Mortality In Critical Patients Research Articles

White Blood Cell, Procalcitonin, C-Reactive Protein and TNF-α as Prognostic Factors in Pediatric Sepsis

Sepsis is the leading causes of morbidity and mortality in critical patients in many intensive care units. There were numerous parameter and biomarkers available to confirm the presence of sepsis. The aim of this study was to determine which one the parameter or biomarkers (white blood cell, CRP, procalcitonin and TNF-α) has a role as an outcome predictor in pediatric sepsis patient. This prospective cohort study was conducted in Pediatric Intensive Care Unit Wahidin Sudirohusodo hospital from Januari 2016untilMay 2017. A total of 108 sepsis patients were included. Plasma specimens were collected at admission, then the patients were being followed up for survived or non-survived. The diagnosis of sepsis is using the International Pediatric Sepsis Consensus 2005 criteria. Serum CRP, Procalcitonin TNF-α were measured using Enzyme Linked Immunosorbent Assay technique. Initial serumprocalcitonin level and TNF-α in non-survived children with septic were very significantly higher than those in the survived groupswith p=0.000 with OR2, 46 CI(0, 905-6, 697) in procalcitonin and p=0.000 with OR 44, 69 CI(5, 749–347, 36)in TNF-α. The initial serum level of PCT and TNF-α can be used as a predictor outcome of sepsis patient in children

A machine learning-based model for 1-year mortality prediction in patients admitted to an Intensive Care Unit with a diagnosis of sepsis.

Sepsis is associated to a high mortality rate, and its severity must be evaluated quickly. The severity of illness scores used are intended to be applicable to all patient populations, and generally evaluate in-hospital mortality. However, patients with sepsis continue to be at risk of death after hospital discharge. To develop a model for predicting 1-year mortality in critical patients diagnosed with sepsis. The data corresponding to 5650 admissions of patients with sepsis from the Medical Information Mart for Intensive Care (MIMIC-III) database were evaluated, randomly divided as follows: 70% for training and 30% for validation. A retrospective register-based cohort study was carried out. The clinical information of the first 24h after admission was used to develop a 1-year mortality prediction model based on Stochastic Gradient Boosting (SGB) methodology. Variable selection was addressed using Least Absolute Shrinkage and Selection Operator (LASSO) and SGB variable importance methodologies. The predictive power was evaluated using the area under the ROC curve (AUROC). An AUROC of 0.8039 (95% confidence interval (CI): [0.8033 0.8045]) was obtained in the validation subset. The model exceeded the predictive performances obtained with traditional severity of disease scores in the same subset. The use of assembly algorithms, such as SGB, for the generation of a customized model for sepsis yields more accurate 1-year mortality prediction than the traditional scoring systems such as SAPS II, SOFA or OASIS.

Mortality and hyperchloremia in the intensive care unit

Introduction: Administrating intravenous fluids is one of the most frequent practices in the care of critically ill patients, since most of them present shock or hypotension from any cause. The rapid and aggressive administration of these fluids may lead to adverse results, including acute renal failure and hydroelectrolytic disorders which are highly associated with fatal outcomes. Objectives: To establish the association between hyperchloremia and mortality in patients admitted to the intensive care unit (ICU) of Hospital Universitario de San Jose between August 2013 and January 2017, in addition to their demographic characteristics, the incidence of chloride abnormalities, and its association to renal failure. Methods: Analytic retrospective cohort study in the adult ICU at the Hospital Universitario de San Jose from August 1, 2013 to January 31, 2017. Results: A total of 839 patients were evaluated, 210 exposed and 629 not exposed. The relative risk of death for those who developed hyperchloremia was 3.12 (95% confidence interval [CI] 2.16^.49) (P <0.001). The multivariate analysis generated an hazard ratio of 2.31 (95% CI 1.47-3.63) adjusted for age, sex, APACHE II at admission, sepsis, neurocritical state, and development of renal failure. Conclusion: Hyperchloremia is a frequent event in patients in the ICU; it may act as an independent variable for mortality in critical patients.

