Pulmonary Intensive Care Unit Research Articles

The Difference in Body Temperature Measured on the Tympanic Membrane, in the Axilla and with Infrared Sensor Thermometer in Pulmonary Intensive Care Patients

Introduction. Measurement of body temperature in an intensive care unit is a standard procedure that provides quick insight into the patient’s condition and possible changes in that condition. The measurement is carried out at different parts of the body and with the help of different thermometers. Patients in intensive care units are hemodynamically unstable, subjected to various invasive methods, and temperature indicates possible changes in their condition. Aim. The aim of this research was to determine if there are differences between the body temperature values measured in the axilla, on the tympanic membrane and using the infrared sensor thermometer on the patient’s forehead with regard to the age, gender and the diagnosis of the patient. Methods. The research was carried out in the Intensive Care Unit of the Clinic for lung diseases Jordanovac, in the period from January 2nd to July 2nd 2017. Author of the research did the measurements by herself during her work shifts. Research included 100 patients. Methods that were used were descriptive statistics (measures of central tendency, arithmetic mean, median and mod) and measures of variability (standard deviation, minimum and maximum). One-way analysis of variance (ANOVA) was also conducted. Results. A statistically significant difference was determined in the measured temperature values using the infrared sensor thermometer on the patients’ forehead which were higher than the axillary and tympanic temperatures in male patients, patients younger than 70 years and in patients with COPD. Conclusion. It is important to choose the adequate method of body temperature measurement, taking into account the peculiarities and the clinical condition of the patient, and the advantages and disadvantages of each measurement procedure. It is necessary to combine or repeat measurements in order to be completely sure of the obtained values. In patients in pulmonary intensive care units taking axillary temperature is recommended.

Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program

BackgroundThe aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients.MethodsThis prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group.ResultsStatistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (p<0.001; r=0.440, r=0.432, r=0.339 and r=0.410, respectively). One and three months mortality- ICU admission had a statistically significant relationship with parenteral nutrition (p<0.001; r=0.346, r=0.300, respectively; r=0.294 and r=0.294, respectively). Similarly, there was also a statistically significant relationship between pneumonia onset and one- and three-month mortality- ICU admission (p<0.05; r=0.217, r=0.127, r=0.185 and r=0.185, respectively). A regression analysis showed that parenteral nutrition (odds ratio [OR] =13.434, 95% confidence interval [CI] =1.148–157.265, p=0.038) was a significant predictor of ICU admission. The relationship between pulmonary physiotherapy (PPT) and ICU admission- pneumonia onset at the end of three months was statistically significant (p=0.04 and p=0.043, respectively).ConclusionThis study showed that PPT improved the prognosis of ischemic stroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes.Trial registrationNCT03195907. Trial registration date: 21.06.2017 ‘Retrospectively registered’.

Evaluation of risk factors for invasive pulmonary aspergillosis and detection of diagnostic values of galactomannan and PCR methods in bronchoalveolar lavage samples from non-neutropenic intensive care unit patients

Non-neutropenic intensive care unit (ICU) patients are at particular risk for invasive pulmonary aspergillosis. In these cases, radiological and microbiological methods (direct microscopy, culture), which can be used for diagnosis, have quite low sensitivity and specificity. The aims of this study were to evaluate the risk factors for invasive pulmonary aspergillosis (IPA) in non-neutropenic ICU patients and to determine the diagnostic values of galactomannan (GM) antigen and Aspergillus nucleic acid detection methods. A total of 44 patients (13 female, 31 male; age range: 36-96 years) who had been followed at pulmonary ICU with invasive mechanical ventilation and undergone bronchoscopy between January to December 2013, were included in the study. Consecutive bronchoalveolar lavage (BAL) and serum samples were obtained from all of the patients. BAL samples were tested for the presence of Aspergillus DNA by polymerase chain reaction (PCR) and both serum and BAL samples were tested for GM antigen by EIA method (Platelia Aspergillus, BioRad, France). EORTC/MSG criteria were used for the case definition of IPA. Patients were classified as high-probable IPA, possible IPA and non-IPA. ROC (receiver operating characteristics) analysis was used to determine the diagnostic values of BAL Aspergillus PCR and BAL GM in the diagnosis of IPA. Five patients were defined as high-probable IPA and six were defined as possible IPA; thus the incidence rate of IPA was estimated as 11.4% (5/44) among non-neutropenic intensive care unit patients. In high-probable IPA patients, BAL GM levels were significantly higher than non-IPA patients (p< 0.05). The prolonged duration in ICU, presence of septic shock and the use of high cumulative doses (> 460 mg) of steroid were found to be risk factors for IPA development. The cut-off value for GM in BAL samples was determined as 0.7, with a sensitivity rate of 100% (95% confidence interval: 47.9-100) and a specificity rate of 87.9% (95% confidence interval: 71.7-96.5), so optimal GM level in BAL was considered as ≥ 0.7 for the diagnosis of IPA. The specificity rates of serum GM and BAL Aspergillus PCR methods were high (97.1% and 93.9%, respectively), however their sensitivity rates were found quite low (33.3% and 40%, respectively), in the diagnosis of IPA. In conclusion, development of IPA should be assessed in non-neutropenic patients when the stay in ICU extends and high dose cumulative steroids are used. GM antigen detection in BAL can be used effectively for diagnosis of IPA in these patients compared to other diagnostic methods.

Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up.

Multiorgan failure (MOF) is a primary cause of morbidity and mortality in sepsis patients in intensive care units (ICU). Finding risk factors and solving preventable problems of MOF in patients who have sepsis can be a favourable step for decreasing mortality. We aimed to examine multiorgan failure and mortality related risk factors in intensive care unit patients who have sepsis. A retrospective data collection and prognostic cohort study was performed. Between January 2009-March 2010, patients accepted to the 22-bed pulmonary intensive care unit with the diagnosis of sepsis were enrolled. Patients' demographic data, ICU severity scores, application of mechanical ventilation, causative agent of sepsis, number of ICU days and presence of mortality were recorded. Logistic regression analysis was carried out for risk factors. 347 patients with sepsis were involved in the study. 43 of the patients (12.4%) developed MOF and overall mortality rate was 14.9% (n= 52). Presence of resistant pathogen, presence of shock, application of TPN and high APACHE II score were found to be risk factors for MOF [p= 0.015 Odds ratio (OR) 3.47 confidence interval (CI): 1.27 - 9.47, p= 0.001, OR: 30.8 CI: 11.41 - 83-49, p= 0.028, OR: 3.08, CI: 1.13 - 8.39, p= 0.003, OR: 1.10, CI: 1.04-1.18, respectively]. Risk factors for overall mortality were presence of nosocomial infection, high 3rd day SOFA score, presence of shock, application of TPN and sedation (p= 0.005, OR: 3.39, CI: 1.45 - 7.93; p= 0.001, OR: 1.51, CI: 1.27 - 1.81; p= 0.014, OR: 3.24, CI: 1.27 - 8.25; p= 0.003, OR: 3.64. CI: 1.54 - 8.58; p= 0.001, OR: 3.38, CI: 1.51 - 7.57, respectively). In sepsis patients who need ICU follow up, presence of resistant pathogen, presence of shock, application of TPN and high APACHE II scores are risk factors for developing MOF. Thus, rational use of antibiotics, reducing the use of TPN, application of infection control programmes and prevention of shock will further reduce multiorgan failure and mortality.

Implementation of a surgical intensive care unit service is associated with improved outcomes for trauma patients.

Our trauma service recently transitioned from a pulmonary intensive care unit (ICU) service to a surgical ICU (SICU) service. We hypothesized that a newly formed SICU service could provide comparable outcomes to the existing pulmonary ICU service. A specific aim of this study was to compare outcomes of trauma patients admitted to the ICU before and after implementation of a SICU service. We performed a retrospective study of trauma patients admitted to the ICU of our urban, American College of Surgeons- verified, Level 1 trauma center during a 4-year period (2009-2012). Patients managed by the pulmonary ICU service (2009-2010) were compared with patients managed by a SICU service (2011-2012). The primary outcome was mortality, while secondary outcomes included complications (pulmonary, infectious, cardiac, and thromboembolic), hospital and ICU length of stay, ventilator days, and need for reintubation. There were 2,253 trauma patients admitted to the ICU during the study period, 1,124 and 1,129 managed by the pulmonary ICU and SICU services, respectively. When comparing outcomes for SICU and pulmonary ICU patients, there was no difference in mortality (11% vs. 13%, p = 0.41), but patients managed by the SICU service had fewer pulmonary complications (3% vs. 6%, p < 0.001), fewer days on the ventilator (3 vs. 4, p = 0.002), and less often required reintubation after extubation (4% vs. 9%, p < 0.001). Transition from a pulmonary ICU service to a SICU service at our institution was associated with no change in mortality but an improvement in pulmonary complications, ventilator days, and reintubation rates. Trauma centers currently staffed with a pulmonary ICU service should feel comfortable converting to SICU service and should expect comparable or improved outcomes for trauma patients admitted to the ICU. Therapeutic/care management study, level IV.

