Impact factor 0.175

Signa Vitae

Journal of Intensive Care and Emergency Medicine

Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma

Abstract

Objectives. Major injury is a time-dependent illness in which the quantification of the life prognosis is fundamental for professionals. The objective of this study is to evaluate the capacity of prehospital lactic acid to predict mortality (2, 7 and 30 days) and the admission to the Intensive Care Unit (ICU) from the index event.

Methods. This is a longitudinal, prospective observational study, which included patients who were treated by an Advanced Life Support Unit and transferred to the Emergency Department between April 1 and September 30, 2018. We calculated sensitivity, specificity, and likelihood ratios. The main outcome variable was mortality from any cause (2, 7 and 30 days) and admission to ICU.

Results. 109 patients were included in our study. Eleven patients (10%) experienced early mortality before the first 48 hours after the index event, with an ICU admission rate of 28%. The sensitivity and specificity of the test to determine mortality in less than two days was 63.6% (95% CI, 35.4-84.8%) and 87.8% (95% CI, 79.8-92.9%).

Conclusions. Prehospital lactic acid has an excellent capacity to predict the mortality and the admission of patients with major injury to the ICU, and it is a cheap, easy-to-obtain and reliable diagnostic tool that can help in clinical decision-making.

Key words: Critical care, emergency department, outcome, survival, intensive care

Read More

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

Read More

Intensive care management of patients with left ventricular assist device

Abstract

Mechanical circulatory support devices, especially left ventricular assist devices (LVADs) represent an important treatment modality for patients with end-stage heart failure (HF). In a 1-year period (from January to December 2017) in our intensive care unit (ICU) we had a total of 8 patients with LVAD implantation. LVADs are devices with unique physiology which restore tissue circulation by increasing blood supply, nevertheless, they can be challenging to manage and are associated with significant complications.

Keywords: Critical Care, Heart-Assist Devices, Heart Failure, Hemodynamics, Hemodynamic Monitoring, Cardiac surgery, Postoperative Complications

Read More

Middle latency auditory evoked potential index for prediction of post-resuscitation survival in elderly populations with out-of-hospital cardiac arrest

Abstract

Background. Out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate in the elderly. Although most reports have investigated among elderly patients with OHCA until 1990s, non-invasive monitorings cannot presently predicted cerebral resuscitation during cardiopulmonary resuscitation (CPR). Findings of a previous study suggest that monitoring of middle latency auditory evoked potentials (MLAEP) during CPR could provide an indicator of effective post-resuscitation survival.

Objectives. We speculated that the MLAEP index (MLAEPi), measured in an emergency room, can predict post-resuscitation survival among elderly patients with OHCA.

Methods. This prospective study included 31 elderly patients aged ≥65 years with OHCA who received basic life support (BLS) and did not achieve restoration of spontaneous circulation (ROSC) until arrival at the emergency center between December 2010 and December 2011. All patients were administered advanced cardiac life support (ACLS) in the emergency room. Initial MLAEPi was measured using an MLAEP monitor (aepEX plus®, Audiomex, UK) during the first cycle of ACLS. Prediction of the post-resuscitation survival was investigated.

Results. Eight patients who achieved ROSC were admitted to our hospital and 23 did not achieve ROSC in the emergency room. Initial MLAEPi was significantly higher in patients with than without ROSC (median, 33 vs. 26, p = 0.02). Three survivors, among patients with ROSC, were discharged from our hospital (survivors) and 5 died during hospitalization (non-survivors). Initial MLAEPi was significantly higher in survivors than in non-survivors (median, 35 vs. 28, p = 0.03) or patients without ROSC (median, 35 vs. 26, p < 0.01).

Conclusions. MLAEPi satisfactorily denotes cerebral function and predicts post-resuscitation survival in elderly populations.

Key words: cardiopulmonary resuscitation, basic life support, advanced cardiac life support, age, monitoring, critical care

Read More

Bispectral analysis in medical-surgical ICU

Abstract

The effectiveness of sedation in the ICU is routinely assessed by subjective monitoring of the patient’s clinical condition or by using the monitors. The aim of our study was to review the monitoring of sedation using bispectral analysis (BIS) in medical-surgical ICU. A retrospective analysis of patients who were treated in the ICU from 2008 to 2014 was made. The data of 104 patients were analyzed. The average values of age are 54.38 (SD ±18,93; median 58). 39 (37,5%) of the patients died. The patients were referred to the ICU from medical (37), surgical departments (23) and traumatology (44). The patients were treated in the ICU for 13.84 days (SD ±17.29; median 8). The burst suppression pattern was noticed in 31 (29.8%) patients. Delirium occurred in 3 patients after the separation from the ventilator. In heterogeneous groups of patients, in which BIS was applied, it is not possible to make certain conclusions. The cost of the method unfortunately limits its wider usage. It is necessary to wait for the results of future studies which will set clear indications for the use of BIS in certain groups of patients.

Key words: bispectral index, critical care, monitoring, sedation

Read More

Page 1 of 2

© 2019. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.