Effects of single-dose etomidate on prognosis of critical patients: a systematic review and Meta-analysis

Objective To evaluate the effects of single-dose etomidate on the mortality and the risk of adrenal insufficiency in patients with critical illness. Methods PubMed, EMBASE, Medline, Web of Science, the Cochrane Library, CNKI, Wanfang Database, and Vip Database were searched for the relevant randomized controlled clinical trials and observational studies. According to the inclusion and exclusion criteria, two researchers independently selected the literature, extracted the data, and then performed Meta-analysis usinge RevMan5.3 software. The Mantel-Haenszel method with the random-effects modeling was used to calculate pooled relative risks (RR) and 95%CI. Results Twenty-six studies [5 randomized controlled trial(RCT) and 21 observational studies] involving 7 430 patients were qualified. Pooled analysis suggested that etomidate was not associated with increased mortality in critical patients [RCT:RR=1.16, 95%CI(0.93, 1.45), P>0.05] [observational studies:RR=1.07, 95%CI(1.00, 1.14)(P=0.05)]. These findings were also consistent across all subgroup analyses off observational studies. Etomidate increased the risk of adrenal insufficiency in critical patients[RCT:RR=1.61, 95%CI(1.06, 2.46)(P<0.01)][observational studies: RR=1.41, 95%CI(1.22, 1.62)(P<0.01)]. Conclusions Current evidence indicates that single-dose etomidate does not increase the mortality, but increases the risk of adrenal insufficiency in critical patients. However, this finding largely relies on data from observational studies and is potentially subject to selection bias. Therefore, high-quality and adequately powered RCT are warranted. Key words: Etomidate; Critical ill patients; Mortality; Adrenal insufficiency; Meta-analysis

Post-operative stress hyperglycemia is a predictor of mortality in liver transplantation

BackgroundA significant association is known between increased glycaemic variability and mortality in critical patients. To ascertain whether glycaemic profiles during the first week after liver transplantation might be associated with long-term mortality in these patients, by analysing whether diabetic status modified this relationship.MethodObservational long-term survival study includes 642 subjects undergoing liver transplantation from July 1994 to July 2011. Glucose profiles, units of insulin and all variables with influence on mortality are analysed using joint modelling techniques.ResultsPatients registered a survival rate of 85% at 1 year and 65% at 10 years, without differences in mortality between patients with and without diabetes. In glucose profiles, however, differences were observed between patients with and without diabetes: patients with diabetes registered lower baseline glucose values, which gradually rose until reaching a peak on days 2–3 and then subsequently declined, diabetic subjects started from higher values which gradually decreased across the first week. Patients with diabetes showed an association between mortality and age, Model for End-Stage Liver Disease score (MELD) score and hepatitis C virus; among non-diabetic patients, mortality was associated with age, body mass index, malignant aetiology, red blood cell requirements and parenteral nutrition. Glucose profiles were observed to be statistically associated with mortality among patients without diabetes (P = 0.022) but not among patients who presented with diabetes prior to transplantation (P = 0.689).ConclusionsGlucose profiles during the first week after liver transplantation are different in patients with and without diabetes. While glucose profiles are associated with long-term mortality in patients without diabetes, after adjusting for potential confounding variables such as age, cause of transplantation, MELD, nutrition, immunosuppressive drugs, and units of insulin administered, this does not occur among patients with diabetes.

Effect of sedation on respiratory function of patients undergoing mechanical ventilation

Sedation and analgesia for ventilated patients is an important treatment in intensive care unit (ICU). Patients receiving mechanical ventilation therapy comfortably and safely can improve patient-ventilator synchrony, reduce ventilation-related lung injury (VILI), improve compliance, decrease oxygen consumption and stress, prevent accidents, and reduce the incidence of complications and mortality in critical patients. Although sedation may protect lung function, it also has a greater impact on respiratory function. Therefore, based on domestic and overseas related researches about sedation therapy in ventilated patients, we expounded on the effects of sedation therapy, different sedatives and different sedative methods on respiratory function of ventilated patients. The effects of sedation improving patient-ventilator synchrony or protecting pulmonary function as well as problems about inhibition of spontaneous respiration or delayed extubation were discussed to provide references for sedation treatment in patients with mechanical ventilation.

