essential to improve patient outcomes and minimize complications. Continued advancements in surgical techniques, neuroprotective strategies, and critical care management are crucial in addressing the complex challenges posed by brain tumors and enhancing the quality of care for affected patients.

Evaluation of Post-thrombolytic Events to Determine Appropriate ICU Monitoring Duration for Patients with Ischemic Stroke.

Standard treatment for eligible patients presenting with acute ischemic stroke (AIS) is thrombolysis with tissue plasminogen activators alteplase or tenecteplase. Current guidelines recommend monitoring patients in an intensive care unit (ICU) for 24h after thrombolytic therapy. However, recent studies have questioned the need for prolonged ICU monitoring. This retrospective cohort study aims to identify potential candidates for early transition to a lower level of care by assessing risk factors for neurological deterioration, symptomatic intracranial hemorrhage (sICH), or need for ICU intervention within 24h post-thrombolysis. This retrospective cohort study included adult patients 18years and older with AIS who received thrombolysis. Patients were excluded if they were transferred to another facility, if they were transitioned to comfort care or hospice care within 24h, or if they lacked imaging and National Institutes of Health Stroke Scale (NIHSS) score data. The primary end point was incidence of sICH between 0-12 and 12-24h. Secondary end points included the need for ICU intervention and rates of neurological deterioration. The analysis included 204 patients who received the full dose of alteplase. Among them, ten patients (4.9%) developed sICH, with the majority (n = 7) occurring within 12h post-thrombolysis. Sixty-two patients required ICU interventions within 12h compared with four patients after 12h. Twenty-four patients had neurological deterioration within 12h, and seven patients had neurological deterioration after 12h. Multivariable analysis identified mechanical thrombectomy and increased blood pressure at presentation as predictors of ICU need beyond 12h post-thrombolysis. Our study demonstrates that sICH, neurological deterioration, and need for ICU intervention rarely occur beyond 12h after thrombolytic administration. Patients presenting with blood pressures < 140/90mm Hg, NIHSS scores < 10, and not undergoing mechanical thrombectomy may be best candidates for early de-escalation. Larger prospective studies are needed to more fully evaluate the safety, feasibility, and financial impact of early transition out of the ICU.

Safety and Feasibility of a “Fast‐Track” Monitoring Protocol for Patients Treated With Intravenous Thrombolytic Therapy

Background Our health care systems continue to face significant strain due to chronically taxed intensive care resources. A subgroup of patients following thrombolytic stroke may not require prolonged intensive monitoring, alleviating some burden. Here, we describe the safety, feasibility, and utility of a Fast‐Track Protocol (FTP) for early deescalation of high‐acuity monitoring. Methods We compared a prospective cohort of patients on the FTP at our stroke centers from April 2020 to February 2022 to a similar retrospective cohort. Those who presented with a National Institutes of Health Stroke Scale &lt;10 and without large‐vessel occlusion or flow‐limiting stenosis, intravenous antihypertensive use, and any hemodynamic or respiratory concerns were eligible. Primary outcomes included early neurologic deterioration, defined as worsening of National Institutes of Health Stroke Scale score of ≥4 points at 24 hours, parenchymal hemorrhage, and symptomatic intracranial hemorrhage. Results Of 574 patients undergoing thrombolysis, 119 (21%) were eligible for the FTP. A total of 100 (88%) were included for analysis. The median±interquartile range hospitalization was 2.0±1.6 days. None of the 4 cases of early neurologic deterioration were due to hemorrhage. No symptomatic intracranial hemorrhages occurred, and no patients on the FTP were transferred back to the intensive care unit. Median±interquartile range 90‐day modified Rankin scale score was 1±1. Conclusion FTP is a safe and feasible strategy to triage intensive care unit patients and decrease unnecessary intensive care unit monitoring. This is important in a postpandemic era as intensive care unit resources continue to fluctuate. Future studies are needed to establish the optimal level of monitoring in patients following thrombolysis.

Exploratory Evaluation of Pre-Treatment Inflammation Profiles in Patients with Colorectal Cancer.

