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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Category: Volume 10 Number 1 (Page 2 of 4)

Extravascular lung water index as an indicator of lung injury in septic patients

Abstract

Introduction. Transpulmonary thermodilution using PiCCO (Pulse-induced Contour Cardiac Output) is a standard minimally invasive method used for haemodynamic monitoring. Objectives. The goal of this paper is to examine the correlation and dynamics of the ExtraVascular Lung Water Index (EVLWI) as an indicator of acute lung injury in septic patients who underwent major abdominal surgery. Two groups of patients were selected: the ones with ALI (Acute Lung Injury): ALI patient group, and the ones without ALI: non-ALI patient group. A correlation between EVLWI and other haemodynamic and respiratory data in both groups were analyzed.

Materials and methods. The study included 48 patients. Throughout the seven-day period EVLWI, GEDVI (Global End-Diastolic Volume Index), ITBVI (IntraThoracic Blood Volume Index), CI (Cardiac Index), SVRI (Systemic Vascular Resistance Index) were measured in both groups using PiCCO monitoring over 8-hour intervals as well as heart rate, mean arterial pressure, serum albumin concentration, PaCO2 (arterial partial pressure of carbon dioxide), PaO2 (arterial partial pressure of oxygen), PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio, lung compliance, lung resistance and ScvO2 (central venous oxygen saturation). All patients were analgosedated, intubated, mechanically ventilated, in sinus cardiac rhythm. Circulatory unstable patients had vasoactive support and Sequential Organ Failure Assessment (SOFA) scores calculated. Ventilator settings and dosage of vasoactive drugs were kept constant during the study.

Results. EVLWI was significantly higher in ALI patients group compared to non-ALI patients group. In patients with ALI group 11/22 patients died (50%), in the non-ALI patients group 6/26 patients died (23%). EVLWI was significantly higher in patients that died compared to ones who survived.

Conclusion. EVLWI is a good indicator of early acute lung injury in surgical patients with sepsis.

Key words: extravascular lung water index, acute lung injury, PiCCO monitoring, sepsis

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Serum levels of nitric oxide as a predictor of survival in acute respiratory distress syndrome caused by H1N1 pneumonia?

Abstract

A large number of studies show elevated levels of nitric oxide (NO) in infective syndromes, but there is an insufficient number of studies which have investigated serum levels of NO in patients with acute respiratory distress syndrome (ARDS), especially in relation to survival. Hence, we created a study with the aim of determining the NO levels in relation to ARDS survival.

Serum levels of NO were measured by Griess reaction in 29 patients [16 men (55%), mean age years 52.72±18]. All data were statistically analyzed using one way ANOVA.

Our results show significantly higher serum NO levels in ARDS survivors compared to ARDS non-survivors, (p < 0.05). We conclude that higher serum levels of NO are strongly associated with better clinical outcomes, including increased survival.

Key words: acute respiratory distress syndrome, nitrogen oxide species, outcome

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Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation

Abstract

Aims. Survival rates for cardiac arrest in acute medicine are higher following out-of-hospital restoration of spontaneous circulation (OH-ROSC). However, data pertaining to OH-ROSC is limited in the elderly population. We aimed to assess the predictors of neurological outcome among elderly patients with OH-ROSC.

Methods. We retrospectively analyzed the data of patients 65 years and older who achieved OH-ROSC and who presented to the emergency department (ED) between 2009 and 2013. The following parameters were considered: age, sex, medical history, vital signs, blood values, initial electrical rhythm, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, resuscitation duration, attempted defibrillation, and neurological outcome. Neurological outcomes were evaluated 3 months after cardiac arrest, using the cerebral performance category (CPC) score, and were classified into two groups: favorable outcome (CPC = 1–2) and unfavorable outcome (CPC = 3–5).

Results. Fifty-five patients were studied, of which 21 and 34 patients were classified as having favorable and unfavorable outcomes, respectively. The following values were associated with favorable outcomes: resuscitation duration, initial cardiac rhythm, base excess, pH, lactate levels, the motor response on the Glasgow Coma Scale (GCS), and the number of patients with GCS ≤8 (p < 0.01). Logistic regression analysis confirmed that motor response scores and lactate levels were independent predictors of neurological outcomes.

Conclusions. Lactate levels and GCS motor response measured immediately at ED arrival are likely to be useful to assess the neurological outcomes among elderly patients with OH-ROSC.

Key words: age, basic life support, cardiac arrest, prediction, resuscitation

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Excessive anticoagulation identified by emergency medical service through point-of-care coagulometry

Abstract

Bleeding because of excessive anticoagulation is a well-recognized complication of coumadin therapy. In cases of potentially life-threatening bleeding such as intracranial haemorrhage, reversal of anticoagulation should be carried out as soon as possible. Here we report the case of an emergency patient in whom excessive anticoagulation was diagnosed at the scene by emergency medical service personnel through the use of a point-of-care coagulometer. Following hospital admission, findings were confirmed by central laboratory assessment of prothrombin time. The time gained through the use of portable coagulometers may contribute to improved pre-hospital emergency management of anticoagulated patients.

Key words: anticoagulation, bedside testing, warfarin, haemorrhage

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A Giant Hydronephrotic Kidney with Ureteropelvic Junction Obstruction with Blunt Renal Trauma in a Boy

Abstract

An 18-year-old male soccer player was transferred from the clinic to our emergency center with suspected blunt renal trauma. A giant ureteropelvic junction (UPJ) obstructed hydronephrosis in blunt renal trauma was revealed by enhanced computed tomography and angiography. The patient then underwent insertion of a double “J” stent and was placed under close observation in the intensive care unit. His improvement was rapid, and he subsequently underwent pyeloplasty. Although UPJ obstruction is one of the common pre-existing renal lesions (PERLs), hydronephrosis of such a giant size, associated with blunt trauma, is relatively rare. Hydronephrosis in the kidneys may easily lead to rupture, even with minor trauma.

Key words: injury, hydronephrosis, urine, angiography, pyeloplasty

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