The predictive value of the modified early warning score with rapid lactate level (ViEWS-L) for mortality in patients of age 65 or older visiting the emergency department.

The purpose of this study is to detect the predictive power of the modified early warning score with rapid lactate level (ViEWS-L) on mortality in critical patients over the age of 65years admitted to the emergency department (ED). A total of 616 non-traumatic patients admitted to the Uludag University Faculty of Medicine ED who were 65years of age or older were included in this study (Ethics board number: 2015-4/8). In this prospective study; the ViEWS-L score of the patients were calculated. The results have been evaluated with rate of mortality in the first 24h starting from submission. The area under the ROC curve was found 0.872 and the cut-off value to detect mortality was found 10.83 for the ViEWS-L score. In the model obtained by the univariate binary logistic regression analysis, ViEWS-L score was found statistically significant and it was determined that mortality risk increased 1.286 times for each unit increase in the score of ViEWS-L score. As a result of this research, it was found that ViEWS-L scoring system is effective in determining the mortality of 65years and older patients.

Renal Resistive Index and mortality in critical patients with acute kidney injury.

The predictive role of Doppler Renal Resistive Index (RRI) for mortality was shown in chronic kidney disease. In selected populations of intensive care unit (ICU), RRI predicts acute kidney injury (AKI) occurrence and anticipates persistent AKI. No data are available about mortality. We investigated whether RRI assay at AKI diagnosis could predict AKI mortality in a 10-bed-mixed medical-surgical and trauma ICU of a tertiary referral teaching hospital. The association between RRI and persistent AKI at discharge was investigated. One hundred and twenty-five of 1512 patients admitted from January 2010 to March 2013 who developed AKI during ICU stay were enrolled. Kidney function was evaluated daily according to risk, injury, failure, loss and end-stage criteria. At AKI diagnosis, we measured RRI. The association between RRI at AKI diagnosis and ICU death or persistent AKI at ICU discharge was analysed by multivariable logistic regression analysis. At AKI diagnosis, RRI was 0·77 (0·70-0·88) in survivors and 0·85 in nonsurvivors (0·79-0·94) (P = 0·002). RRI values were significantly associated with ICU death (OR = 1·63-95% CI 1·06-2·49, P = 0·025). A RRI cut-off value of 0·77 was identified by receiver operating characteristic curve. Multivariate analysis selected RRI and abdominal hypertension as strongest predictors of AKI mortality. At AKI diagnosis, RRI was 0·78 (0·70-0·85) or 0·85 (0·73-0·92) (P = 0·026) in patients with or without persistent AKI at discharge. Multivariate analysis selected RRI at AKI diagnosis as the strongest predictor of persistent AKI. High RRI values at AKI diagnosis are strictly and independently associated with in-ICU mortality and persistent AKI at ICU discharge.

Emergence in Taiwan of novel imipenem-resistant Acinetobacter baumannii ST455 causing bloodstream infection in critical patients.

Acinetobacter baumannii is one of the most important noscomial pathogens worldwide. The study aimed to use multilocus sequence typing (MLST) for epidemiological surveillance of A. baumannii isolates in Taiwan and analyze the clinical presentations and patients' outcomes. MLST according to both Bartual's PubMLST and Pasteur's MLST schemes was applied to characterize bloodstream imipenem-resistant A. baumannii (IRAB) infection in intensive care units in a medical center. A total of 39 clinical IRAB bloodstream isolates in 2010 were enrolled. We also collected 13 imipenem-susceptible A. baumannii bloodstream isolates and 30 clinical sputum isolates (24 IRAB and 6 imipenem-susceptible A. baumannii) for comparison. Clinical presentations and outcome of the patients were analyzed. We found that infection by ST455B/ST2P and inappropriate initial therapy were statistically significant risk factors for mortality. More than one third of the IRAB isolates belonged to ST455B/ST2P. Most ST455B/ST2P (80%) carried ISAba1-blaOXA-23, including 10 (66.7%) with Tn2006 (ISAba1-blaOXA-23-ISAba1) in an AbaR4-type resistance island. ST455B/ST2P appears to evolve from ST208B/ST2P of clonal complex (CC) 92B/CC2P. In this hospital-based study, A. baumannii ST455 accounted for 38.5% of IRAB bacteremia, with a high mortality of 86.7%. Approximately 85% of ST455B/ST2P bacteremia had a primary source of ventilation-associated pneumonia. We report the emergence in Taiwan of IRAB ST455B/ST2P, which is the current predominant clone of IRAB in our hospital and has been causing bacteremia with high mortality in critical patients.