In light of the elevated incidence and consequential prognostic implications associated with colorectal cancer, a comprehensive investigation into the impact exerted by inflammatory status on patient management becomes imperative. A retrospective study spanning 7 years was conducted, involving the retrospective collection of data on colorectal cancer patients undergoing surgical intervention. We evaluated six inflammation ratios derived from complete peripheral blood counts. A thorough analysis of these markers' prognostic capacity was conducted, revealing that patients who died postoperatively displayed significantly higher preoperative Aggregate Index of Systemic Inflammation-AISI (p = 0.014) and Systemic Inflammation Response Index-SII (p = 0.0197) levels compared to those with successful discharge. Noteworthy variations in neutrophil-to-lymphocyte ratio (p = 0.0103), platelet-to-lymphocyte ratio (p = 0.0041), AISI (p < 0.001), and SII (p = 0.0045) were observed in patients necessitating postoperative Intensive Care Unit (ICU) monitoring. Furthermore, patients with complications, such as an intestinal fistula, exhibited significantly elevated AISI (p = 0.0489). Inflammatory biomarkers stand out as valuable prognostic tools for colorectal cancer patients, offering potential assistance in predicting their prognosis.

Current Status of Stroke Thrombolysis in the Mission Thrombectomy 2020+ Caribbean Region

Background Low‐ to middle‐income countries have limited access to thrombolytic therapy. To our knowledge, there is no validated tool available to objectively measure access to thrombolytic agents or barriers to routine clinical use. Methods We developed the 17‐item tissue plasminogen activator Spot Check tool to assess usage of acute stroke thrombolysis regarding local experience, financial constraints, and perceived barriers to care; evaluating the current state of clinical practices in the Mission Thrombectomy 2020+ Caribbean region. The survey was disseminated via an online link, and the information was collected and analyzed via SPSS. Results The tool was validated by 3 international experts with an Average Content Validity Index of 1 and a Universal Agreement Index of 1 across 3 domains: local experience, financial constraints, and barriers to usage. The participant survey response rate was 64%, representing 15 of 44 Mission Thrombectomy 2020+ Caribbean countries. There was limited or no access to thrombolytic agents in 40% of countries surveyed. Among cases treated with thrombolytics, 43% of patients had to pay out of pocket before treatment was provided, and l&lt;10% were covered by insurance/government. Among 51% of countries surveyed, no acute thrombolytic treatment was provided for acute stroke in the 2021 calendar year. Only 1 center treated &gt;100 cases per year. Most respondents (88%) agreed there were barriers to acute stroke thrombolysis in the region. The tissue plasminogen activator Spot Check tool was able to identify barriers impacting the number of cases per year, including absence of stroke protocol ( P &lt;0.001), upfront cost of alteplase ( P = 0.003), restricted the amount of thrombolytics ( P = 0.002), neurology intensive care unit or stroke unit monitoring of patients following thrombolytics ( P = 0.017), cost of thrombolytic agents to the hospital ( P = 0.042), and access to computed tomography scan ( P = 0.03). Conclusion This survey brings light to an enormous disparity in the care of stroke patients around the world, specifically in the Mission Thrombectomy 2020+ Caribbean region.

Comparison between Portable Pulse Oximeter and Conventional ICU Pulse Oximeter measurements in healthy adults: A Cross Sectional Study

ABSTRACT: Objective: To assess the agreement between oxygen saturation reading between portable pulse oximeter and conventional ICU monitor pulse oximeter. Methods: This cross-sectional study was conducted at Department of Medicine, Fatima Hospital Baqai Medical University, Karachi, from 1st March 2023 to 31st March 2023. Participants in the study in- cluded healthy health care workers and medical students who were over the age of 18 and did not have any known co-morbid conditions like hypertension or diabetes that may affect peripheral perfu- sion. None of the participants had hypotension, clinical evidence of anemia, fingernail paint or poor peripheral perfusion as these are the factors that may influence pulse oximetry readings. Both the portable pulse oximeter and the traditional intensive care unit (ICU) monitors were utilized to take and record the oxygen saturation levels of each of the ten fingers in a sequential manner while the patient was seated. Data was analyzed using SPSS version 22. Readings of both instruments were com- pared employing Regression analysis. Bland-Altman analysis was applied to measure the level of agreement between readings of portable pulse oximeter and conventional ICU monitors. Results: Total 200 participants were enrolled for this study and most of them were from younger age group. (Mean age of participants = 33.05 ± 10.31). There was no significant difference between oxy- gen saturation readings of respective finger from portable pulse oximeter and conventional ICU moni- tors on regression analysis (p &gt; 0.05). Highest mean oxygen saturation was recorded in right middle finger using portable pulse oximeter (98.71 ± 1.21). On the ICU monitor pulse oximeter, it was 2nd highest in right middle finger (98.33 ± 2.49). Therefore, Bold-Altman analysis applied between oxygen saturation reading for two devices in right middle finger and was found to be comparable. (Mean dif- ference (bias) = 0.375 with 95% confidence interval). Conclusion: Modern portable pulse oximeters can reliably be used to rule out hypoxemia.

