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Smith MC, Medvecz AJ, Smith MR, Streams JR, Dennis BM. Computed tomography scanning is feasible in select patients with REBOA catheter deployment. Injury 2024; 55:111387. [PMID: 38360518 DOI: 10.1016/j.injury.2024.111387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Rapidly localizing and controlling bleeding is central to treating hemorrhagic shock. While REBOA allows temporary control, identifying the source of bleeding remains challenging. CT imaging with REBOA in place may provide information to direct hemorrhage control. The purpose of this study is to provide a descriptive summary of data comparing patients who did and did not undergo CT scan following REBOA deployment. Our hypothesis was that performing CT scan after REBOA placement in select patients is safe and can guide management of hemorrhagic shock. METHODS We queried the AAST AORTA registry for patients receiving REBOA at our level 1 trauma center from May 2017 to December 2021. Clinical data was obtained through the Trauma Registry of the American College of Surgeons (TRACS). Comparison groups were those who underwent CT scan after REBOA deployment versus those who did not undergo CT scan after REBOA deployment. The primary outcome was inhospital mortality, and secondary outcomes included hospital-, ICU-, and ventilator-free days. RESULTS 61 patients underwent CT scan with REBOA in place; 25 patients proceeded directly to hemorrhage control. Patients with REBOA prior to CT were more likely to have blunt mechanism, higher ISS, pelvic bleeding, and zone 3 REBOA placement. Mortality was not significantly different (51 % vs. 64 %). Patients who underwent CT with REBOA were more likely to undergo hemorrhage control in interventional radiology (43 % vs. 0 %). There was no difference in hospital-, ICU-, and ventilator-free days. DISCUSSION We demonstrate the feasibility of performing CT in select trauma patients who undergo REBOA. We describe a pathway to enable expeditious workup and management of these patients. Optimal hemorrhage control management is impacted by CT scans when it can be performed. It is important to note that this is a severely injured patient population, and mortality is high even when hemorrhage is controlled. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael C Smith
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA.
| | - Andrew J Medvecz
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
| | - Melissa R Smith
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
| | - Jill R Streams
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
| | - Bradley M Dennis
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
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Ciaraglia A, Lumbard D, DeLeon M, Barry L, Braverman M, Schauer S, Eastridge B, Stewart R, Jenkins D, Nicholson S. Retrospective analysis of the effects of hypocalcemia in severely injured trauma patients. Injury 2024; 55:111386. [PMID: 38310003 DOI: 10.1016/j.injury.2024.111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND It has been suggested that the Lethal Triad be modified to include hypocalcemia, coined as the Lethal Diamond. Hypocalcemia in trauma has been attributed to multiple mechanisms, but new evidence suggests that traumatic injury may result in the development of hypoCa independent of blood transfusion. We hypothesize that hypocalcemia is associated with increased blood product requirements and mortality. METHODS A retrospective study of 1,981 severely injured adult trauma patients from 2016 to 2019. Ionized calcium (iCa) levels were obtained on arrival and subjects were categorized by a threshold iCa level of 1.00 mmol/L and compared. Univariable and multivariable logistic regression analysis was performed. RESULTS The hypocalcemia (iCa <1.00 mmol/L) group had increased rate of overall (p = 0.001), 4-hr (p = 0.007), and 24-hr (p = 0.003) mortality. There was no difference in prehospital transfusion volume between groups (p = 0.25). Hypocalcemia was associated with increased blood product requirements at 4 h (p <0.001), 24 h (p <0.001), and overall hospital length of stay (p <0.001). Logistic regression analysis showed increased odds of 4-hour mortality (OR 0.077 [95 % CI 0.011, 0.523], p = 0.009) and 24-hour mortality (OR 0.121 [95 % CI 0.019, 0.758], p = 0.024) for every mmol/L increase in iCa. CONCLUSIONS This study shows the association of hypoCa and traumatic injury. Severe hypoCa was associated with increased odds of early and overall mortality and increased blood product requirements. These results support the need for future prospective trials assessing the role of hypocalcemia in trauma.
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Affiliation(s)
- Angelo Ciaraglia
- UT Health Science Center San Antonio, Department of Surgery, United States.
| | - Derek Lumbard
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Michael DeLeon
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Lauran Barry
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Maxwell Braverman
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Steven Schauer
- San Antonio Military Medical Center, Department of Emergency Medicine, United States
| | - Brian Eastridge
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Ronald Stewart
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Donald Jenkins
- UT Health Science Center San Antonio, Department of Surgery, United States
| | - Susannah Nicholson
- UT Health Science Center San Antonio, Department of Surgery, United States
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Iba T, Maier CL, Helms J, Ferrer R, Thachil J, Levy JH. Managing sepsis and septic shock in an endothelial glycocalyx-friendly way: from the viewpoint of surviving sepsis campaign guidelines. Ann Intensive Care 2024; 14:64. [PMID: 38658435 DOI: 10.1186/s13613-024-01301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
Maintaining tissue perfusion in sepsis depends on vascular integrity provided by the endothelial glycocalyx, the critical layer covering the luminal surface of blood vessels. The glycocalyx is composed of proteoglycans, glycosaminoglycans, and functional plasma proteins that are critical for antithrombogenicity, regulating tone, controlling permeability, and reducing endothelial interactions with leukocytes and platelets. Degradation of the glycocalyx in sepsis is substantial due to thromboinflammation, and treatments for sepsis and septic shock may exacerbate endotheliopathy via additional glycocalyx injury. As a result, therapeutic strategies aimed at preserving glycocalyx integrity should be considered, including modifications in fluid volume resuscitation, minimizing catecholamine use, controlling hyperglycemia, and potential use of corticosteroids and anticoagulants. In this review, we explore treatment strategies aligned with the recommendations outlined in the Surviving Sepsis Campaign Guidelines 2021 with a special emphasis on evidence regarding glycocalyx protection.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie Helms
- Strasbourg University Hospital, Medical Intensive Care Unit-NHC, INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg University (UNISTRA), Strasbourg, France
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Oxford Road, Manchester, UK
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
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4
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Ndoudi-Likoho B, Simon D, Maroni A, Dauger S, Levy M. Excessive pickle consumption: beware of adrenal crisis. Arch Pediatr 2024:S0929-693X(24)00059-9. [PMID: 38644058 DOI: 10.1016/j.arcped.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 04/23/2024]
Abstract
Adrenal insufficiency (AI) is one of the most life-threatening disorders resulting from adrenal cortex dysfunction. Symptoms and signs of AI are often nonspecific, and the diagnosis can be missed and lead to the development of AI with severe hypotension and hypovolemic shock. We report the case of a 13-year-old child admitted for cardiac arrest following severe hypovolemic shock. The patient initially presented with isolated mild abdominal pain and vomiting together with unexplained hyponatremia. He was discharged after an initial short hospitalization with rehydration but with persistent hyponatremia. After discharge, he had persistent refractory vomiting, finally leading to severe dehydration and extreme asthenia. He was admitted to pediatric intensive care after prolonged hypovolemic cardiac arrest with severe anoxic encephalopathy leading to brain death. After re-interviewing, the child's parents reported that he had experienced polydipsia, a pronounced taste for salt with excessive consumption of pickles lasting for months, and a darkened skin since their last vacation 6 months earlier. A diagnosis of autoimmune Addison's disease was made. Primary AI is a rare life-threatening disease that can lead to hypovolemic shock. The clinical symptoms and laboratory findings are nonspecific, and the diagnosis should be suspected in the presence of unexplained collapse, hypotension, vomiting, or diarrhea, especially in the case of hyponatremia.