Total Unilateral Obstruction by Sputum Immediately after Tracheal Bougienage

A 25-year-old man developed tracheal stenosis due to prolonged intubation for five days. Immediately after bougienage, his left lung was not possible to ventilate and emergency tracheostomy was performed to produce ample space for airflow. Fiberoptic bronchoscopy showed that his left main bronchus was totally obstructed by sputum at the entrance of the superior and inferior lobar bronchi. Inadequate airway clearance increases the risk of infection and airway obstruction. We suggest chest physiotherapy be applied to all patients in the intensive care unit (ICU), especially patients with tracheal stenosis, due to its positive impact on pulmonary functional ability and ICU stay.

581

Introduction: Although an increased body mass index (BMI) is associated with an elevated risk of chronic health diseases such as diabetes and hypertension, it is unclear whether patients with high BMIs fare worse when they are admitted to an intensive care unit (ICU) for an acute disorder. Some studies have instead described an "obesity paradox" where obese patients (BMI>30 kg/m2) have a lower ICU mortality rate, particularly when diagnosed with acute infections and septic shock. However, most studies have not addressed the outcomes of patients with more extreme obesity, defined as "super obesity" (BMI > 50), who may have outcomes that are different from patients whose BMI are below this threshold. Methods: A retrospective analysis of patients admitted to the MICU at LAC+USC Medical Center from 2008 to 2013 was performed. Patients were divided into 3 groups: BMI of 30-39, 40-49 and >50. In this pilot study, the first 55 patients reviewed in each BMI set were assigned to their respective group. Variables assessed included age, sex, APACHE II score, reason for ICU admission, use of non-invasive and invasive mechanical ventilation, need for dialysis, tracheostomy, use of a pulmonary artery catheter, mortality, and hospital and ICU length of stay (LOS). Analysis of variance was used to detected differences in means of continuous data and a chi square test was used to evaluate categorical data among the three groups. A p<0.05 was considered significant. Results: The mean age for super obese patients (BMI >50) was younger (44 + 2.7 SEM) than either of the BMI 30-39 and BMI 40-49 groups at 49 + 2.7 and 51 + 3.1 years, respectively (p<0.05). There was no significant difference among APACHE II scores or ICU length of stay. However, the mean hospital LOS was 7 + 2.1 days longer for patients with BMI > 50 than those with a BMI = 30-39, and 4 + 1.5 days longer than those with a BMI = 40-49. Mortality was similar among the three groups. Although there was no difference in the need or duration of invasive mechanical ventilation, there was a higher proportion of noninvasive mechanical ventilation used in the BMI>50 cohort (p<0.05), in that 34 (62%) of the super obese patients used noninvasive ventilation compared with 16 (29%) in the 40-49 group and 6 (11%) in the 30-39 group. Although there was a trend toward higher rates of tracheostomy or pulmonary artery catheter placement in the super obese patients, this did not achieve statistical significance. Super obese patients did not have a higher propensity to require hemodialysis than did the other groups (p>0.05). Indications for admission were different among the groups, with the BMI>50 patients being admitted to the ICU more frequently for cardiopulmonary indications (arrhythmias, heart failure, dyspnea, hypoxia) than were patients in the other groups (p<0.05). Conclusions: Super obese patients with a BMI >50 who are admitted to the MICU were younger in comparison to less obese patients. While there was no difference in use or duration of invasive mechanical ventilation in the 3 groups, patients with BMI >50 more often required non-invasive ventilation. Patients at the higher extremes of obesity were admitted to the ICU for cardiopulmonary issues more so than patients with BMI 30-50. Despite these differences, crude mortality rates were similar among these 3 groups of obese patients.