Health Care Professionals’ and Parents’ Perspectives on the Use of AI for Pain Monitoring in the Neonatal Intensive Care Unit: Multisite Qualitative Study

Background The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of information on the perceived benefits and barriers to the implementation of AI for neonatal pain monitoring in the neonatal intensive care unit (NICU) from the perspective of health care professionals (HCPs) and parents. This qualitative analysis provides novel data obtained from 2 large tertiary care hospitals in Canada and the United Kingdom. Objective The aim of the study is to explore the perspectives of HCPs and parents regarding the use of AI for pain assessment in the NICU. Methods In total, 20 HCPs and 20 parents of preterm infants were recruited and consented to participate from February 2020 to October 2022 in interviews asking about AI use for pain assessment in the NICU, potential benefits of the technology, and potential barriers to use. Results The 40 participants included 20 HCPs (17 women and 3 men) with an average of 19.4 (SD 10.69) years of experience in the NICU and 20 parents (mean age 34.4, SD 5.42 years) of preterm infants who were on average 43 (SD 30.34) days old. Six themes from the perspective of HCPs were identified: regular use of technology in the NICU, concerns with regard to AI integration, the potential to improve patient care, requirements for implementation, AI as a tool for pain assessment, and ethical considerations. Seven parent themes included the potential for improved care, increased parental distress, support for parents regarding AI, the impact on parent engagement, the importance of human care, requirements for integration, and the desire for choice in its use. A consistent theme was the importance of AI as a tool to inform clinical decision-making and not replace it. Conclusions HCPs and parents expressed generally positive sentiments about the potential use of AI for pain assessment in the NICU, with HCPs highlighting important ethical considerations. This study identifies critical methodological and ethical perspectives from key stakeholders that should be noted by any team considering the creation and implementation of AI for pain monitoring in the NICU.

Analysis of a Large 19-Year Database in Vascular Surgery in Southern Iran: Evaluation of Trends and Limitations

IntroductionLarge databases with data elements of clinical interest are essential for carrying out high-quality observational studies. Such databases have become increasingly popular for clinical research in fields like Vascular Surgery. Our goal is to create a solid and reliable database of the patients who have been admitted and undergone different vascular-surgery procedures over 19 years and to provide surgeons with the current trends and limitations in managing patients with vascular disease. MethodThe database of patients operated in Namazi Hospital, the referral center for Vascular Surgery in southern Iran, from 2001 to 2019, was retrieved and patients undergoing vascular procedures were parted. Demographic and perioperative data were evaluated and patients were categorized into subgroups based on the type and cause of operation. All data were analyzed with SPSS version 26.0 (IBM. NY. USA). ResultsDuring the period of our study, a total of 226,051 operations were performed at the Namazi Hospital. Among these operations, 6,386 (2.82%) Vascular Surgery-related operations were entered into our study. The average age of the patients in our study was 53.22 ± 18.92 years (range: 1 day old – 97 years) and 4,061 (63.6%) were male. Furthermore, 147 (2.3%) were operated by multiple surgeons. Moreover, 798 (12.5%) of the patients were admitted postoperatively to the intensive care unit (ICU), while the rest (5,588; 87.5%) in the common surgery ward. The cause of operation in 609 (9.5%) of the cases was trauma. Based on wound categorization, 5,132 (80.4%) were type I (clean). The most frequent operation performed in our center was arterial reconstruction and limb revascularization (31.4%), followed by hemodialysis access (31.3%). The most frequent surgery in the age group of under 18 years was fasciotomy, in the 19 to 40 years group was tumor (56.8%) and varicose veins (52.9%), in the 41 to 60 years group was implantation of ventral venous port catheter (47%). Only carotid and thoracic outlet syndrome surgeries were significantly higher in females. The remaining operations were all significantly higher among male patients. Finally, carotid body tumor surgery was the most frequent operation requiring ICU monitoring. ConclusionWe demonstrated, for the first time, an overview of Vascular Surgeries performed in a referral tertiary center in Southwest Iran. There is an increase in the number of surgical procedures in the field of Vascular Surgery, and large databases will be a valuable tool for addressing critical problems in this field and also the healthcare system.