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Affiliation(s)
- Bellaure Ndoudi-Likoho
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, and University Paris Cité, Paris, France
| | - Dominique Simon
- Paediatric Endocrinology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, and University Paris Cité, Paris, France
| | - Arielle Maroni
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, and University Paris Cité, Paris, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, and University Paris Cité, Paris, France
| | - Michael Levy
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, and University Paris Cité, Paris, France.
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Leisman DE, Handisides DR, Busse LW, Chappell MC, Chawla LS, Filbin MR, Goldberg MB, Ham KR, Khanna AK, Ostermann M, McCurdy MT, Adams CD, Hodges TN, Bellomo R. ACE inhibitors and angiotensin receptor blockers differentially alter the response to angiotensin II treatment in vasodilatory shock. Crit Care 2024; 28:130. [PMID: 38637829 PMCID: PMC11027368 DOI: 10.1186/s13054-024-04910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blockers (ARB) medications are widely prescribed. We sought to assess how pre-admission use of these medications might impact the response to angiotensin-II treatment during vasodilatory shock. METHODS In a post-hoc subgroup analysis of the randomized, placebo-controlled, Angiotensin Therapy for High Output Shock (ATHOS-3) trial, we compared patients with chronic angiotensin-converting enzyme inhibitor (ACEi) use, and patients with angiotensin receptor blocker (ARB) use, to patients without exposure to either ACEi or ARB. The primary outcome was mean arterial pressure after 1-h of treatment. Additional clinical outcomes included mean arterial pressure and norepinephrine equivalent dose requirements over time, and study-drug dose over time. Biological outcomes included baseline RAS biomarkers (renin, angiotensin-I, angiotensin-II, and angiotensin-I/angiotensin-II ratio), and the change in renin from 0 to 3 h. RESULTS We included n = 321 patients, of whom, 270 were ACEi and ARB-unexposed, 29 were ACEi-exposed and 22 ARB-exposed. In ACEi/ARB-unexposed patients, angiotensin-treated patients, compared to placebo, had higher hour-1 mean arterial pressure (9.1 mmHg [95% CI 7.6-10.1], p < 0.0001), lower norepinephrine equivalent dose over 48-h (p = 0.0037), and lower study-drug dose over 48-h (p < 0.0001). ACEi-exposed patients treated with angiotensin-II showed similarly higher hour-1 mean arterial pressure compared to ACEi/ARB-unexposed (difference in treatment-effect: - 2.2 mmHg [95% CI - 7.0-2.6], pinteraction = 0.38), but a greater reduction in norepinephrine equivalent dose (pinteraction = 0.0031) and study-drug dose (pinteraction < 0.0001) over 48-h. In contrast, ARB-exposed patients showed an attenuated effect of angiotensin-II on hour-1 mean arterial pressure versus ACEi/ARB-unexposed (difference in treatment-effect: - 6.0 mmHg [95% CI - 11.5 to - 0.6], pinteraction = 0.0299), norepinephrine equivalent dose (pinteraction < 0.0001), and study-drug dose (pinteraction = 0.0008). Baseline renin levels and angiotensin-I/angiotensin-II ratios were highest in ACEi-exposed patients. Finally, angiotensin-II treatment reduced hour-3 renin in ACEi/ARB-unexposed and ACEi-exposed patients but not in ARB-exposed patients. CONCLUSIONS In vasodilatory shock patients, the cardiovascular and biological RAS response to angiotensin-II differed based upon prior exposure to ACEi and ARB medications. ACEi-exposure was associated with increased angiotensin II responsiveness, whereas ARB-exposure was associated with decreased responsiveness. These findings have clinical implications for patient selection and dosage of angiotensin II in vasodilatory shock. Trial Registration ClinicalTrials.Gov Identifier: NCT02338843 (Registered January 14th 2015).
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Affiliation(s)
- Daniel E Leisman
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St., GRB 7-730, Boston, MA, 02114, USA.
| | - Damian R Handisides
- Innoviva Specialty Therapeutics, Inc - an Affiliate of La Jolla Pharmaceutical Company, Waltham, MA, USA
| | - Laurence W Busse
- Department of Medicine, Emory University, Atlanta, GA, USA
- Emory Critical Care Center, Emory Healthcare, Atlanta, GA, USA
| | - Mark C Chappell
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lakhmir S Chawla
- Department of Medicine, Veterans Affairs Medical Center, San Diego, CA, USA
| | - Michael R Filbin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Marcia B Goldberg
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Division of Infectious Diseases, Department of Medicine, Center for Bacterial Pathogenesis, Massachusetts General Hospital, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Kealy R Ham
- Department of Critical Care, Mayo Clinic, Phoenix, AZ, USA
| | - Ashish K Khanna
- Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher D Adams
- Innoviva Specialty Therapeutics, Inc - an Affiliate of La Jolla Pharmaceutical Company, Waltham, MA, USA
| | - Tony N Hodges
- Innoviva Specialty Therapeutics, Inc - an Affiliate of La Jolla Pharmaceutical Company, Waltham, MA, USA
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Australia
- Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Jouffroy R, Djossou F, Neviere R, Jaber S, Vivien B, Heming N, Gueye P. The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization. Ann Intensive Care 2024; 14:58. [PMID: 38625453 PMCID: PMC11019190 DOI: 10.1186/s13613-024-01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France.
- Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM - Paris Saclay University, Paris, France.
- EA 7329 - Institut de Recherche Médicale et d'Épidémiologie du Sport - Institut National du Sport, de l'Expertise et de la Performance, Paris, France.
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique - Hôpitaux de Paris, and Paris Saclay University, Saclay, France.
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Guyane and Laboratoire Ecosystèmes Amazoniens et Pathologie Tropicale EA 3593, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, France
| | - Rémi Neviere
- Service des Explorations Fonctionnelles Centre Hospitalier Universitaire de Martinique et UR5_3 PC2E Pathologie Cardiaque, toxicité Environnementale et Envenimations (ex EA7525, Université des Antilles, Antilles, France
| | - Samir Jaber
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, University of Montpellier, INSERM U1046, Centre Hospitalier Universitaire Montpellier, Montpellier, 34295, France
| | - Benoît Vivien
- Service d'Anesthésie Réanimation, SAMU de Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nicholas Heming
- Department of Intensive Care, Raymond Poincaré Hospital, Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), APHP University Versailles Saint Quentin - University Paris Saclay, University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches, Garches, 92380, France
| | - Papa Gueye
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, University of the Antilles, French West Indies, Antilles, France
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Luo JC, Luo MH, Zhang YJ, Liu WJ, Ma GG, Hou JY, Su Y, Hao GW, Tu GW, Luo Z. Skin mottling score assesses peripheral tissue hypoperfusion in critically ill patients following cardiac surgery. BMC Anesthesiol 2024; 24:130. [PMID: 38580909 PMCID: PMC10996133 DOI: 10.1186/s12871-024-02474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Skin mottling is a common manifestation of peripheral tissue hypoperfusion, and its severity can be described using the skin mottling score (SMS). This study aims to evaluate the value of the SMS in detecting peripheral tissue hypoperfusion in critically ill patients following cardiac surgery. METHODS Critically ill patients following cardiac surgery with risk factors for tissue hypoperfusion were enrolled (n = 373). Among these overall patients, we further defined a hypotension population (n = 178) and a shock population (n = 51). Hemodynamic and perfusion parameters were recorded. The primary outcome was peripheral hypoperfusion, defined as significant prolonged capillary refill time (CRT, > 3.0 s). The characteristics and hospital mortality of patients with and without skin mottling were compared. The area under receiver operating characteristic curves (AUROC) were used to assess the accuracy of SMS in detecting peripheral hypoperfusion. Besides, the relationships between SMS and conventional hemodynamic and perfusion parameters were investigated, and the factors most associated with the presence of skin mottling were identified. RESULTS Of the 373-case overall population, 13 (3.5%) patients exhibited skin mottling, with SMS ranging from 1 to 5 (5, 1, 2, 2, and 3 cases, respectively). Patients with mottling had lower mean arterial pressure, higher vasopressor dose, less urine output (UO), higher CRT, lactate levels and hospital mortality (84.6% vs. 12.2%, p < 0.001). The occurrences of skin mottling were higher in hypotension population and shock population, reaching 5.6% and 15.7%, respectively. The AUROC for SMS to identify peripheral hypoperfusion was 0.64, 0.68, and 0.81 in the overall, hypotension, and shock populations, respectively. The optimal SMS threshold was 1, which corresponded to specificities of 98, 97 and 91 and sensitivities of 29, 38 and 67 in the three populations (overall, hypotension and shock). The correlation of UO, lactate, CRT and vasopressor dose with SMS was significant, among them, UO and CRT were identified as two major factors associated with the presence of skin mottling. CONCLUSION In critically ill patients following cardiac surgery, SMS is a very specific yet less sensitive parameter for detecting peripheral tissue hypoperfusion.