Emergence in Taiwan of novel imipenem-resistant Acinetobacter baumannii ST455 causing bloodstream infection in critical patients.

Acinetobacter baumannii is one of the most important nosocomial pathogens worldwide. This study aimed to use multilocus sequence typing (MLST) for the epidemiological surveillance of A. baumannii isolates in Taiwan and analyze the clinical presentations and patients' outcome. MLST according to both Bartual's PubMLST and Pasteur's MLST schemes was applied to characterize bloodstream imipenem-resistant A. baumannii (IRAB) infection in intensive care units in a medical center. A total of 39 clinical IRAB bloodstream isolates in 2010 were enrolled. We also collected 13 imipenem-susceptible A. baumannii (ISAB) bloodstream isolates and 30 clinical sputum isolates (24 IRAB and 6 ISAB) for comparison. Clinical presentations and outcome of the patients were analyzed. We found that infection by ST455(B)/ST2(P) and inappropriate initial therapy were statistically significant risk factors for mortality. More than one-third of the IRAB isolates belonged to ST455(B)/ST2(P). Most ST455(B)/ST2(P) (80%) carried ISAba1-blaOXA-23, including 10 (66.7%) with Tn2006 (ISAba1-blaOXA-23-ISAba1) in an AbaR4-type resistance island. ST455(B)/ST2(P) appears to evolve from ST208(B)/ST2(P) of clonal complex (CC) 92(B)/CC2(P). In this hospital-based study, A. baumannii ST455 accounted for 38.5% of IRAB bacteremia, with a high mortality of 86.7%. Approximately 85% of ST455(B)/ST2(P)bacteremia had a primary source of ventilation-associated pneumonia. We report the emergence in Taiwan of IRAB ST455(B)/ST2(P), which is the current predominant clone of IRAB in our hospital and has been causing bacteremia with high mortality in critical patients.

Effects of gabexate mesilate on coagulopathy and organ dysfunction in rats with endotoxemia

Sepsis and its associated multiple organ failure are related to high mortality in critical patients. Several studies have reported that gabexate mesilate, a synthetic inhibitor of trypsin-like serine protease, protects tissues/organs against injury in the models of endotoxemia. The aim of this study was to examine whether gabexate mesilate could attenuate coagulopathy and organ dysfunction in lipopolysaccharide (LPS)-induced sepsis model by using thrombelastography (TEG). LPS (7.5 mg/kg/h, intravenouly for 4 h) was administered to male adult Wistar rats. Some of the LPS rats received a continuous infusion of gabexate mesilate (10 mg/kg/h, intravenously for 8.5 h) for 30 min before the LPS administration. Variable parameters of hemodynamics, biochemistry, hemostasis and inflammatory response were measured for 6 h after the LPS infusion. TEG variables (R-time, K-time, α-angle, and maximal amplitude) were also measured. The pretreatment of LPS rats with gabexate mesilate significantly attenuated the lung, liver and kidney dysfunction, consumptive coagulopathy, the increases in serum tumor necrosis factor-α, interleukin-6, plasma thrombin-antithrombin complex and plasminogen activator inhibitor-1, and neutrophils infiltration score in lung, liver and kidney, compared with the LPS alone group. In addition, TEG parameters correlated with tissue and liver injury in the late phase of endotoxemia. In particular, a strong negative correlation between maximal amplitude at 4 h and Ln (lactate dehydrogenase) at 6 h after LPS infusion was noted (r = -0.752, P < 0.001, R = 0.566). These results indicate that beneficial effects of anticoagulants (e.g. gabexate mesilate) in endotoxemia could be monitored by TEG per se.