Standard practices in cardiac monitoring: training needs of intensive care unit nurses

BackgroundEnforcing practice standards for cardiac monitoring in intensive care units (ICUs) has been shown to reduce misdiagnoses and inappropriate interventions. Continuous professional development (CPD) programs are committed to aligning clinical practices with recommended standards. The crucial initial phase in CPD development involves assessing the training needs of the targeted population.ObjectiveTo assess the training needs of ICU nurses in cardiac monitoring. The overarching goal was to formulate a focused Continuous Professional Development (CPD) program geared towards implementing standard practices in cardiac monitoring.MethodsThis study employed a generic qualitative approach with a descriptive design, utilizing interviews and focus groups from July to September 2018. Involving 16 ICU nurses. Content analysis was employed, encompassing transcription, fluctuant and iterative reading, unitization, categorization, coding, description, and interpretation.ResultsAll nurses recognized cardiac monitoring’s importance in the ICU but reported barriers to its effective implementation which were related to factors that could addressed by a CPD as insufficient knowledge and skills. Training needs were identified in both clinical and technical aspects, with recommendations for practical and theoretical activities and e-learning strategies. Barriers related to organizational aspects (equipment and communication within the healthcare team) were also mentioned.ConclusionICU nurses presented clear and specific training needs related to cardiac monitoring as knowledge, skills, and competencies. Other organizational aspects were also reported as barriers. Addressing these learning needs through targeted CPD aligned with organizational initiatives can contribute to enhancing the quality of cardiac monitoring practices in ICUs.

Blindness is decreasing among children born preterm during the last four decades in Denmark.

Children born preterm are believed to be at increased risk of visual impairment (VI). The increased survival rate of extremely preterm children may have changed the spectrum of diseases occurring postnatally. The aim of this study was to analyse the prevalence and causes of VI in an ex-preterm Danish population during the last 4 decades. The study was based on the National Register of Blind and Visually Impaired Children (NRVIC). Ex-preterms born at gestational age (GA) <32 weeks and enrolled in NRVIC at any time between 1988 and 2020 were included. The main cause of VI, the severity of VI and systemic comorbidities were analysed for temporal changes. A total of 335 patients were included. The prevalence of VI decreased from 26/1000 preterm children in the 1980s to 15/1000 in 2000s. Blindness due to preterm birth is almost eliminated affecting 1/1000 today. Sequelae to retinopathy of prematurity (ROP) was the most common cause of VI (51% of cases) in the 1980s but decreased to 34% in 2010s, whereas non-ocular causes of VI increased from 1% to 36%, respectively. More than half of the children (64%) had combined comorbidities and 36% had isolated VI. The improved monitoring in neonatal intensive care units and management of ROP has reduced the prevalence of severe VI due to ROP and almost eliminated blindness over the last decades in Denmark. However, preterm children are still at risk of non-ocular causes of VI and comorbidities following the premature delivery.

Heart rate complexity helps mortality prediction in the intensive care unit: A pilot study using artificial intelligence

BackgroundIn intensive care units (ICUs), accurate mortality prediction is crucial for effective patient management and resource allocation. The Simplified Acute Physiology Score II (SAPS-2), though commonly used, relies heavily on comprehensive clinical data and blood samples. This study sought to develop an artificial intelligence (AI) model utilizing key hemodynamic parameters to predict ICU mortality within the first 24 h and assess its performance relative to SAPS-2. MethodsWe conducted an analysis of select hemodynamic parameters and the structure of heart rate curves to identify potential predictors of ICU mortality. A machine-learning model was subsequently trained and validated on distinct patient cohorts. The AI algorithm’s performance was then compared to the SAPS-2, focusing on classification accuracy, calibration, and generalizability. Measurements and main resultsThe study included 1298 ICU admissions from March 27th, 2015, to March 27th, 2017. An additional cohort from 2022 to 2023 comprised 590 patients, resulting in a total dataset of 1888 patients. The observed mortality rate stood at 24.0%. Key determinants of mortality were the Glasgow Coma Scale score, heart rate complexity, patient age, duration of diastolic blood pressure below 50 mmHg, heart rate variability, and specific mean and systolic blood pressure thresholds. The AI model, informed by these determinants, exhibited a performance profile in predicting mortality that was comparable, if not superior, to the SAPS-2. ConclusionsThe AI model, which integrates heart rate and blood pressure curve analyses with basic clinical parameters, provides a methodological approach to predict in-hospital mortality in ICU patients. This model offers an alternative to existing tools that depend on extensive clinical data and laboratory inputs. Its potential integration into ICU monitoring systems may facilitate more streamlined mortality prediction processes.

Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry.

Wide interhospital variations exist in cardiovascular intensive care unit (CICU) admission practices and the use of critical care restricted therapies (CCRx), but little is known about the differences in patient acuity, CCRx utilization, and the associated outcomes within tertiary centers. The Critical Care Cardiology Trials Network is a multicenter registry of tertiary and academic CICUs in the United States and Canada that captured consecutive admissions in 2-month periods between 2017 and 2022. This analysis included 17 843 admissions across 34 sites and compared interhospital tertiles of CCRx (eg, mechanical ventilation, mechanical circulatory support, continuous renal replacement therapy) utilization and its adjusted association with in-hospital survival using logistic regression. The Pratt index was used to quantify patient-related and institutional factors associated with CCRx variability. The median age of the study population was 66 (56-77) years and 37% were female. CCRx was provided to 62.2% (interhospital range of 21.3%-87.1%) of CICU patients. Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST-elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. The unadjusted in-hospital mortality (median, 12.7%) was 9.6%, 11.1%, and 18.7% in low, intermediate, and high CCRx tertiles, respectively. No clinically meaningful differences in adjusted mortality were observed across tertiles when admissions were stratified by the provision of CCRx. Baseline patient-level variables and institutional differences accounted for 80% and 5.3% of the observed CCRx variability, respectively. In a large registry of tertiary and academic CICUs, there was a >4-fold interhospital variation in the provision of CCRx that was primarily driven by differences in patient acuity compared with institutional differences. No differences were observed in adjusted mortality between low, intermediate, and high CCRx utilization sites.

Acute Systemic Toxicity Associated with Ingestion of Juniper Tar

Juniper Tar has been utilized in traditional folk medicine to treat various ailments. Despite its historical use, documented cases are scarce regarding the potential complications associated with Juniper Tar, some of which have been fatal. A 62-year-old male patient with no previous medical history presented to the emergency department complaining of confusion and respiratory distress after drinking a glass of Juniper Tar approximately four hours ago. The patient, who experienced multiple seizures and cardiac arrest at the emergency department, was discharged after an 11-day intensive care unit monitoring period. We present this case to raise awareness among emergency physicians about Juniper Tar, which is widely used for various purposes in folk medicine and cosmetics but can cause poisoning due to its content of essential oils, triterpenes, and phenols. This is a case of cardiac arrest and status epilepticus associated with juniper tar poisoning.

Rationale and Design of a Wearable Cardiopulmonary Monitoring System for Improving the Efficiency of Critical Care Monitoring

Despite the recent development of wearable cardiopulmonary monitoring devices and their necessity in clinical settings, the evidence regarding their application in real-world intensive care units (ICUs) is limited. These devices have notable problems, such as inefficient manufacturing and cumbersome hardware for medical staff and patients. In this study, we propose a simplified cardiopulmonary monitoring system and present a protocol for a single-center prospective study to evaluate the efficacy of the proposed system compared with those from the conventional monitoring system. The system was designed to continuously measure electrocardiogram, respiration rate, and oxygen saturation in a stand-alone device with an intuitive data visualization platform and automatic data collection. The accuracy of the data measured from the proposed device will be pre-validated by comparing them with those from the reference device. Medical staff from the St. Vincent’s Hospital ICU will complete a five-point Likert-type scale questionnaire regarding their experience with conventional ICU monitoring systems. The result will be compared with the second questionnaire conducted after deploying the system. Since this is a study proposal paper, we do not have any data on this study yet. However, compared with the conventional patient monitoring system, the proposed device should be a promising method to relieve medical staff fatigue and that of the patients who must wear and attach the monitoring device for a long time.

Quality of fluid balance charting and interventions to improve it: a systematic review

IntroductionFluid balance monitoring is pivotal to patients’ health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality...

Overcoming the Challenges of Prolonged Ventilation and Critical Illness Polyneuropathy in Severe ARDS Patients Due to Extensive Viral Pneumonia: A Case Report