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Affiliation(s)
- Jing-Chao Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Geriatric Medical Center, Shanghai, 200032, China
| | - Ming-Hao Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yi-Jie Zhang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wen-Jun Liu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guo-Guang Ma
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun-Yi Hou
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ying Su
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guang-Wei Hao
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guo-Wei Tu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Zhe Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Orsatti VN, Ribeiro VST, de Oliveira Montenegro C, Costa CJ, Raboni EA, Sampaio ER, Michielin F, Gasparetto J, Telles JP, Tuon FF. Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities. Med Intensiva 2024:S2173-5727(24)00058-4. [PMID: 38575400 DOI: 10.1016/j.medine.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. DESIGN This retrospective cohort study was conducted between 2016 and 2021. SETTING Two university hospitals in Brazil. PARTICIPANTS Patients with sepsis. INTERVENTIONS Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. MAIN VARIABLE OF INTEREST In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. RESULTS A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. CONCLUSIONS Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.
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Affiliation(s)
- Vinicius Nakad Orsatti
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Carolina de Oliveira Montenegro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Clarice Juski Costa
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Eduardo Albanske Raboni
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Eduardo Ramos Sampaio
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Fernando Michielin
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Juliano Gasparetto
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - João Paulo Telles
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil.
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Williams S, Kalakoutas A, Olusanya S, Schrage B, Tavazzi G, Carnicelli AP, Montero S, Vandenbriele C, Luk A, Lim HS, Bhagra S, Ott SC, Farrero M, Samsky MD, Kennedy JLW, Sen S, Agrawal R, Rampersad P, Coniglio A, Pappalardo F, Barnett C, Proudfoot AG. The management of heart failure cardiogenic shock: an international RAND appropriateness panel. Crit Care 2024; 28:105. [PMID: 38566212 PMCID: PMC10988801 DOI: 10.1186/s13054-024-04884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. METHODS A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1-3 as inappropriate, 4-6 as uncertain and as 7-9 appropriate). RESULTS Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. CONCLUSION This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.
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Affiliation(s)
- Stefan Williams
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Antonis Kalakoutas
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Segun Olusanya
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Benedict Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Anthony P Carnicelli
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Adriana Luk
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Hoong Sern Lim
- Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sai Bhagra
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sascha C Ott
- Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany
| | | | - Marc D Samsky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jamie L W Kennedy
- Heart Failure / Transplant Program, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richa Agrawal
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Amanda Coniglio
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christopher Barnett
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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10
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Omar S, Parris P, Gurke CR. Hemoadsorption Therapy for Calcium Channel Blocker Overdose: A Case Report. J Emerg Med 2024; 66:e463-e466. [PMID: 38461133 DOI: 10.1016/j.jemermed.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/24/2023] [Accepted: 11/23/2023] [Indexed: 03/11/2024]
Abstract
BACKGROUND Modern resin hemoadsorption/hemoperfusion for calcium channel blocker overdose is yet to be reported. The characteristics of calcium channel blockers make them unamenable to removal by hemodiafiltration or charcoal hemoperfusion; however, elimination, using styrene bead adsorption in an ex vivo model, has been demonstrated. Its clinical use is described. CASE REPORT A man in his 20s was admitted with shock into the Intensive Care Unit (ICU) after an overdose of amlodipine and risperidone. Resuscitation and supportive care were administered, but hypotension did not resolve despite the administration of intravenous fluids, infusions of calcium, adrenaline, and hyperinsulinemic-euglycemic therapy. Methylene blue was then administered to maintain the mean arterial pressures. However, the hemodynamic effect did not allow the weaning of the adrenaline. Drug clearance using hemoadsorption/hemoperfusion was attempted using a styrene resin filter (Jafron HA230; Jafron Biomedical Co., Ltd., Guangdong, China). During the two hemoperfusion sessions (6 h duration each, and 18 h apart) the patient had successfully weaned off all supportive measures, with lactate levels returning to normal and was later discharged home. At the end of each session, significant amlodipine concentrations were detected in blood aspirated from both filters, suggesting enhanced clearance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our case illustrates a temporal relationship between resin hemoperfusion therapy, resolution of hemodynamic instability, and shock without proving causation. Significant amlodipine elimination was suggested by high concentrations found in blood from the filter. At the same time, shock resolution after initiation of hemoperfusion occurred in less than one elimination half-life of amlodipine.
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Affiliation(s)
- Shahed Omar
- Department of Critical Care, School of Clinical Medicine/University of Witwatersrand/Chris Hani Baragwanath, Johannesburg, South Africa.
| | - Pano Parris
- Department of Critical Care, School of Clinical Medicine/University of Witwatersrand/Chris Hani Baragwanath, Johannesburg, South Africa
| | - Chloe Rose Gurke
- Department of Critical Care, School of Clinical Medicine/University of Witwatersrand/Chris Hani Baragwanath, Johannesburg, South Africa
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11
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Sink J, Peigh G, Speakman B, Banno J, Sanders D, Nso N, Waits G, Lohrmann G, Elsayed M, Carneiro H, Baman J, Pfenniger A, Patil KD, Arora R, Kim SS, Chicos AB, Lin AC, Passman RS, Knight BP, Dandamudi S, Kaplan RM, Huang H, Wasserlauf J, Verma N. Correlation between high- and low-voltage impedance measurements following subcutaneous implantable cardioverter-defibrillator implantation. Heart Rhythm 2024; 21:492-494. [PMID: 38159788 DOI: 10.1016/j.hrthm.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Joshua Sink
- Department of Internal Medicine, Northwestern University, Chicago, Illinois
| | - Graham Peigh
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Joseph Banno
- Division of Cardiology, Corewell Health, Grand Rapids, Michigan
| | - David Sanders
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nso Nso
- Division of Cardiology, Northshore University Health System, Evanston, Illinois
| | - George Waits
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Graham Lohrmann
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Mahmoud Elsayed
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Herman Carneiro
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jayson Baman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Anna Pfenniger
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Rishi Arora
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Susan S Kim
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Albert C Lin
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Rachel M Kaplan
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Henry Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology, Northshore University Health System, Evanston, Illinois
| | - Nishant Verma
- Division of Cardiology, Northwestern University, Chicago, Illinois.
