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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: June 2015 (Page 1 of 9)

What affects the outcome of severe preeclampsia?


Preeclampsia is a severe multi-system pregnancy related disorder associated with multiple maternal and fetal adverse outcomes, including fetal and maternal mortality. The aim of this study is to investigate the clinical difference between early- and late-onset preeclampsia and their impact to perinatal outcome, and to detect possible antenatal parameters that can predict adverse fetal and maternal outcomes. The research team conducted a retrospective cohort study of 308 singleton pregnancies complicated with severe preeclampsia over an 8-year period in our tertiary level centre. Clinical differences and perinatal outcomes between early- (<34 weeks, n=147) and late-onset (≥34 weeks, n=161) preeclampsia were analyzed. Possible antenatal risk factors that can influence adverse perinatal outcomes in severe preeclampsia were also evaluated. Clinical symptoms and perinatal outcomes were significantly unfavourable in early-onset preeclampsia. Adverse perinatal outcomes in the early-onset group were complicated with 10 (6.08%) intrauterine fetal deaths and 4 (2.37%) neonatal deaths. Primiparity seems to be the significant antenatal risk factor for appearance of early-onset of the disease (p<0.001, OR 2.39, 95% CI 1.48-3.86) and for the first minute Apgar score <7 (p=0.036, OR 1.68, 95% CI 1.04-2.74). Patients with severe preeclampsia are high- risk obstetric patients because of the unpredictability, varying clinical presentation and potential adverse outcomes of the disease. Pregnant women with an early appearance of the disease had severe clinical presentation and more often an unfavourable perinatal outcome.

Key words: early-onset preeclampsia, perinatal outcome, HELLP

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Acinetobacter baumannii microbiological and phenotypic characteristics of isolates from Intensive Care Unit of the Department of Internal Medicine at the University Hospital Centre in Zagreb over a four-year period


Acinetobacter baumannii is an opportunistic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in intensive care units (ICU).

The aim of this study was to determine the prevalence of antimicrobial resistant A. baumannii strains in ICU.

We analysed antibiotic susceptibility of A. baumannii isolates collected in University Hospital Centre Zagreb over a four-year period (2011-2014) based on the hospital computer system data (BIS). The data were interpreted according to Clinical and Laboratory Standards Institute criteria.

All strains from 2014 were found to be resistant to meropenem, which is a significant increase when compared to 1.4% in 2011 and 81.8% in 2012. The resistance rate to imipenem increased to 95.8% in 2014 from 91.4% in 2011 and 81.8% in 2012. Colistin resistance, confirmed by E test, was found only in one strain in 2013. The resistance rates of other antimicrobial agents were as follows: ampicillin/sulbactam 8.6% and 73.9%, netilmicin 70.6% and 83.3%, gentamicin 48.6% and 91.7%, amikacin 82.4% and 80.0% and ciprofloxacin 100% and 100% in 2011 and 2014 respectively.

Our data confirmed a multidrug-resistance phenotype in Acinetobacter baumannii strains isolated in ICU at the Clinical Hospital Centre, with a significant increase in resistance rates between 2011 and 2014 against certain antimicrobial agents including ampicilin/sulbactam and carbapenems.

Key words: Acinetobacter baumannii, multidrug resistance, extensively drug resistance, nosocomial pathogen

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Peripherally inserted central catheter complications in neonates – our experiences


The aim of this study was to investigate the incidence and risk factors of peripherally inserted central venous catheters (PICCs) in critically ill premature neonates; A retrospective analysis of 30 infants with very low and extremely low birth weights (VLBW, ELBW) who underwent PICC placement over a three-year period, from January 2012 till January 2015. Gestational age, birth weight (BW), sex, site of catheter placement, reason for catheter removal, duration of catheter use, proven sepsis, type of reported organism and rate of complications were collected. The infants were classified into two groups according to BWs: Group 1—VLBW infants (BW between 1,000 and 1,500 g) and Group 2—ELBW infants (BW <1,000 g). During the study period PICCs were attempted in 40 patients. A PICC was successfully inserted into 30 patients (75%). PICCs placed in either the upper or the lower extremity. There were no differences in complication rates. The median time of catheter insertion was 13 (1-35) days for Group 1 and 11 (6-19) days for Group 2. The median duration of PICCs was 10.5 (2-16) and 12.2 (3-25) days. Statistical analysis showed that there was a significant difference between the groups for both catheter insertion day and mean duration of PICCs (p= 0.241, respectively). There were no significant differences between groups for the reasons for catheter removal (p=0.598). PICCs are convenient for the administration of long course antibiotics and parenteral nutrition for both VLBW and ELBW infants, but there are many risks associated with the insertion of PICCs, including serious and fatal complications.

Key words: Catheter-related infections, Central venous catheterization, Complications, Extremely low birth weight infant, Very low birth weight infant

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Bispectral analysis in medical-surgical ICU


The effectiveness of sedation in the ICU is routinely assessed by subjective monitoring of the patient’s clinical condition or by using the monitors. The aim of our study was to review the monitoring of sedation using bispectral analysis (BIS) in medical-surgical ICU. A retrospective analysis of patients who were treated in the ICU from 2008 to 2014 was made. The data of 104 patients were analyzed. The average values of age are 54.38 (SD ±18,93; median 58). 39 (37,5%) of the patients died. The patients were referred to the ICU from medical (37), surgical departments (23) and traumatology (44). The patients were treated in the ICU for 13.84 days (SD ±17.29; median 8). The burst suppression pattern was noticed in 31 (29.8%) patients. Delirium occurred in 3 patients after the separation from the ventilator. In heterogeneous groups of patients, in which BIS was applied, it is not possible to make certain conclusions. The cost of the method unfortunately limits its wider usage. It is necessary to wait for the results of future studies which will set clear indications for the use of BIS in certain groups of patients.

Key words: bispectral index, critical care, monitoring, sedation

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Vibration Response Imaging in medical-surgical ICU


The new method of monitoring lung function (“vibration response imaging”- VRI) converts vibration energy that appears in the bronchial tree during airflow into an image. The VRI does not use energy that could have a detrimental effect on the cells and organs. The goal of our research was to verify the VRI device in the diagnosis and the localization of various lung pathologies. In our medical-surgical ICU we did a retrospective analysis of the prospective database that included 61 patients. We compare VRI with chest X-ray and CT scan in patients with intrathoracic (the presence of air and fluid in the intrapleural space, pulmonary hypoventilation, atelectasis, contusion and inflammatory lung pathology) or extrathoracic pathology that affect respiratory function.

Intrathoracic pathology was observed in 32 patients and extrathoracic pathology in 29 patients. The use of the VRI device showed earlier disorder of hypoventilation compared to chest X-ray, especially after abdominal surgical procedures, intraabdominal hypertension and various lung pathology as it detected laterobasal pneumothorax earlier.

In our patients VRI has been proven to be a reliable method for detecting regional distribution of ventilation and atelectasis of the lungs of individual parts regardless of pulmonary pathology. VRI is shown as a reliable method for detecting air and fluid in the intrapleural space.

Key words: Vibration response imaging, lung, ventilation

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