Late pharmacologic conditioning with volatile anesthetics after cardiac surgery

IntroductionThe aim of this randomized controlled trial was to investigate whether volatile anesthetics used for postoperative sedation have any beneficial effects on myocardial injury in cardiac surgery patients after on-pump valve replacement.MethodsAnesthesia was performed with propofol. After arrival in the intensive care unit (ICU), 117 patients were randomized to be sedated for at least 4 hours with either propofol or sevoflurane. Sevoflurane was administered by using the anesthetic-conserving device. Troponin T, creatine kinase, creatine kinase from heart muscle tissue, myoglobin, and oxygenation index were determined on arrival at the ICU, 4 hours after sedation, and in the morning of the first postoperative day (POD1). Primary end points were cardiac injury markers on POD1. As secondary end points oxygenation, postoperative pulmonary complications, and ICU and hospital stay were documented.ResultsFifty-six patients were analyzed in the propofol arm, and 46 patients in the sevoflurane arm. Treatment groups were comparable with regard to patient demographics and intraoperative characteristics. Concentration of troponin T as the most sensitive marker for myocardial injury at POD1 was significantly lower in the sevoflurane group compared with the propofol group (unadjusted difference, -0.4; 95% CI, -0.7 to -0.1; P < 0.01; adjusted difference, -0.2; 95% CI, -0.4 to -0.02; P = 0.03, respectively).ConclusionsThe data presented in this investigation indicate that late postconditioning with the volatile anesthetic sevoflurane might mediate cardiac protection, even with a late, brief, and low-dose application.Trial registrationClinicalTrials.gov: NCT00924222.

The prognostic variables predictive of mortality in patients with an exacerbation of COPD admitted to the ICU: an integrative review

Chronic Obstructive Pulmonary Disease (COPD) frequently presents with an acute exacerbation (AECOPD). Debate exists as to whether these patients should be admitted to intensive care units (ICUs). An integrative review was performed to determine whether clinical variables available at the time of ICU admission are predictive of the intermediate-term mortality of patients with an AECOPD. An integrative review was structured to incorporate a five-stage review framework to facilitate data extraction, analysis and presentation. The quality of the studies contributing to the integrative review was assessed with a novel scoring system developed from previously published data and adapted to this setting. The integrative review search strategy identified 28 studies assessing prognostic variables in this setting. Prognostic variables associated with intermediate-term mortality were low Glasgow Coma Scale (GCS) on admission to ICU, cardio-respiratory arrest prior to ICU admission, cardiac dysrhythmia prior to ICU admission, length of hospital stay prior to ICU admission and higher values of acute physiology scoring systems. Premorbid variables such as age, functional capacity, pulmonary function tests, prior hospital or ICU admissions, body mass index and long-term oxygen therapy were not found to be associated with intermediate-term mortality nor was the diagnosis attributed to the cause of the AECOPD. Variables associated with intermediate-term mortality after AECOPD requiring ICU admission are those variables, which reflect underlying severity of acute illness. Premorbid and diagnostic data have not been shown to be predictive of outcome. A scoring system is proposed to assess studies of prognosis in AECOPD.

Value of APACHE II, SOFA and CPIS Scores in Predicting Prognosis in Patients with Ventilator-Associated Pneumonia

Background: Ventilator-associated pneumonia (VAP) is the most frequent infection with high mortality rates in intensive care units (ICUs) and the prediction of outcome is important in the decision-making process. Objective: To assess the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Clinical Pulmonary Infection Score (CPIS) in the prediction of mortality during VAP episodes in pulmonary patients. Methods: This study was a prospective observational cohort study. Sixty-three patients who were admitted to the ICU and developed VAP were included in the study consecutively. Clinical and laboratory data conforming to the APACHE II and SOFA scores were recorded on admission and APACHE II, SOFA and CPIS scores on the day of the diagnosis of VAP. The outcome measure was the ICU mortality. Logistic regression and receiver operating characteristic (ROC) curve analyses and the area under the curve (AUC) were used to estimate the predictive ability of the scoring systems. Results: Mortality rate was 54%. The mean APACHE II (21 ± 6, 14 ± 5; p = 0.001), SOFA (7 ± 3, 4 ± 2; p = 0.002) and CPIS (8 ± 2, 7 ± 3; p = 0.025) scores determined at the time of VAP diagnosis were significantly higher in nonsurvivors than in survivors. Discrimination was excellent for APACHE II (ROC AUC: 0.81; p = 0.001) and acceptable for SOFA (ROC AUC: 0.71; p = 0.005) scores. Of the three scores only APACHE II >16 was an independent predictor of the mortality (OR: 5; 95% CI: 1.3–18; p = 0.019) in the logistic regression analysis. Conclusion: These results suggest that APACHE II determined at the time of VAP diagnosis may be useful in predicting mortality in the pulmonary ICU patient population who develops VAP.