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12
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Wu CH, Chang TH, Tan BF, Wu JL, Huang SM, Yen TY, Wu ET, Wang CC, Lin MT, Lu CY, Chang LY, Huang LM. Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome. J Formos Med Assoc 2024; 123:496-500. [PMID: 37903693 DOI: 10.1016/j.jfma.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/14/2023] [Accepted: 10/01/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients' clinical manifestations and identify risk factors for shock. METHODS We included patients diagnosed with MIS-C at two medical centers from May 2022 to August 2022. We separated those patients into two groups according to whether they experienced shock. We collected demographic, clinical manifestation, and laboratory data of the patients and performed statistical analysis between the two groups. RESULTS We enrolled 28 patients, including 13 (46 %) with shock and 15 (54 %) without shock. The median age was 6.4 years (IQR: 1.9-7.5). In single variable analysis, patients with shock tended to be older, had more neurological symptoms, more conjunctivitis and strawberry tongue, lower lymphocyte count, lower platelet counts, and higher C-reactive protein, higher procalcitonin, higher ferritin, and higher D-dimer levels than those without shock. The area under the ROC curve that used procalcitonin to be the risk factor of shock with MIS-C was 0.815 (95 % CI 0.644 to 0.987). The cutoff value obtained by ROC analysis of procalcitonin was 1.68 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 77 %, specificity 93 %, positive predictive value 91 %, negative predictive value 82 %. Multivariable analysis revealed that procalcitonin was the only independent risk factor of shock with MIS-C on admission (OR, 26.00, 95 % CI, 1.01-668.89). CONCLUSIONS MIS-C patients with high initial procalcitonin levels have higher risks of experiencing shock and may need ICU admission.
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Affiliation(s)
- Chi-Hsien Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Boon-Fatt Tan
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Jong-Lin Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Song-Ming Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Rodríguez-Holguín F, Salcedo A, Leib P, Caicedo Y, Serna JJ, Toro L, Carvajal S, Riascos M, Parra MW, García A, Ordoñez CA. Is REBOA the Last Card to Control a Massive Gastrointestinal Bleeding? J Surg Res 2024; 296:735-741. [PMID: 38368774 DOI: 10.1016/j.jss.2023.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potential tool for the management of massive gastrointestinal bleeding (MGB). This study aims to describe the experience of the use of REBOA as adjunctive therapy in patients with MGB and to evaluate its effectiveness. METHODS Serial cases of patients with hemorrhagic shock secondary to MGB in whom REBOA was placed were collected. Patient demographics, bleeding severity, etiology, management, and clinical outcomes were recorded. RESULTS Between 2017 and 2020, five cases were analyzed. All patients had a severe gastrointestinal bleeding (Glasgow Blatchford Bleeding Score range 12-17; Clinical Rockal Score range 5-9). The etiologies of MGB were perforated gastric or duodenal ulcers, esophageal varices, and vascular lesions. Systolic blood pressure increased after REBOA placement and total occlusion time was 25-60 min. REBOA provided temporary hemorrhage control in all cases and allowed additional hemostatic maneuvers to be performed. Three patients survived more than 24 h. All patients died in index hospitalization. The main cause of death was related to hemorrhagic shock. CONCLUSIONS Endovascular aortic occlusion can work as a bridge to further resuscitation and attempts at hemostasis in patients with MGB. REBOA provides hemodynamic support and may be used simultaneously with other hemostatic maneuvers, facilitating definitive hemorrhage control.
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Affiliation(s)
- Fernando Rodríguez-Holguín
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia
| | - Alexander Salcedo
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia; División de Cirugía de Trauma y Emergencias, Universidad del Valle, Cali, Colombia
| | - Philip Leib
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - Yaset Caicedo
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - José Julián Serna
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Luis Toro
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Sandra Carvajal
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Manolo Riascos
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Michael W Parra
- Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, Florida
| | - Alberto García
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia; División de Cirugía de Trauma y Emergencias, Universidad del Valle, Cali, Colombia
| | - Carlos A Ordoñez
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia; División de Cirugía de Trauma y Emergencias, Universidad del Valle, Cali, Colombia.
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14
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Cheng YW, Kuo PC, Chen SH, Kuo YT, Liu TL, Chan WS, Chan KC, Yeh YC. Early prediction of mortality at sepsis diagnosis time in critically ill patients by using interpretable machine learning. J Clin Monit Comput 2024; 38:271-279. [PMID: 38150124 DOI: 10.1007/s10877-023-01108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023]
Abstract
This study applied machine learning for the early prediction of 30-day mortality at sepsis diagnosis time in critically ill patients. Retrospective study using data collected from the Medical Information Mart for Intensive Care IV database. The data of the patient cohort was divided on the basis of the year of hospitalization, into training (2008-2013), validation (2014-2016), and testing (2017-2019) datasets. 24,377 patients with the sepsis diagnosis time < 24 h after intensive care unit (ICU) admission were included. A gradient boosting tree-based algorithm (XGBoost) was used for training the machine learning model to predict 30-day mortality at sepsis diagnosis time in critically ill patients. Model performance was measured in both discrimination and calibration aspects. The model was interpreted using the SHapley Additive exPlanations (SHAP) module. The 30-day mortality rate of the testing dataset was 17.9%, and 39 features were selected for the machine learning model. Model performance on the testing dataset achieved an area under the receiver operating characteristic curve (AUROC) of 0.853 (95% CI 0.837-0.868) and an area under the precision-recall curves of 0.581 (95% CI 0.541-0.619). The calibration plot for the model revealed a slope of 1.03 (95% CI 0.94-1.12) and intercept of 0.14 (95% CI 0.04-0.25). The SHAP revealed the top three most significant features, namely age, increased red blood cell distribution width, and respiratory rate. Our study demonstrated the feasibility of using the interpretable machine learning model to predict mortality at sepsis diagnosis time.
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Affiliation(s)
- Yi-Wei Cheng
- Taiwan AI Labs, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Po-Chih Kuo
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Shih-Hong Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | | | - Wing-Sum Chan
- Department of Anesthesiology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S Rd, Banqiao District, New Taipei City, 220, Taiwan.
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan.
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15
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Théry G, Gascon V, Fraile V, Ochagavia A, Hamzaoui O. How to use echocardiography to manage patients with shock? Med Intensiva 2024; 48:220-230. [PMID: 38151372 DOI: 10.1016/j.medine.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 12/29/2023]
Abstract
Echocardiography enables the intensivist to assess the patient with circulatory failure. It allows the clinician to identify rapidly the type and the cause of shock in order to develop an effective management strategy. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied. Early and repeated echocardiography is a valuable tool for the management of shock in the intensive care unit. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. The four core types of shock (cardiogenic, hypovolemic, obstructive, and septic) can readily be identified by echocardiography. Echocardiography can differentiate the different pathologies that may be the cause of each type of shock. More importantly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock, which emphasises on the added value of transthoracic echocardiography (TTE) in such population of patients. In this review we aimed to provide to clinicians a bedside strategy of the use of TTE parameters to manage patients with shock. In the first part of this overview, we detailed the different TTE parameters and how to use them to identify the type of shock. And in the second part, we focused on the use of these parameters to evaluate the effect of treatments, in different types of shock.
