Impact factor 0.175

Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: outcome (Page 1 of 3)

Respiratory disorders and neonatal outcomes of triplet pregnancies – our ten year experience

Abstract

Objective. To compare respiratory disorders (respiratory distress syndrome, requirement for respiratory support, development of chronic lung disease), duration of hospitalization and other neonatal outcomes between newborns born from triplet pregnancies over a ten year period.

Methods. A retrospective analysis of 34 triplet pregnancies delivered between 2006 and 2015 in one perinatal tertiary centre. Ninety-nine newborns from these pregnancies were divided into 2 groups: one consisted of 56 neonates (19 sets of triplets) born between 2006 and 2011 and the second contained 43 neonates delivered from 15 triplet pregnancies between 2012 and 2015.

Results. There were no differences in the incidence of respiratory distress syndrome and chronic lung disease between group I and group II. In both groups, a similar amount of patients required respiratory support. We did not notice any significant differences in the type of ventilation (mechanical ventilation or nasal continuous positive airway pressure -nCPAP), duration of ventilation, length of hospitalization or the incidence of complications of prematurity, such as 3rd or 4th grade intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) stage > 2, between both groups.

Conclusion. Despite important progress in perinatal care and wide use of advanced technologies in neonatal intensive care there has been no significant improvement in neonatal outcomes of triplets during the past 10 years. Multiple pregnancies still remain a risk factor for respiratory disorders and other neonatal complications in prematurely delivered newborns.

Key words: triplets, newborn, respiratory disorders, outcome

Read More

Geriatric patients in the ICU

Abstract

The proportion of patients older than 80 years admitted to the ICU is constantly increasing. Despite well-known admission criteria, older patients are frequently not referred and are admitted to the ICU. The emergency ward and ICU management of acute medical conditions should not depend on age only, but should be tailored to the individual patient in line with standards of care. After the successful treatment of acute illness, elderly people should receive complex and prolonged physical, social and psychological rehabilitation. Nevertheless, we must be able to recognize the point of futile treatment and provide proper palliative care. Less traumatised procedures that are better tolerated are preferred in the management of specific medical conditions in geriatric patients. General preventive programs promoting healthy lifestyles have been developed, but these must be implemented by a majority of older people. Medical science should promote adequate education of all professionals who are involved in the treatment of geriatric patients; societies should provide equal access to health-care in developed countries and countries in transition.

Key words: intensive care unit, outcome, survival, elderly, treatment intensity

Read More

CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Abstract

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting.

Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC).

Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality.

Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs.

Key words: CRIB, CRIB II, mortality, neonates, outcome, prematurity, scoring system

Read More

Anesthesia for carotid endarterectomy: where do we stand at present?

Abstract

Carotid endarterectomy (CEA) is a surgical procedure performed to reduce the incidence of embolic and thrombotic stroke. Although only a preventive procedure, CEA carries the risk of perioperative complications. There is constant searching for an optimal anesthetic technique. There are pros and cons for both anesthetic techniques used: regional (RA) and general anesthesia (GA). A large number of studies have compared RA and GA techniques in CEA surgery patients. The primary outcome was the proportion of patients with stroke, myocardial infarction, or death. However, neither the GALA trial nor the pooled analysis was adequately powered to reliably detect an effect of type of anesthesia on mortality. It may therefore be appropriate to consider other additional parameters (stress response, incidence of postoperative delirium and cognitive impairment, functional recovery, total surgery time, intensive care unit requirement, hospital stay, hospital costs and patients satisfaction) when comparing the outcomes of the two techniques.

Although, the debate continues as to whether regional anesthesia or general anesthesia is safer, the choice of anesthetic technique is a complex decision and surgical teams should be able to offer both RA and GA. The individual approach is the ideal choice and should be determined at the discretion of the surgeon, anesthetist and patient depending on the clinical situation and own preferences.

Key words: surgery, carotid endarterectomy, anesthesia, general, regional, outcome

Read More

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

Read More

Page 1 of 3

© 2018. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.