Preventing catheter-related infections in ICUs: comparing catheter care techniques

Catheter-related bloodstream infections (CRBSI) are common and an important cause of morbidity and mortality in critical patients. Optimum approaches for preventing infections are presented in guidelines. This study aims to evaluate efficacy of different care techniques and education, to define risk factors for decreasing ratio of CRBSIs and to analyze effects on morbidity and mortality.

Clinical study of the influence of daily sedation interruption on fluctuation of blood glucose level and mortality of critical patients with multiple trauma

To assess the influence of a protocol of routine daily interruption of sedation on fluctuation of blood glucose level and mortality of critical patients with multiple trauma. A prospective study involving 68 critical patients with multiple trauma admitted to intensive care unit (ICU) was performed. Finger blood glucose level was measured after the implementation of daily interruption of sedation, and the results were recorded every 2 hours during the first 24 hours. Mean (MEAN), standard deviation (SD) and coefficient of variability (CV) of blood glucose level, glycemic liability index (GLI), mean amplitude of glycemic excursion (MAGE) and largest amplitude of glycemic excursions (LAGE) were calculated respectively, and 30-day mortality was recorded. The patients under study were divided into four groups according to the median values of MEAN and GLI, group A with patients of low MEAN+low GLI (n=34), group B with patients of low MEAN+high GLI (n=14), group C with patients of high MEAN+low GLI (n=12), and group D with patients of high MEAN+high GLI (n=8). Glucose levels, their range of fluctuation, and the prognosis were compared among groups. Five of the 68 patients died, with a gross mortality rate of 7.4%. Group analysis demonstrated that the patients in group A had the best prognosis with the 30-day mortality rate of 0 (0/34), while that of the group D was worst with the 30-day mortality rate of 37.5% (3/8). The MEAN levels of glucose were relatively lower in groups A and B (6.7±1.3 mmol/L, 7.6±0.8 mmol/L) and higher in groups C and D (9.3±1.4 mmol/L, 10.7±1.3 mmol/L). Indicators of glucose level fluctuation, including SD, CV, GLI, LAGE, and MAGE, were lower in groups A and C (SD: 1.6±0.4 mmol/L, 1.7±0.6 mmol/L; CV: 0.2±0.1, 0.2±0.1; GLI: 26.5±19.5, 40.1±17.6; LAGE: 4.6±2.3 mmol/L, 6.5±1.9 mmol/L; MAGE: 2.7±0.8 mmol/L, 3.1±0.80 mmol/L), and higher in groups B and D (SD: 2.9±0.7 mmol/L, 3.9±0.8 mmol/L; CV: 0.4±0.1, 0.4±0.1; GLI: 120.5±33.2, 184.6±98.4; LAGE: 9.5±2.0 mmol/L, 12.7±4.0 mmol/L; MAGE: 6.2±1.2 mmol/L, 7.6±1.8 mmol/L). The incidence of hypoglycemia was highest in group D [5.8% (6/104)], followed by that of group B [1.6% (3/182)], while that of groups A and C was lower [0.9% (4/442), 0.1% (2/256)]. The incidence of hyperglycemia were highest in groups C and D [67.3% (105/156), 69.2% (72/104)], and it was followed by that of group B [33.5% (61/182)], and that of group A was the lowest [15.4% (68/442)]. The duration of mechanical ventilation [(3.4±3.3) days], the incidence of multiple organ failure (MOF, 44.1%, 15/34), rate of continuous renal replacement therapy (CRRT, 11.8%, 4/34), and day in ICU [(5.1±3.9) days] were shortest and lowest in group A, and highest and longest in group D [(9.4±5.2) days, 87.5% (7/8), 75.0% (4/8), (10.3±7.4) days]. Daily interruption of sedation can reduce fluctuation of blood glucose level in critical patients with multiple trauma, and improve patients' outcome.