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Affiliation(s)
- Guillaume Théry
- Service de Médecine Intensive - Réanimation Polyvalente, Hôpital Robert Debré, Centre Hospitalo-Universitaire de Reims; Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801.
| | - Victor Gascon
- Servicio de Medicina Intensiva, Hospital Universitario de la Ribera, Alcira (Valencia)
| | - Virginia Fraile
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid
| | - Ana Ochagavia
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | - Olfa Hamzaoui
- Service de Médecine Intensive - Réanimation Polyvalente, Hôpital Robert Debré, Centre Hospitalo-Universitaire de Reims; Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801
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16
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Conlon TW, Baker D, Bhombal S. Cardiac point-of-care ultrasound: Practical integration in the pediatric and neonatal intensive care settings. Eur J Pediatr 2024; 183:1525-1541. [PMID: 38236402 DOI: 10.1007/s00431-023-05409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024]
Abstract
Cardiac point-of-care ultrasound (POCUS) is a technology increasingly leveraged at the bedside by pediatric critical care and neonatology providers to identify real-time hemodynamic pathophysiology. We present a framework for (1) identifying the scope of cardiac POCUS within the clinical practice setting, (2) standardizing views for protocolized hemodynamic assessment relevant to pediatric critical illness and (3) integrating POCUS findings for therapeutic guidance. Within the review, we also discuss practical strengths and limitations to image acquisition and interpretation within the varied cardiac POCUS views. Finally, we explore unique considerations within the neonatal population. Conclusion: Cardiac POCUS is a technology and tool that reveals important real-time information at the bedside of the critically ill child and infant. Understanding strengths and limitations of cardiac POCUS views and protocolizing an approach to answer focused clinical questions provides a framework for training and translation to clinical care. What is Known: • Ultrasound technology is now ubiquitous among pediatric critical care and neonatology settings, and growing literature supports an expanded role in not only procedural but also diagnostic applications. • Cardiac POCUS influences provider perception of pathophysiology and changes clinical management. What is New: • Effective cardiac POCUS training and subsequent translation to clinical practice should improve when clinical questions and protocolized approaches to image acquisition are standardized within a specialty. • Cardiac POCUS views have strengths and limitations which must be recognized when assessing the hemodynamic profile of a child or neonate.
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Affiliation(s)
- Thomas W Conlon
- The Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - David Baker
- The Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Shazia Bhombal
- Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
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17
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Movahed MR, Talle A, Hashemzadeh M. Intra-aortic balloon pump is associated with the lowest whereas Impella with the highest inpatient mortality and complications regardless of severity or hospital types. Cardiovasc Interv Ther 2024:10.1007/s12928-024-00993-8. [PMID: 38555535 DOI: 10.1007/s12928-024-00993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
Impella and intra-aortic balloon pumps (IABP) are commonly utilized in patients with cardiogenic shock. However, the effect on mortality remains controversial. The goal of this study was to evaluate the effect of Impella and IABP on mortality in patients with cardiogenic shock the large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of IABP or Impella on outcome. ICD-10 codes for Impella, IABP, and cardiogenic shock for available years 2016-2020 were utilized. A total of 844,020 patients had a diagnosis of cardiogenic shock. A total of 101,870 patients were treated with IABP and 39645 with an Impella. Total inpatient mortality without any device was 34.2% vs only 25.1% with IABP use (OR = 0.65, CI 0.62-0.67) but was highest at 40.7% with Impella utilization (OR = 1.32, CI 1.26-1.39). After adjusting for 47 variables, Impella utilization remained associated with the highest mortality (OR: 1.33, CI 1.25-1.41, p < 0.001), whereas IABP remained associated with the lowest mortality (OR: 0.69, CI 0.66-0.72, p < 0.001). Separating rural vs teaching hospitals revealed similar findings. In patients with cardiogenic shock, the use of Impella was associated with the highest whereas IABP was associated with the lowest in-hospital mortality regardless of comorbid condition.
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Affiliation(s)
- Mohammad Reza Movahed
- University of Arizona Sarver Heart Center, 1501 North Campbell Avenue, Tucson, Arizona, USA.
- University of Arizona, College of Medicine, Phoenix, Arizona, USA.
| | - Armin Talle
- University of Arizona, College of Medicine, Phoenix, Arizona, USA
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Laghlam D, Benghanem S, Ortuno S, Bouabdallaoui N, Manzo-Silberman S, Hamzaoui O, Aissaoui N. Management of cardiogenic shock: a narrative review. Ann Intensive Care 2024; 14:45. [PMID: 38553663 PMCID: PMC10980676 DOI: 10.1186/s13613-024-01260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/06/2024] [Indexed: 04/02/2024] Open
Abstract
Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. We aimed to review evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill patient population.
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Affiliation(s)
- Driss Laghlam
- Research & Innovation Department, RIGHAPH, Service de Réanimation polyvalente, CMC Ambroise Paré-Hartmann, 48 Ter boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
| | - Sarah Benghanem
- Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- AfterROSC, Paris, France
| | - Sofia Ortuno
- Service Médecine intensive-réanimation, Hopital Européen Georges Pompidou, Paris, France
- Université Sorbonne, Paris, France
| | - Nadia Bouabdallaoui
- Institut de cardiologie de Montreal, Université de Montreal, Montreal, Canada
| | - Stephane Manzo-Silberman
- Université Sorbonne, Paris, France
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France
| | - Olfa Hamzaoui
- Service de médecine intensive-réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, Reims, France
- Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801, Reims, France
| | - Nadia Aissaoui
- Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- AfterROSC, Paris, France
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19
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Leite GGF, de Brabander J, Michels EHA, Butler JM, Cremer OL, Scicluna BP, Sweeney TE, Reyes M, Salomao R, Peters-Sengers H, van der Poll T. Monocyte state 1 (MS1) cells in critically ill patients with sepsis or non-infectious conditions: association with disease course and host response. Crit Care 2024; 28:88. [PMID: 38504349 PMCID: PMC10953179 DOI: 10.1186/s13054-024-04868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Sepsis is a life-threatening condition arising from an aberrant host response to infection. Recent single-cell RNA sequencing investigations identified an immature bone-marrow-derived CD14+ monocyte phenotype with immune suppressive properties termed "monocyte state 1" (MS1) in patients with sepsis. Our objective was to determine the association of MS1 cell profiles with disease presentation, outcomes, and host response characteristics. METHODS We used the transcriptome deconvolution method (CIBERSORTx) to estimate the percentage of MS1 cells from blood RNA profiles of patients with sepsis admitted to the intensive care unit (ICU). We compared these profiles to ICU patients without infection and to healthy controls. Host response dysregulation was further studied by gene co-expression network and gene set enrichment analyses of blood leukocytes, and measurement of 15 plasma biomarkers indicative of pathways implicated in sepsis pathogenesis. RESULTS Sepsis patients (n = 332) were divided into three equally-sized groups based on their MS1 cell levels (low, intermediate, and high). MS1 groups did not differ in demographics or comorbidities. The intermediate and high MS1 groups presented with higher disease severity and more often had shock. MS1 cell abundance did not differ between survivors and non-survivors, or between patients who did or did not acquire a secondary infection. Higher MS1 cell percentages were associated with downregulation of lymphocyte-related and interferon response genes in blood leukocytes, with concurrent upregulation of inflammatory response pathways, including tumor necrosis factor signaling via nuclear factor-κB. Previously described sepsis host response transcriptomic subtypes showed different MS1 cell abundances, and MS1 cell percentages positively correlated with the "quantitative sepsis response signature" and "molecular degree of perturbation" scores. Plasma biomarker levels, indicative of inflammation, endothelial cell activation, and coagulation activation, were largely similar between MS1 groups. In ICU patients without infection (n = 215), MS1 cell percentages and their relation with disease severity, shock, and host response dysregulation were highly similar to those in sepsis patients. CONCLUSIONS High MS1 cell percentages are associated with increased disease severity and shock in critically ill patients with sepsis or a non-infectious condition. High MS1 cell abundance likely indicates broad immune dysregulation, entailing not only immunosuppression but also anomalies reflecting exaggerated inflammatory responses.
