Abstract

Hemodynamic monitoring in Intensive Care Unit (ICU) settings is usually introduced when a patient becomes hemodynamically unstable. We analyzed how empirically guided volume management relates to first measured intrathoracic blood volume (ITBV), at the moment of the beginning of Puls Contour Cardiac Output (PiCCO) hemodynamic monitoring.
Data and measurements from 37 ICU patients, divided into four groups according to diagnosis of primary condition, were retrospectively studied. The first group consisted of polytrauma patients, second group of patients with pancreatitis and/or peritonitis, third group were postoperative patients, and fourth group were patients with various medical diagnosis: sepsis, acute respiratory distress syndrome (ARDS), acute lung failure (ALF), and acute heart failure (AHF). PiCCO monitor was introduced when the signs of hemodynamic instability were observed. First measured ITBV was recorded and analyzed according to deviation from reference values.
First measured ITBV was in reference range in 14 (37.8%) patients. Volume overloading was observed in 16 (43.2%) and hypovolemia in 7 (18.9%) patients.
The observed inappropriate blood volume in patients of all studied groups suggests that there is the need for defining indications and earlier application of hemodynamic monitoring, as well as reassessment of usual empirically guided infusion therapy in ICU setting.

Key words: hemodynamic process, intensive care, hypovolemia, monitoring

Abstract

Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants.
Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement.
Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p<0,01). Treatment with multiple doses is more effective in comparison to one dose, although there was not a significant difference (p<0,20) between the treated groups. There is a significant difference (p<0,01) between groups related to O2 requirement. In the group of babies which required 60% or more O2 concentration in inhaled air at the time of surfactant replacement, mortality rate was significantly higher (p<0,01).
Conclusion. Our study confirmed the benefits of surfactant therapy in preterm babies with respiratory distress syndrome. We confirmed the advantages of early treatment vs. late treatment, but we could not confirm the obvious advantage of multiple over single doses. So, a reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant.

Key words: respiratory distress syndrome, surfactant, preterm

Abstract

Background: Postoperative intragastric enteral feeding in cardiac surgery patients is frequently complicated by delayed gastric emptying.
Objective: To evaluate how early postoperative gastric enteral nutrition affects gastric emptying in coronary artery by-pass graft (CABG) surgery patients.
Methods: In this prospective, randomized study a group of 40 patients treated in the intensive care unit after CABG surgery were studied. Patients were divided in two groups: group E (20 patients: age 59±8 yr.; male 70%) and control group C (20 patients: age 58±10 yr.; male 80%), respectively. The paracetamol absorption test was used to evaluate gastric emptying. In group E gastric enteral nutrition begun 18 hours after surgery and 6 hours later this was stopped and paracetamol solution was administered. The patients in group C received only crystalloid solutions for first 24 hours. Blood samples were obtained at 0 (t0), 15 (t+15), 30 (t+30), 60 (t+60) and 120 (t+120) min after administration of paracetamol.
Results:  The values of plasma paracetamol concentration (PPC) at 15 and 120 min were significantly higher in group E when compared with .group C: (t+15) 3.3±2.5 vs. 1.7±1.9 and (t+120) 5.2±2.8 vs. 3.3±1.6 (p <0.05). The PPC values at 30 and 60 min were higher, but not significantly, in group E vs. group C: (t+30) 3.7±2.0 vs. 2.9±2.7 and (t+60) 5.1±3.2 vs. 3.9±3.5 (p = NS). The area under the PPC curve was 429 ± 309 in the E group vs. 293 ± 204 in the group C (p < 0.05).
Conclusion:  Early postoperative gastric administration of nutritients after CABG surgery stimulates gastric emptying.

Key words: Early postoperative enteral nutrition; gastric emptying

Abstract

The objective of this study was to evaluate the use of central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Split University Hospital (SUH). We reviewed the records of all children that had CVCs and were hospitalized between January 2002 and March 2006. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site and side of the body of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 352 CVCs were inserted in 300 children. Patient age ranged from 0 to 18 years. The average catheter insertion time was 12.88 days. We noted 66 (18.8%) CVC-related complications. Complications related to CVCs insertion were malposition of catheter (5.4%) and pneumothorax (0.9%). Occlusion of CVCs (4.3%), catheter related-bloodstream infections (CRBI) (4.0%), dislodgment (3.7%) and catheter damage (0.6%) were complications associated with lenght of CVCs use. We conclude that central venous catheterization is a safe and efficient procedure with minimal complications in pediatric patients.

Key words: central venous catheter, indications, complications, children.

Abstract

Introduction. Some studies have shown that the presence of bradycardia in hemorrhage-caused-hypotension is associated with a better prognosis. The aim of this retrospective study was to compare bradycardic and tachycardic responses to hemorrhaging in a pre-hospital setting and to evaluate the outcome.

Patients and methods. All patiens were adults (>18 years) with tachycardia and bradycardia hypotension (hemorrhaging) in a pre-hospital setting. We compared a tachycardic group with a bradycardic group using the following criteria: age, gender, APACHE II on admission, trauma vs. non-trauma patients, outcome (survival) and the use of vasopressors.
Results. Over a two year period, 107 patients were screened. The tachycardic group was younger in age than the bradycardic group. Tachycardia was significantly more common in males. The bradycardic group had better APACHE II on admission and also better outcome (survival). Mortality was lower in bradycardic patients than in tachycardic patients.
Conclusion. Bradycardia is a real phenomenon in hemorrhaging patients in a prehospital setting. It might be associated with both better APACHE II on admission and better outcome.

Keywords: bradycardia, hypotensive (hemorrhagic) patients, prehospital setting, APACHE II, prognosis.