Value of a model based on PIRO conception in predicting the prognosis in critical patients

To investigate the values of factors based on PIRO conception in predicting the prognosis of critical patients. The clinical data of critical patients admitted to Hainan Branch of PLA General Hospital from December 2011 to August 2013 were retrospectively analyzed. The patients were randomly divided into non-survivors and survivors groups according to 28-day outcome. Predisposition (P), injury (I), response (R) and organ dysfunction induced by injury (O) were compared between two groups. The indexes with statistical significance (P<0.2) by univariate analysis were included in multivariate logistic regression analysis, and the receiver operating characteristic curve (ROC curve) was plotted to evaluate the values of factors based on PIRO conception in predicting the prognosis of critical patients. One hundred and eighty-seven critical patients were enrolled, and among them 75 (40.1%) patients died. Univariate analysis showed that the age, underlying disease scores, history of cardiovascular disease, diabetes mellitus, and cerebrovascular disease, positive blood culture, whether or not complicated with acute respiratory distress syndrome (ARDS) or severe sepsis/septic shock, procalcitonin (PCT), acute physiology and chronic health evaluation II (APACHE II), acute pathophysiology score (APS) and sequential organ failure assessment (SOFA) were found to be the factors related with the prognosis (all P<0.2). Multivariate logistic regression analysis showed that the underlying disease scores [odds ratio (OR)=1.874, 95% confidence interval (95%CI) 1.138-3.084, P=0.014], whether patients occurrence of severe sepsis/septic shock (OR=0.167, 95%CI 0.064-0.435, P=0.000) and SOFA scores (OR=1.498, 95%CI 1.283-1.750, P=0.000) were independent factors for predicting 28-day mortality. The new model combined with above factors had more prognostic value in predicting the mortality than a single variable. The area under ROC curve (AUC) for PIRO model based on indexes with statistical significance by univariate analysis was 0.877 (0.821-0.934), P=0.000. AUC for PIRO model based on underlying disease scores, severe sepsis/septic shock, SOFA scores was 0.871 (0.814-0.928), P=0.000. AUC for SOFA was 0.762 (0.687-0.837), P=0.000. AUC for APS was 0.726 (0.647-0.805), P=0.000. AUC for underlying disease scores was 0.678 (0.593-0.763), P=0.000. AUC for PCT was 0.636 (0.548-0.724), P=0.004. AUC for age was 0.618 (0.532-0.705), P=0.013]. The multivariate regression analysis based on PIRO system may help to predict 28 days mortality in critical patients.

Quantitative proteomic analysis by iTRAQ for identification of candidate biomarkers in plasma from acute respiratory distress syndrome patients

Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality in critical patients. Proteomic analysis of plasma from individuals with ARDS could elucidate new biomarkers for diagnosis and pathophysiology and identify potential ARDS treatment targets. In this study, we recruited 26 patients (15 controls, 11 ARDS). The ARDS group was subdivided into two groups depending on the type of injury: (1) direct lung injury (AD) and (2) indirect lung injury (AI). Using iTRAQ (isobaric tags for relative and absolute quantitation) analysis, we identified 2429 peptides representing 132 plasma proteins. Among these, 16 were differentially expressed in ARDS patients, including 11 overlapping proteins between the AI and AD group and 5 AI-specific proteins. Protein annotation revealed that lipid transport and complement activation were significantly enriched in the biological process category, and lipid transporter, transporter, and serine-type peptidase activities were significantly enriched in the molecular function category. IPA (Ingenuity Pathway Analysis) signaling pathways revealed that the overlapping proteins were involved in a variety of signaling pathways, including those underlying acute phase response; liver X receptor/retinoid X receptor (LXR/RXR) and farnesoid X (FXR)/RXR activation; clathrin-mediated endocytosis; atherosclerosis; interleukin (IL)-12; complement system; and cytokine, nitric oxide, and reactive oxygen species production in macrophages. We present the first proteomic analysis of ARDS plasma using the iTRAQ approach. Our data provide new biomarker candidates and shed light on potential pathological mechanisms underlying ARDS.