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Affiliation(s)
- Giuseppe G F Leite
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Justin de Brabander
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Erik H A Michels
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joe M Butler
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Brendon P Scicluna
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, Msida, Malta
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | | | - Miguel Reyes
- Department of Infectious Diseases, Genentech, South San Francisco, USA
| | - Reinaldo Salomao
- Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Division of Infectious Diseases, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
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20
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Rottmann FA, Abraham H, Welte T, Westermann L, Bemtgen X, Gauchel N, Supady A, Wengenmayer T, Staudacher DL. Atrial fibrillation and survival on a medical intensive care unit. Int J Cardiol 2024; 399:131673. [PMID: 38141732 DOI: 10.1016/j.ijcard.2023.131673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is common among patients in the intensive care unit (ICU) and can be triggered by severe illness or preexisting conditions. It is debated if AF is an independent predictor of poor outcome. METHODS Data derives from a single center retrospective registry including all patients with a stay on the medical ICU for >24 h. The primary endpoint was ICU survival. Secondary endpoints included receiving mechanical support (renal, respiratory or circulatory), hemodynamic parameters during AF, rate and rhythm control strategies, anticoagulation, and documentation. RESULTS A total of 616 patients (male gender 62.3%, median age 75 years) were included in our analysis. New-onset AF was diagnosed in 87 patients (14.1%), 136 (22.1%) presented with preexisting AF, and 393 (63.8%) did not develop AF. Initial episodes of new-onset AF exhibited higher hemodynamic instability than episodes in preexisting cases, with elevated heart rates and increased catecholamine doses (both p < 0.001). ICU survival in new-onset AF was 80.5% (70/87) compared to 92.4% (363/393) in patients without AF (OR 0.340, CI 0.182-0.658, p < 0.001). Likewise, ICU survival in preexisting AF was 86.8% (118/136) was significantly lower compared to no AF (OR 0.542, CI 0.290-0.986, p = 0.050*). Independent predictors of ICU survival for patients were atrial fibrillation (p = 0.016), resuscitation before or during ICU stay (p < 0.001), and receiving acute dialysis on ICU (p = 0.002). CONCLUSIONS ICU survival is noticeably lower in patients with new-onset or preexisting atrial fibrillation compared to those without. Patients who develop new-onset AF during their ICU stay warrant special attention for both short-term and long-term care strategies.
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Affiliation(s)
- F A Rottmann
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
| | - H Abraham
- Interdisciplinary Medical intensive Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - T Welte
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - L Westermann
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - X Bemtgen
- Department of Cadiology and Angiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - N Gauchel
- Department of Cadiology and Angiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - A Supady
- Interdisciplinary Medical intensive Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - T Wengenmayer
- Interdisciplinary Medical intensive Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - D L Staudacher
- Interdisciplinary Medical intensive Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ. Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev 2024:10.1007/s10741-024-10394-x. [PMID: 38483658 DOI: 10.1007/s10741-024-10394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/09/2024]
Abstract
Takotsubo syndrome (TTS) in the pediatric population is an infrequent but relevant cause of morbidity and mortality, with limited studies addressing its clinical course and prognosis. We aimed to analyze the clinical features and prognosis of pediatric TTS in a nation-wide multicenter registry and considering the published literature. We included a total of 54 patients from 4 different hospitals in Spain, as well as pediatric TTS patients from the published literature. Comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between pediatric and adult population features. Patients with pediatric TTS are more commonly male and exhibit a higher prevalence of physical triggers. The left ventricular ejection fraction (LVEF) was significantly lower in the pediatric population (30.5 + 10.4 vs 36.9 + 16.9, p < 0.05), resulting in more than fivefold rates of cardiogenic shock on admission compared to the general adult TTS population (Killip IV 74.1% vs 10.5%, p < 0.001) with similar rates of death and recurrence between groups. TTS in the pediatric population presents a distinctive clinical profile, with higher prevalence of atypical symptoms and physical triggers, as well as higher rates of cardiogenic shock on admission and similar mortality and recurrence rates than those of the adult population. This study provides valuable insights into understanding pediatric TTS and underscores the necessity for further research in this age group.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Mireia Andrés
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Manuel Almendro-Delia
- Department of Cardiology, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Oscar Vedia Cruz
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
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Li X, Wang S, Ma J, Bai SG, Fu SZ. Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock. World J Crit Care Med 2024; 13:88540. [PMID: 38633475 PMCID: PMC11019628 DOI: 10.5492/wjccm.v13.i1.88540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock. AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit. METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited. Patient population characteristics and laboratory data were collected for analysis. RESULTS The study group consisted of 85 (39%) inpatients with bloodstream infection, and the control group consisted of 133 (61%) with negative results or contamination. The percentage decline in platelet counts (PPCs) in patients positive for pathogens [57.1 (41.3-74.6)] was distinctly higher than that in the control group [18.2 (5.1-43.1)] (P < 0.001), whereas the PPCs were not significantly different among those with gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection. Using receiver operating characteristic curves, the area under the curve of the platelet drop rate was 0.839 (95%CI: 0.783-0.895). CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock. However, it cannot identify gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection.
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Affiliation(s)
- Xia Li
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Sheng Wang
- Department of Physiology, Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jun Ma
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Su-Ge Bai
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Su-Zhen Fu
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
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Zapata L, Gómez-López R, Llanos-Jorge C, Duerto J, Martin-Villen L. Cardiogenic shock as a health issue. Physiology, classification, and detection. Med Intensiva 2024:S2173-5727(24)00022-5. [PMID: 38458914 DOI: 10.1016/j.medine.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/27/2023] [Indexed: 03/10/2024]
Abstract
Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and a growing incidence. It is characterized by an imbalance between the tissue oxygen demands and the capacity of the cardiovascular system to meet these demands, due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS. However, non-ischemic cases have seen a rise in incidence. The pathophysiology involves ischemic damage of the myocardium and a sympathetic, renin-angiotensin-aldosterone system and inflammatory response, perpetuating the situation of tissue hypoperfusion and ultimately leading to multiorgan dysfunction. The characterization of CS patients through a triaxial assessment and the widespread use of the Society for Cardiovascular Angiography and Interventions (SCAI) scale has allowed standardization of the severity stratification of CS; this, coupled with early detection and the "hub and spoke" approach, could contribute to improving the prognosis of these patients.