Incidence and risk factors for the development of acute renal failure in patients with ventilator‐associated pneumonia

Infections are one of the most important risk factors for the development of acute renal failure (ARF) and ventilator-associated pneumonia (VAP) has been reported as one of the most frequent infection in intensive care units (ICU). Sepsis, shock, multiorgan dysfunction syndrome (MODS), use of nephrotoxic antibiotics and mechanical ventilation are potential risk factors for development of ARF during VAP. The objective of the study was to evaluate the incidence of ARF in patients with VAP and the role of VAP-related potential risk factors in the development of ARF. One hundred and eight patients who were admitted to the pulmonary ICU of a university hospital and developed VAP were included in this prospective observational cohort study. Only first episodes of VAP were studied. Diagnosis was based on microbiologically confirmed clinical findings. Potential outcome variables including responsible pathogens, recurrence, polymicrobial aetiology, bacteraemia, multidrug resistance of microorganisms, late/early VAP and sepsis and other known risk factors for development of ARF were evaluated. Risk factors were analysed by logistic regression analysis for significance. Incidence of ARF was 38% (n = 41). Pneumonia with multidrug resistant pathogens (odds ratio, (OR) 5; 95% confidence interval (95%CI), 1.5-18; P = 0.011), sepsis (OR, 5.6; 95%CI, 1.7-18; P = 0.005) and severity of admission disease (Acute Physiology and Chronic Health Evaluation II score: OR, 1.1; 95%CI, 1.02-1.3; P = 0.017) were independent risk factors for the development of ARF during VAP episodes in multivariate analysis. These results showed that the incidence of ARF is high during the VAP episodes and that VAP developed with multidrug resistant pathogens and sepsis have an independent effect on the development of ARF.

Needle aspiration as first-line management of primary spontaneous pneumothorax

Initial management of primary spontaneous pneumothorax (PSP) remains a topic of debate. Recent guidelines recommend needle aspiration as the initial strategy for large PSP, but chest tube drainage is still widely used. Over a six-year period, we used needle aspiration in all cases of large PSP at our center to assess this technique's efficacy in real-life clinical practice. Our prospective study in the pulmonary intensive care unit of a 680-bed university hospital included patients with a PSP greater than 20%, as estimated by the Light's index. Needle aspiration, performed after local anesthesia, used a plastic intravenous catheter. If it failed, we performed thoracic drainage. The study included 35 patients. The initial success rate of needle aspiration was 69% (n=24/35), the one-week success rate 63% (n=22/35), and the one-year rate 51% (n=18/35). Tolerance of needle aspiration was good except for transient vagal reaction in four patients. No risk factors (age, body mass index, delay before hospitalization, previous pneumothorax, or Light index at inclusion) predicted initial failure of needle aspiration. Our results confirmed that needle aspiration is an attractive therapeutic option for patients with large PSP: success was observed in approximately two thirds of cases.

Is the fall in platelet count associated with intensive care unit acquired pneumonia?

Intensive Care Unit Acquired Pneumonia is the most frequent infection among patients receiving mechanical ventilation and has an important impact on patient mortality. Thrombocytopenia is one of the most common laboratory abnormalities in Intensive Care Unit (ICU). The aim of this study was to evaluate the relationship between platelet count and Intensive Care Unit Acquired Pneumonia (ICUAP). Medical records of 41 mechanically-ventilated pulmonary ICU patients having at least one ICUAP were reviewed. The date of first ICUAP, etiologic pathogens, platelet count at admission, the nadir value within seven days before and after the date of ICUAP, development of thrombocytopenia (platelet <100 x 10(3)/mm(3)), acute physiology and chronic health evaluation (APACHE) II scores on admission, medications and events that can effect platelet count and other laboratory values were noted. The meantime for the first ICUAP was 13 +/- 10.3 days after ICU admission. The nadir platelet count associated with ICUAP (ICUAPplatelet count) was seen on 12.1 +/- 11.3th day after ICU admission; with a significant fall (30% fall) when compared to admission platelet count (platelet counts are 157.2 +/- 87.4 x 10(3)/mm(3), 224.1 +/- 106.3 x 10(3)/mm(3) respectively, p <0.001). Fifteen of the 41 patients had an episode of thrombocytopenia during their ICU stay and these patients had a higher mortality rate than nonthrombocytopenics (mortality rates are 80% and 50% respectively, p = 0.05). Besides the proven role of thrombocytopenia in prognosis in ICU, the significant fall in platelet count can be an early warning parameter and possible diagnostic hint for severe infections in ICU such as ICUAP.