ARDS is a life-threatening condition requiring intensive care unit monitoring. We present a 46-year-old male patient with ARDS and its complications, ventilator-associated pneumonia (VAP) and critcal illness polyneuropathy after extensive bilateral viral pneumonia. The objective of this case report is to understand better and manage the complications of ARDS. This study addresses ARDS and its complications, providing a comprehensive clinical understanding. It details a 46-year-old male patient’s case, treatment strategies, complications, weaning processes, and rehabilitation and emphasises the importance of physical therapy. This case report discusses the successful management and weaning of a patient with extensive viral pneumonia complicated with acute respiratory distress syndrome (ARDS), impending organ dysfunction, and critical illness polyneuropathy. The patient had a medical history of diabetes, hypertension, and dyslipidemia. Initial treatment involved oxygen therapy, nebulization, and empirical antiviral for seasonal flu. However, the patient required invasive ventilation with sedation and muscle relaxants following the ARDSNET protocol due to worsening respiratory status and extensive lung infiltrates. Secondary bacterial infections were also identified and treated accordingly. The weaning process was initiated but was complicated by re-intubation and the development of critical illness polyneuropathy. After successful weaning and recovery from ARDS and associated lung infections, physical therapy was provided for polyneuropathy regularly to overcome the manifest weakness all over the body muscles, including respiratory muscle weakness. The case report highlights the successful management of a patient with viral pneumonia, ARDS, and critical illness polyneuropathy, highlighting the importance of comprehensive treatment and physical therapy.

Continuing Monitoring in Respiratory Intensive Care Unit and Mortality in Patient Post Bronchoscopy Procedure

Background: Bronchoscopy is a relatively safe procedure in the diagnosis and therapy of lung disease, however in some cases complications can occur which lead to further monitoring in the intensive care or respiratory intensive care unit (RICU) and even lead to mortality. This study aimed to determine the need for intensive care unit monitoring and the risk factors that increase the need for intensive care unit monitoring followed by mortality after bronchoscopy procedure. Method: A retrospective data of consecutive bronchoscopy procedures in Persahabatan Hospital between July to December 2021. Results: From 410 patients underwent bronchoscopy procedures, there were 52 patients (12.6%) were admitted to RICU after bronchoscopy. From patients who were treated in RICU 3 (5.8%) of them died. Patients who died during monitoring in intensive care unit had an older mean age of 60.3 years. There were 2 (12.5%) died after bronchoscopy procedures with two or more intervention, 1 patients (3%) died in the group with one intervention. There were 2 patients (13.3%) died with two or more comorbidities and 1 patient (5.9%) died with one comorbid. In the group with diagnosis of malignancy, 3 patients (7.5%) died. Whereas in patients who were performed surgery during bronchoscopy there were 2 patients (20%) died and only 1 patient (2.4%) died without any surgery during bronchoscopy. Conclusion: Although bronchoscopy is a relatively safe procedure but the need of monitoring in intensive care after bronchoscopy procedures were relatively high and mortality quite high compare to previous study. Further research is needed to determine the risk factors that increase the need of continuing monitoring in intensive care unit followed by mortality after bronchoscopy procedure.

Spatio-temporal features for fast early warning of unplanned self-extubation in ICU

Patients’ behaviors in the Intensive Care Units (ICU) have garnered research attention, particularly regarding the impact of Unplanned Extubation (UEX). However, there is currently no existing report on methods for early warning of UEX action in RGB video. Applying traditional human action recognition algorithms to UEX in the complex ICU environment proves challenging. To address the above issue, we propose a novel feature for early warning of UEX action in patients using RGB videos. Firstly, we employ the YOLOv3 detection method to extract the region of interest (ROI), which corresponds to the region where the patient is located. Subsequently, we develop a spatio-temporal (ST) feature for human action tracking by using the L-K optical flow algorithm. This ST feature encompasses optical flow corner number, trajectory distance, and wavelet transform features. Finally, we utilize support vector machine (SVM) for patient action classification and early warning. Experimental results on the ICU monitoring dataset demonstrate the superior performance of the proposed feature in UEX prediction.

Concomitant high-risk pulmonary embolism and subdural hematoma: endo-vascular system thrombolysis as a possible solution to a difficult challenge

Acute pulmonary embolism (PE) is a challenging and potentially fatal cardiovascular disorder. In high-risk patients, percutaneous catheter embolectomy may be considered when thrombolysis is contraindicated or has failed. We hereby discuss the case of a 60-year-old man who was found unconscious on the ground with signs of head trauma and respiratory failure. He was found to have a massive pulmonary embolism and multiple basilar skull fractures associated with slight subdural and subarachnoid hemorrhages. His acute treatment required a multidisciplinary discussion and approach. EkoSonic™ Endovascular System (EKOS) thrombolysis was successfully performed. The patient required intensive care unit (ICU) monitoring and treatment for 31 days. Upon discharge, henoxaparin 4000 UI twice per day was prescribed as anticoagulant, without any evidence of pulmonary hypertension or severe neurological sequelae.