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Affiliation(s)
- Luis Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Rocío Gómez-López
- Servicio de Medicina Intensiva, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Celina Llanos-Jorge
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jorge Duerto
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Luis Martin-Villen
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Seville, Spain
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Mitra B, Jorgensen M, Reade MC, Keegan A, Holley A, Farmer S, Harvey N, Winearls J, Parr M, French CJ. Patient blood management guideline for adults with critical bleeding. Med J Aust 2024; 220:211-216. [PMID: 38282333 DOI: 10.5694/mja2.52212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/09/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. The 2011 Patient blood management guidelines: module 1 - critical bleeding/massive transfusion were updated and published. Systematic reviews were conducted for pre-specified research questions, and recommendations were based on meta-analyses of included studies. MAIN RECOMMENDATIONS The critical bleeding/massive transfusion guideline includes seven recommendations and 11 good practice statements addressing: major haemorrhage protocols (MHPs) facilitating a multidisciplinary approach to haemorrhage control, correction of coagulopathy and normalisation of physiological derangement; measurement of physiological, biochemical and metabolic parameters in critical bleeding/massive transfusion; the optimal ratio of red blood cells to other blood components; the use of tranexamic acid; viscoelastic haemostatic assays; and cell salvage. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE The new guideline recommends MHPs be established as standard of care in all institutions managing patients with critical bleeding. In addition to routine physiological markers, the new guideline recommends temperature, biochemistry and coagulation profiles be measured early and frequently, providing parameters that define critical derangements. Ratio-based MHPs should include no fewer than four units of fresh frozen plasma and one adult unit of platelets for every eight units of red blood cells. In the setting of trauma and obstetric haemorrhage, administration of tranexamic acid within three hours of bleeding onset is recommended. The use of recombinant activated factor VII (rFVIIa) is not recommended. There was insufficient evidence to make recommendations on the use of viscoelastic haemostatic assays or cell salvage as part of MHPs.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | | | - Michael C Reade
- Joint Health Command, Australian Defence Force, Canberra, ACT
- Royal Brisbane and Women's Hospital, Brisbane, QLD
| | - Anastazia Keegan
- PathWest Laboratory Medicine, King Edward Memorial Hospital, Perth, WA
- Australia Red Cross Lifeblood, Perth, WA
| | - Anthony Holley
- Joint Health Command, Australian Defence Force, Canberra, ACT
- Royal Brisbane and Women's Hospital, Brisbane, QLD
| | - Shannon Farmer
- University of Western Australia, Perth, WA
- Royal Perth Hospital, Perth, WA
| | | | - James Winearls
- Monash University, Melbourne, VIC
- Gold Coast University Hospital, Gold Coast, QLD
| | - Michael Parr
- Liverpool Hospital, Sydney, NSW
- University of New South Wales, Sydney, NSW
- Macquarie University Hospital, Sydney, NSW
- Macquarie University, Sydney, NSW
| | - Craig J French
- Western Health, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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Lee JH, Ward KR. Blood failure: traumatic hemorrhage and the interconnections between oxygen debt, endotheliopathy, and coagulopathy. Clin Exp Emerg Med 2024; 11:9-21. [PMID: 38018069 PMCID: PMC11009713 DOI: 10.15441/ceem.23.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/28/2023] [Indexed: 11/30/2023] Open
Abstract
This review explores the concept of "blood failure" in traumatic injury, which arises from the interplay of oxygen debt, the endotheliopathy of trauma (EoT), and acute traumatic coagulopathy (ATC). Traumatic hemorrhage leads to the accumulation of oxygen debt, which can further exacerbate hemorrhage by triggering a cascade of events when severe. Such events include EoT, characterized by endothelial glycocalyx damage, and ATC, involving platelet dysfunction, fibrinogen depletion, and dysregulated fibrinolysis. To manage blood failure effectively, a multifaceted approach is crucial. Damage control resuscitation strategies such as use of permissive hypotension, early hemorrhage control, and aggressive transfusion of blood products including whole blood aim to minimize oxygen debt and promote its repayment while addressing endothelial damage and coagulation. Transfusions of red blood cells, plasma, and platelets, as well as the use of tranexamic acid, play key roles in hemostasis and countering ATC. Whole blood, whether fresh or cold-stored, is emerging as a promising option to address multiple needs in traumatic hemorrhage. This review underscores the intricate relationships between oxygen debt, EoT, and ATC and highlights the importance of comprehensive, integrated strategies in the management of traumatic hemorrhage to prevent blood failure. A multidisciplinary approach is essential to address these interconnected factors effectively and to improve patient outcomes.
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Affiliation(s)
- Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kevin R. Ward
- Department of Emergency Medicine, Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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26
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Gebray HM, Abeje AE, Boye AT. BRASH syndrome with a complete heart block- a case report. BMC Cardiovasc Disord 2024; 24:114. [PMID: 38373878 PMCID: PMC10877849 DOI: 10.1186/s12872-024-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the profound bradycardia seen in patients on AV nodal blockers who present with acute kidney injury (AKI) and hyperkalemia. CASE PRESENTATION We present a case of a 68 years old female patient with past history of hypertension taking atenolol and Enalapril presented to emergency department with the complaint of loss of consciousness of 02 hours duration. She had 03 days history of fatigue, poor oral intake, decreased urine output, appetite loss, vertigo and global headache. Her vital signs were blood pressure of 60/40 mmHg, absent radial pulse and temperature of 36.4 °C. Her systemic examination was remarkable for dry buccal mucosa; apical heart rate was 22 beats per minute. Glasgow Coma Scale was 13/15. Her laboratory tests showed creatinine of 1.83 mg/dL, blood urea nitrogen of 89 mg/dL and potassium elevated to the level of 6.39 mEq/dL. ECG revealed complete heart block with a normal QT interval and T waves and no U waves with ventricular rate of 22 beats per minute. Her previous medications were discontinued and the patient was resuscitated with intravenous (IV) fluids. She was given 03 doses of 1 mg atropine every 5 minutes but there was no increment in heart rate. She was given 50% dextrose with 10 international units of regular insulin, 1 g of calcium gluconate and Intravenous perfusion of norepinephrine and dopamine. Subsequently, after 14 hours of ICU admission the patient had a cardiac arrest with asystole and resuscitation was attempted but she couldn't survive. CONCLUSION BRASH syndrome is largely an under-recognized life threatening clinical diagnosis. Physicians should have high index of suspicion for BRASH when they encounter patients with bradycardia, hyperkalemia, and renal failure, as timely diagnosis is crucial in the management.
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Abuelazm M, Rezq H, Mahmoud A, Tanashat M, Salah A, Saleh O, Morsi S, Abdelazeem B. The efficacy and safety of pre-hospital plasma in patients at risk for hemorrhagic shock: an updated systematic review and meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02461-7. [PMID: 38367091 DOI: 10.1007/s00068-024-02461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Plasma is a critical element in hemostatic resuscitation post-injury, and its prompt administration within the prehospital setting may reduce the complications resulting from hemorrhage and shock. Our objective is to assess the efficacy and safety of prehospital plasma infusion in patients susceptible to hemorrhagic shock. METHODS We conducted our study by aggregating randomized controlled trials (RCTs) sourced from PubMed, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL up to January 29, 2023. Quality assessment was implemented using the Cochrane RoB 2 tool. Our study protocol is registered in PROSPERO under ID: CRD42023397325. RESULTS Three RCTs with 760 individuals were included. There was no difference between plasma infusion and standard care groups in 24-h mortality (P = 0.11), 30-day mortality (P = 0.12), and multiple organ failure incidences (P = 0.20). Plasma infusion was significantly better in the total 24-h volume of PRBC units (P = 0.03) and INR on arrival (P = 0.009). For all other secondary outcomes evaluated (total 24-h volume of packed FFP units, total 24-h volume of platelets units, massive transfusion, vasopressor need during the first 24 h, any adverse event, acute lung injury, transfusion reaction, and sepsis), no significant differences were observed between the two groups. CONCLUSION Plasma infusion in trauma patients at risk of hemorrhagic shock does not significantly affect mortality or the incidence of multiple organ failure. However, it may lead to reduced packed red blood cell transfusions and increased INR at hospital arrival.