Is the fall in platelet count associated with intensive care unit acquired pneumonia?

Intensive Care Unit Acquired Pneumonia is the most frequent infection among patients receiving mechanical ventilation and has an important impact on patient mortality. Thrombocytopenia is one of the most common laboratory abnormalities in Intensive Care Unit (ICU). The aim of this study was to evaluate the relationship between platelet count and Intensive Care Unit Acquired Pneumonia (ICUAP). Medical records of 41 mechanically-ventilated pulmonary ICU patients having at least one ICUAP were reviewed. The date of first ICUAP, etiologic pathogens, platelet count at admission, the nadir value within seven days before and after the date of ICUAP, development of thrombocytopenia (platelet <100 x 10(3)/mm(3)), acute physiology and chronic health evaluation (APACHE) II scores on admission, medications and events that can effect platelet count and other laboratory values were noted. The meantime for the first ICUAP was 13 +/- 10.3 days after ICU admission. The nadir platelet count associated with ICUAP (ICUAPplatelet count) was seen on 12.1 +/- 11.3th day after ICU admission; with a significant fall (30% fall) when compared to admission platelet count (platelet counts are 157.2 +/- 87.4 x 10(3)/mm(3), 224.1 +/- 106.3 x 10(3)/mm(3) respectively, p <0.001). Fifteen of the 41 patients had an episode of thrombocytopenia during their ICU stay and these patients had a higher mortality rate than nonthrombocytopenics (mortality rates are 80% and 50% respectively, p = 0.05). Besides the proven role of thrombocytopenia in prognosis in ICU, the significant fall in platelet count can be an early warning parameter and possible diagnostic hint for severe infections in ICU such as ICUAP.

Acute Renal Failure in Medical and Surgical Intensive Care Units—A One Year Prospective Study

The spectrum of acute renal failure is different in intensive care unit (ICU) vs. non-ICU population. This one year prospective study carried out in medical and surgical intensive care units showed an incidence of 8.6% of acute renal failure. The incidence of acute renal failure was highest in medical ICU (17.2%) followed by burns ICU (5.3%), pulmonary ICU (5.2%), stroke ICU (4.4%), surgical ICU (3.1%) and least in coronary ICU (1.3%). The acute renal failure was attributable to medical causes in 68% followed by surgery and trauma in 21.2%, burns in 5.6% and pregnancy related in 5.1%. In majority, acute renal failure was multifactorial. Septicemia was the commonest cause in both medical (50%) and surgical (86%) ICUs. Multi organ system failure was present in 77.3% of patients with acute renal failure. Approximately 40% required dialysis. The mortality of acute renal failure was 62% and the mortality was correlated with the number of organ system failures, presence of oliguria and septicemia. The mean ICU stay was significantly shorter in the non-survivors.

EFFECT OF MELATONIN ON SLEEP QUALITY OF COPD INTENSIVE CARE PATIENTS: A PILOT STUDY

Sleep deprivation is extremely common in the intensive care unit (ICU), and this lack of sleep is associated with low melatonin secretion. The objective of the current study was to explore the effect of exogenous melatonin administration on sleep quality in patients hospitalized in the pulmonary intensive care unit (ICU). We performed a double-blind, placebo-controlled study in the pulmonary ICU of a tertiary care hospital. Eight adult patients hospitalized in the pulmonary ICU with respiratory failure caused by exacerbation of chronic obstructive pulmonary disease (COPD) or with pneumonia were studied. Patients received either 3 mg of controlled-release melatonin or a placebo at 22:00, and sleep quality was evaluated by wrist actigraphy. Treatment with controlled-release melatonin dramatically improved both the duration and quality of sleep in this group of patients. Our results suggest that melatonin administration to patients in intensive care units may be indicated as a treatment for sleep induction and resynchronization of the “biologic clock.” This treatment may also help in the prevention of the “ICU syndrome” and accelerate the healing process. (Chronobiology International, 17(1), 71–76, 2000)

Heroin pulmonary edema.

