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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Page 2 of 98

Comparison of three methods of predictive postoperative FEV1 and DLCO calculations in relation to their observed postoperative values in lung resection

Abstract

Introduction: Three ways of simple calculations (segmental based on 18 segments method, segmental based on 19 segments method and subsegmental method) of predictive postoperative values of forced expiratory volume in one second (FEV1) and diffusion lung capacity for carbon monoxyde (DLCO) are in use during the preoperative survey for patients planned for lung resection as treatment of lung carcinoma as a part of risk assessment. Hypothesis: Segmental calculation method based on 19 segments is better than subsegmental method and segmental calculation method based on 18 segments in prediction of postoperative values of both FEV1 and DLCO one month after lung lobectomy. Materials and methods: Expected postoperative calculated values of FEV1 and DLCO (two segmental and one subsegmental method) of 52 patients undergone lobectomy are related to real postoperative values for same patients one month after surgery. Results: According to univariate analysis, real values of postoperative DLCO correlate most significantly with ppoDLCO calculated by segmental method (18 segments), but real values of postoperative FEV1 correlate most significantly with ppoFEV1 calculated by 19 overall segments segmental method. Data analysis as well showed that preoperative calculated PpoFEV1 and PpoDLCO underestimate real postoperative values of FEV1 and DLCO one month after lobectomy, but it is not statistically significant. Discussion: Same as contemporary guidelines suggest, ppoFEV1 calculation by 19 segments segmental method seems to be the best choice. However, it may be better to calculate PpoDLCO by 18 segments segmental method.

Key words: thoracic surgery, FEV1, DLCO

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Discernment of mortality predictors in patients with major injuries-direct trauma impact or systemic complications

Dear Editor,

I have recently read the article by Martin-Rodriguez and Lopez- Izquiedro ”Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma”, where the authors analysed the prehospital lactate acid (PLA) serum level, and found it as good mortality predictor in patients who suffered major injury (MI) (1).

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Do Inhalational Anesthetic Agents Still Hold Their Place in Modern Anesthesia Practice?

Abstract

Inhalational anesthetic agents are chemical substances that are administered into the body via lungs and distributed to organs and tissues by blood circulation. The main site of their action is the brain, but they also affect other parts of central nervous system. Volatile and intravenous anesthetics alike have nearly reached the characteristics of an ideal anesthetic, but at a first glance, the increase in use of intravenous anesthetics could likely push out their volatile counterparts. Looking at the situation more thoroughly, positive side effects of volatile anesthetics that are not found in their intravenous counterparts, still give them a place in modern anesthesia practice. It is also possible to combine both techniques to reduce negative adverse effects, while making use of the positive ones.

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Can echocardiographic assessment of interatrial septum shape and motion improve the accuracy of the BLUE protocol?

Abstract

Acute respiratory failure is one of the most challenging critical conditions due to a wide variety of differential diagnosis. Bedside lung ultrasound in emergency (BLUE) protocol allows accurate differentiation between the most common underlying causes of acute respiratory failure in up to 90% of the cases. The assessment of left atrial pressure affecting left ventricular filling is essential in critically ill patients guiding volume substitution, optimization of left ventricular function and prevention of pulmonary congestion, thus ensuing haemodynamic stability. A simple, non-invasive method of left atrial pressure evaluation is the echocardiographic assessment of interatrial septum shape and motion, which is affected by interatrial pressure gradient. Aiming to improve the accuracy of the BLUE protocol, we propose the simple, non-invasive echocardiographic assessment of interatrial septum shape and motion as an upgrade, providing additional information of the loading of left and right atrium thus distinguishing the most common causes of acute respiratory failure.

Key words: lung ultrasound, BLUE protocol, interatrial septum, echocardiography

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Prophylactic use of the probiotic strain Lactobacillus casei rhamnosus as part of a triple anti-infective regimen in very preterm infants during neonatal intensive care

Abstract

Background. Probiotics are increasingly used in neonatal intensive care and prove to reduce rates of necrotizing enterocolitis (NEC), sepsis and all-cause mortality by meta-analyses.

Objective. Aim of the study was to analyze the prophylactic use of the probiotic Lactobacillus casei rhamnosus (LCR) as part of a triple anti-infective treatment regimen in very preterm neonates in respect to complications and possible side effects.

Setting. This was a study on 1169 very preterm infants of 32 weeks of gestational age and less born between 2005 and 2015 who were admitted within the first 24 hours of life to the neonatal intensive care unit (NICU) and hospitalized for at least 7 days.

Design. Retrospective observational STROBE compliant single-center cohort study

Intervention. All infants received a standardized prophylactic anti-infective treatment regimen with enteral probiotics (LCR), antifungal agents, and oral gentamycin over the study time starting at the first day of life.

Outcome measures. Perinatal and neonatal data were collected for descriptive analysis. Complications possibly avoided by the anti-infective regimen included NEC, late-onset sepsis (LOS), late-onset multiple organ dysfunction syndrome (MODS), and ventilator associated pneumonia (VAP).

Main results. Eleven of 1169 infants 11 (0.9%) had diagnosis of NEC ≥ IIa, 141 (12.1%) exhibited at least one episode of LOS, 31 (2.7%) a VAP, and 44 (3.8%) a MODS. Those infants with complications were of younger gestational age (p<0.001), had lower birth weight (p<0.001), lower Apgar scores at 1/5/10 minutes (p<0.001), were more common SGA (p=0.007), had longer courses of mechanical ventilation and longer hospital stays and for longer time parenteral antibiotics (all p<0.001). Mortality rate was increased in infants having experienced complications (6.9 vs. 1.7%, p<0.001).

Conclusions. Over an 11-year period, the use of the probiotic LCR as part of an anti-infective regimen was safe and resulted in low rates of NEC, LOS, VAP, and MODS compared to the literature. Those infants with complications had higher mortality rates.

Key words: very preterm infant, probiotics, Lactobacillus casei rhamnosus, necrotizing enterocolitis, multiple organ dysfunction syndrome, neonatal intensive care, ventilator associated pneumonia, late-onset sepsis, antibiotic-associated diarrhea 

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