Effect of adequate initial antimicrobial therapy on mortality in critical patients with Pseudomonas aeruginosa bacteremia

Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.

Improvements in the Hemodynamic Stability of Combat Casualties During En Route Care

Three Forward Aeromedical Evacuation platforms operate in Southern Afghanistan: UK Medical Emergency Response Team (MERT), US Air Force Expeditionary Rescue Squadron (PEDRO), and US Army Medical Evacuation Squadrons (DUSTOFF), each with a different clinical capability. Recent evidence suggests that retrieval by a platform with a greater clinical capability (MERT) is associated with improved mortality in critical patients when compared with platforms with less clinical capability (PEDRO and DUSTOFF). It is unclear whether this is due to en route resuscitation or the dispatch procedure. The aim of this study was to compare prehospital Shock Index (SI = heart rate / systolic blood pressure) with admission values as a measure of resuscitation, across these platforms. Patients were identified from the Department of Defense Trauma Registry, who were evacuated between June 2009 and June 2011 in Southern Afghanistan. Data on platform type, physiology, and injury severity was extracted. Overall, 865 patients were identified: 478 MERT, 291 PEDRO, and 96 DUSTOFF patients and groups were compared across three injury severity scoring (ISS) bins: 1 to 9, 10 to 25, and 26 or greater. An improvement in the admission SI was observed across all platforms in the lowest ISS bin. Within the middle bin, both the MERT and PEDRO groups saw improved SI on admission, but not the DUSTOFF group. This trend was continued only in the MERT group for the highest ISS bin (1.39 ± 0.62 vs. 1.09 ± 0.42; P = 0.001), whereas a deterioration was identified in the PEDRO group (0.88 ± 0.37 vs. 1.02 ± 0.43; P = 0.440). The use of a Forward Aeromedical Evacuation platform with a greater clinical capability is associated with an improved hemodynamic status in critical casualties. The ideal prehospital triage should endeavor to match patient need with clinical capability.

New treatment for sepsis: stem cell therapy

Sepsis is the systemic inflammatory response to infection and a major cause of mortality in critical patients. The severe disorder of immune system is the common pathophysiological changes in septic patients. Mesenchymal stem cells (MSCs) have shown great immunoloregulation properties in recent studies. It can increase the level of IL-10, an anti-inflammatory cytokine, promote the secretion of prostaglandin E2 (PGE2), indolamine 2,3-dioxygenase (IDO), and regulate the proliferation, differentiation and function of the immune cells such as mononuclear macrophage, t-lymphocytes, natural killer cells and so on. MSCs may provide new ideas for the treatment of sepsis.

The Statistical Analysis of Patients’ Clinical Data in Emergency Department by Using Hospital Information System

ObjectivesUsing hospital information system (HIS) to classify the patients who were treated in the emergency department and discuss the spectrum of diseases. MethodsWe collected the clinical information of the patients who were treated in the emergence department from July 1, 2010 to June 30, 2011. The patients were divided into different groups by their disease, and analyzed the numbers and frequencies of each subgroup. ResultsFrom the data of 12 months, we concluded that the most frequencies of diseases are cardiovascular diseases, respiratory diseases, neurological diseases and digestive diseases. There were no significant difference among the first three diseases, but the patients number of digestive diseases were increased in the winter. And the mortality of critical patients in January and February was higher than other months. Conclusion1) The increasing patients number of cardio-cerebrovascular diseases was corresponding to the increasing of aging population, and there were no difference in 12 months. 2) The increasing number of digestive diseases between December to February maybe associated with diet change. 3) The mortality of critical patients in January and February was higher than other months.

Delirium in intensive care: an under-diagnosed reality

Delirium occurs in up to 80% of patients admitted to intensive care units. Although under-diagnosed, delirium is associated with a significant increase in morbidity and mortality in critical patients. Here, we review the main risk factors, clinical manifestations and preventative and therapeutic approaches (pharmacological and non-pharmacological) for this illness.