To the Editor:The Clinical Conference in Pulmonary Disease in the August, 1972 issue discussed “The Pulmonary Edema of Heroin Toxicity—an Example of the Stiff Lung Syndrome.” The question is whether this patient had a case of pulmonary edema due solely to heroin overdosage or whether it was also initially complicated by aspiration of gastric secretions. On admission, she was found to have evidence of gastric contents in her pharynx. Later in her course she developed complications of chronic PEEP, respiratory care, and oxygen toxicity.The protracted clinical course of this patient is rather unusual for one with heroin pulmonary edema alone. A total of 106 cases of this syndrome treated in the pulmonary intensive care unit at Metropolitan Hospital were reviewed. One-hundred and-one had heroin overdosage or mixed heroin and other narcotic or hypnotic overdosage. The majority had developed pulmonary edema. Four patients had methadone overdosage and one patient had cocaine overdosage. All five of these patients developed pulmonary edema. Of this number, 98 survived and nine succumbed. Of the 98 who survived, only one required respiratory intensive care therapy for more than four days. He had developed aspiration pneumonia. Almost all of the patients, including those most severely ill on admission, recovered sufficiently to be discharged from the intensive care unit within the first 48 hours; none required PEEP therapy.Of the nine patients who died, two might have benefited from PEEP therapy. One was known to have aspirated, and the other was suspected to have aspirated. To the Editor: The Clinical Conference in Pulmonary Disease in the August, 1972 issue discussed “The Pulmonary Edema of Heroin Toxicity—an Example of the Stiff Lung Syndrome.” The question is whether this patient had a case of pulmonary edema due solely to heroin overdosage or whether it was also initially complicated by aspiration of gastric secretions. On admission, she was found to have evidence of gastric contents in her pharynx. Later in her course she developed complications of chronic PEEP, respiratory care, and oxygen toxicity. The protracted clinical course of this patient is rather unusual for one with heroin pulmonary edema alone. A total of 106 cases of this syndrome treated in the pulmonary intensive care unit at Metropolitan Hospital were reviewed. One-hundred and-one had heroin overdosage or mixed heroin and other narcotic or hypnotic overdosage. The majority had developed pulmonary edema. Four patients had methadone overdosage and one patient had cocaine overdosage. All five of these patients developed pulmonary edema. Of this number, 98 survived and nine succumbed. Of the 98 who survived, only one required respiratory intensive care therapy for more than four days. He had developed aspiration pneumonia. Almost all of the patients, including those most severely ill on admission, recovered sufficiently to be discharged from the intensive care unit within the first 48 hours; none required PEEP therapy. Of the nine patients who died, two might have benefited from PEEP therapy. One was known to have aspirated, and the other was suspected to have aspirated.

Treatment of hypoxia with 24 percent oxygen. A new approach to the interpretation of data collected in a pulmonary intensive care unit.

Treatment of hypoxia with 24 percent oxygen. A new approach to the interpretation of data collected in a pulmonary intensive care unit.

Narcotics and pulmonary edema.

Letters, Comments, and Corrections1 November 1972Narcotics and Pulmonary EdemaKENNETH MASTER, M.D.KENNETH MASTER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-77-5-817_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Drs. Frand, Shim, and Williams at Einstein Medical Center have presented us with two excellent discussions on the pathogenesis, clinical course, and pulmonary function results in methadone-induced and heroin-induced pulmonary edema (76:975-979 and 77: 29-35, 1972).We have had similar findings at Metropolitan Hospital: of 31 patients admitted to the pulmonary intensive care unit in the past 12 months for heroin or methadone overdosage, 23 developed overt pulmonary edema, and 8 did not. Two of the 31 patients had methadone overdosage and developed pulmonary edema. One of the two was a nonaddict who had ingested an unknown... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: KENNETH MASTER, M.D.Affiliations: Pulmonary Division Metropolitan Hospital New York, N.Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDrug-induced pulmonary edema and acute respiratory distress syndromeOut-of-hospital Treatment of Opioid Overdoses in an Urban Setting 1 November 1972Volume 77, Issue 5Page: 817-817KeywordsEdemaHeroinPathogenesisPulmonary functionPulmonary intensive care units ePublished: 1 December 2008 Issue Published: 1 November 1972 PDF downloadLoading ...