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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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


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


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


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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Hyperperfusion and intracranial haemorrhage after carotid angioplasty with stenting – latest review


The number of endovascular procedures is constantly increasing. As far as the carotid artery is concerned, carotid angioplasty with stenting (CAS) is an alternative to surgical treatment (carotid endarterectomy; CEA).

Two major devastating complications can occur after both procedures – cerebral hyperperfusion syndrome (CHS) and intracranial haemorrhage (ICH).

The incidence of CHS and ICH in CAS is fortunately low but overall morbidity and mortality remains high.

This latest review re-evaluates the pathogenesis, clinical features, risk factors and diagnostic procedures as well as management of these two complications.

Key words: carotid artery stenting, complications, hyperperfusion syndrome, intracranial haemorrhage

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Veno-venous two-site cannulation versus veno-venous double lumen ECMO: complications and survival in infants with respiratory failure


Objective. To compare complications and survival between the two-site veno-venous versus the veno-venous double lumen extracorporeal membrane oxygenation (ECMO) in infants with respiratory failure.
Methods. The Extracorporeal Life Support Organization (ELSO, Ann Arbor, Michigan) provided the registry database, collected between 1999-2009 for this research project. During this period, 9086 infants ≤ 7 kg birth weight (BW) were treated with ECMO. From these children, those who were older than 32 days and received veno-venous extracorporeal membrane oxygenation (VV ECMO), were extracted for analysis. From a total of 270 infants who met the inclusion criteria, 236 infants were treated with veno-venous double lumen (VVDL) ECMO and 34 infants received VV two-site ECMO. ELSO records were reviewed for the following information: demographic data, type of ventilation, ventilator days and settings during ECMO, complications during ECMO and survival.
Results. Eighty-seven percent (n=236) of infants were cannulated with VVDL and 13% (n=34) with VV two-site cannulation. Twenty-four hours after ECMO onset, ventilator settings were significantly higher in the VV two-site group. Median ECMO duration was significantly shorter in the VV two-site group (137(90/208) vs. 203(128/336) hours, p=0.01). Total complication rate and survival rates (71% in the VVDL group and 56% in the VV two-site group) were not significantly different.
Conclusion. Both cannulation modes for ECMO are safe for use in infants with respiratory failure. The decision regarding which technique should be used for this group of patients depends mainly on best practice experience of the individual ECMO center and on the technical equipment routinely used by the center.


Key words: ECMO, infants, respiratory failure, complications, survival

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