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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Role of Redcell Distribution Weight in Predicting Disease Severity, Mortality and Complication in Patients With Acute Pancreatitis

Abstract

The goal of the present study was to investigate the significance of the Red Cell Distribution Width (RDW) in identifying the severity, mortality and complications of the disease at an early stage in patients with acute pancreatitis (AP).

343 patients with AP presented to the emergency department during one year were included in this retrospective study. Demographic, laboratory and imaging results were recorded. Bedside Index for Severity in AP (BISAP) score was calculated. The patients who developed pancreatitis-related mortality were recorded.

The diagnostic powers of RDW values in the diagnosis of BISAP Score (≥3), exitus, severe pancreatitis and pancreatitis with complication were analysed by means of Receiver Operating Characteristic Curve (ROC) analysis. p<0,05 was considered statistically significant.

The mean age of the subjects was 59,7 ± 18,0 years. Area under curve (AUC) in ROC analysis conducted for RDW in patients with BISAP score≥ 3 was 0,649 (95% Cl 0,576-0,722) and p <0,001. For developed complications, AUC for RDW was 0,558 (95% Cl 0,454-0,662) and p was 0,243. For RDW<14,4 cut-off value; the sensitivity was 66,25%, specificity was 71,48% in the prediction of BISAP≥ 3, sensitivity was 87,5%, specificity was 65,14% in the prediction of mortality, sensitivity was 72,73%, specificity was 71,12% in the prediction of severe AP.

RDW is as significant as the BISAP score in predicting the severity and mortality of pancreatitis in the patients with acute pancreatitis in the emergency department(ED). But it cannot predict the complications in AP.

Keywords: Emergency, acute pancreatitis, mortality, severity, complications, redcell distribution weight.

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Tortuosity of the brachiocephalic artery complicated with arterial injury after tracheotomy: a case report

Abstract

Tracheotomy is an operation of the airway performed even on critical care patients. Surgical complications of tracheotomies are fatal. In this study, tortuosity of the brachiocephalic artery complicated with arterial injury was observed in a patient after tracheotomy. A 95-year-old woman in coma was admitted to our medical center. The patient needed airway management, and tracheal intubation was performed. The cause of the coma was extensive cerebral infarction of the right middle cerebral artery. It was expected that the coma would be prolonged, and a tracheotomy was performed after 7 days. Tortuosity of the brachiocephalic artery was confirmed with cervical computed tomography before surgery. The patient bled through the tracheostomy after 30 days. To arrest bleeding from the right common carotid artery, a vascular repair surgery was performed. There was no recurrent bleeding after surgery. After 37 days, the patient died of deteriorating primary disease. Although tracheotomy is a common operation, attention should be paid to abnormalities of blood vessels including tortuosity of the brachiocephalic artery.

Key words: arterial injury, brachiocephalic artery, complications, critical care, tracheotomy

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The impact of early percutaneous tracheotomy on reduction of the incidence of ventilator associated pneumonia and the course and outcome of ICU patients

Abstract

The aim of the study. The primary objective of this study was to determine the differences in the incidence of respiratory infections and septic episodes in patients who underwent early percutaneous tracheotomy (ET) and in patients who underwent translaryngeal intubation i.e late tracheotomy (LT). Secondary objectives were to determine the differences in the early mortality of patients, duration of mechanical ventilation and length of Intensive care unit (ICU) stay.

Materials and methods. The study included 72 surgical and trauma patients older than 18 years of age, treated at the ICU of the University Clinical Hospital Mostar who had undergone translaryngeal intubation and were mechanically ventilated for at least 48 hours. The basic criterion for inclusion in the study was expected duration of mechanical ventilation of at least 14 days. Forty-eight hours after enrollment, patients were randomly divided into two groups. The first group of patients underwent ET after 2-4 days of mechanical ventilation; the second group underwent LT if they exhibited longer episodes of hypoxemia after 15 days.

Results. The ET group of patients spent less time in mechanical ventilation and ICU. The ET group had a lower rate of VAS pneumonia (p=0.137), sepsis episodes (p=0.029) and mortality rate (p=0.056).

Conclusion. The results of our study support ET being performed 2–4 days from the start of mechanical ventilation. Despite a lack of power, we found significant benefits of ET regarding the incidence of pneumonia, sepsis, hospital mortality, duration of mechanical ventilation and length of ICU stay

Key words: tracheotomy, mechanical ventilation, intensive care unit, ventilator-associated pneumonia, treatment outcome, complications

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Complications after bilateral thoracoscopic sympathicotomy for primary focal hyperhidrosis

Introduction

Primary focal hyperhidrosis is a functional disorder of an excessive sweating that can significantly deteriorate the person’s every day quality of life. It is estimated that there is about 2.8% of world population affected with this unpleasant condition, especially among young people. Bilateral thoracoscopic sympathicotomy is nowadays well established one-day minimal invasive surgical procedure, with very good postoperative results and the opportunity for the patients to be capable for their everyday life and working, a day after the operation, with adequate analgetics if necessary. However, the complications after bilateral thoracoscopic sympathicotomy can seriously worsen their quality of life, beyond this functional disorder of an excessive perspiration.

The aim of this study is to evaluate the postoperative complications after bilateral thoracoscopic sympathicotomy and their influence on person’s quality of life.

Key words: primary focal hiperhidrosis, bilateral thoracoscopic sympathectomy, minimal invasive surgery, complications

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Peripherally inserted central catheter complications in neonates – our experiences

Abstract

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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