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Affiliation(s)
| | - Hazem Rezq
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | | | | | | | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Samah Morsi
- Department of Radiation Oncology, UT Texas MD Anderson, Houston, TX, USA
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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Tsuji M, Nii M, Furuta M, Baba S, Maenaka T, Matsunaga S, Tanaka H, Sakurai A. Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review. BMC Pregnancy Childbirth 2024; 24:138. [PMID: 38355477 PMCID: PMC10865663 DOI: 10.1186/s12884-024-06309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic-induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy. METHOD We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST. RESULTS After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died. CONCLUSION Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data-including adverse events-to enable clinicians to conduct risk-benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice.
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Affiliation(s)
- Makoto Tsuji
- Department of Obstetrics and Gynecology, Saiseikai Mastusaka General Hospital, Mastusaka, Mie, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan.
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan.
| | - Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
| | - Shinji Baba
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
| | - Takahide Maenaka
- Regional Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
| | - Atsushi Sakurai
- Department of Acute Medicine, Division of Emergency and Critical Care Medicine, Nihon University School of Medicine, Itabashi, Tokyo, Japan
- Japan Resuscitation Council, Shinjuku, Tokyo, Japan
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Vine J, Lee JH, Kravitz MS, Grossestreuer AV, Balaji L, Leland SB, Berlin N, Moskowitz A, Donnino MW. Thiamine administration in septic shock: a post hoc analysis of two randomized trials. Crit Care 2024; 28:41. [PMID: 38321529 PMCID: PMC10845751 DOI: 10.1186/s13054-024-04818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND This is a post hoc analysis of combined cohorts from two previous Phase II clinical trials to assess the effect of thiamine administration on kidney protection and mortality in patients with septic shock. METHODS Patient-level data from the Thiamine in Septic Shock Trial (NCT01070810) and the Thiamine for Renal Protection in Septic Shock Trial (NCT03550794) were combined in this analysis. The primary outcome for the current study was survival without the receipt of renal replacement therapy (RRT). Analyses were performed on the overall cohort and the thiamine-deficient cohort (thiamine < 8 nmol/L). RESULTS Totally, 158 patients were included. Overall, thiamine administration was associated with higher odds of being alive and RRT-free (adjusted odds ratio [aOR]: 2.05 [95% confidence interval (CI) 1.08-3.90]) and not needing RRT (aOR: 2.59 [95% CI 1.01-6.62]). In the thiamine-deficient group, thiamine administration was associated with higher odds of being alive and RRT-free (aOR: 8.17 [95% CI 1.79-37.22]) and surviving to hospital discharge (aOR: 6.84 [95% CI 1.54-30.36]). There was a significant effect modification by baseline thiamine deficiency for alive and RRT-free (interaction, p = 0.016) and surviving to hospital discharge (p = 0.019). CONCLUSION In the combined analysis of two previous randomized trials, thiamine administration was associated with higher odds of being alive and RRT-free at hospital discharge in patients with septic shock. This signal was stronger in patients with thiamine deficiency.
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Affiliation(s)
- Jacob Vine
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - John H Lee
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Max S Kravitz
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne V Grossestreuer
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lakshman Balaji
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shannon B Leland
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Noa Berlin
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Ari Moskowitz
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Critical Care Medicine, Montefiore Medical Center, The Bronx, NY, USA
- Bronx Center for Critical Care Outcomes and Resuscitation Research, The Bronx, NY, USA
| | - Michael W Donnino
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Zhang M, Wang C, Li Q, Wang H, Li X. Risk factors and an early predictive model for Kawasaki disease shock syndrome in Chinese children. Ital J Pediatr 2024; 50:22. [PMID: 38310292 PMCID: PMC10837898 DOI: 10.1186/s13052-024-01597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Kawasaki disease shock syndrome (KDSS), though rare, has increased risk for cardiovascular complications. Early diagnosis is crucial to improve the prognosis of KDSS patients. Our study aimed to identify risk factors and construct a predictive model for KDSS. METHODS This case-control study was conducted from June, 2015 to July, 2023 in two children's hospitals in China. Children initially diagnosed with KDSS and children with Kawasaki disease (KD) without shock were matched at a ratio of 1:4 by using the propensity score method. Laboratory results obtained prior to shock syndrome and treatment with intravenous immunoglobulin were recorded to predict the onset of KDSS. Univariable logistic regression and forward stepwise logistic regression were used to select significant and independent risk factors associated with KDSS. RESULTS After matching by age and gender, 73 KDSS and 292 KD patients without shock formed the development dataset; 40 KDSS and 160 KD patients without shock formed the validation dataset. Interleukin-10 (IL-10) > reference value, platelet counts (PLT) < 260 × 109/L, C-reactive protein (CRP) > 80 mg/ml, procalcitonin (PCT) > 1ng/ml, and albumin (Alb) < 35 g/L were independent risk factors for KDSS. The nomogram model including the above five indicators had area under the curves (AUCs) of 0.91(95% CI: 0.87-0.94) and 0.90 (95% CI: 0.71-0.86) in the development and validation datasets, with a specificity and sensitivity of 80% and 86%, 66% and 77%, respectively. Calibration curves showed good predictive accuracy of the nomogram. Decision curve analyses revealed the predictive model has application value. CONCLUSIONS This study identified IL-10, PLT, CRP, PCT and Alb as risk factors for KDSS. The nomogram model can effectively predict the occurrence of KDSS in Chinese children. It will facilitate pediatricians in early diagnosis, which is essential to the prevention of cardiovascular complications.
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Affiliation(s)
- Mingming Zhang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
| | - Congying Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
- Department of Cardiology, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Qirui Li
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Hongmao Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
| | - Xiaohui Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China.
- Department of Cardiology, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
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El-Nawawy A, Elwafa RAHA, Khalil Abouahmed A, Rasheed RA, Omar OM. Evaluation of non-thyroidal illness syndrome in shock patients admitted to pediatric intensive care unit in a developing country. Eur J Pediatr 2024; 183:769-778. [PMID: 37994931 PMCID: PMC10912421 DOI: 10.1007/s00431-023-05338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
During critical illness, children my experience various changes in their thyroid hormone levels. Such changes are termed non-thyroidal illness syndrome (NTI). The extent of change correlates with the severity of the illness and its outcomes in critically ill patients. This study aimed to investigate the correlation between the severity of shock and thyroid hormone derangement. This prospective observational study included forty patients aged one month to five years who were admitted to the pediatric intensive care unit (PICU) with shock. Thyroid function tests were conducted on admission, after shock reversal, and five days later. NTI patterns were observed in 70% of patients. The PIM2 score showed a significant negative correlation with T3 (r = - 0.353, p = 0.026) and FT3 levels on admission (r = - 0.417, p = 0.007). Furthermore, after shock reversal, the PIM2 score continued to exhibit significant negative correlations with T4 (r = - 0.444, p = 0.004), T3 (r = - 0.329, p = 0.038), FT3 (r = - 0.355, p = 0.025), and FT4 levels (r = - 0.379, p = 0.016). Conclusion: This study underscores the high prevalence of NTI in PICU shock patients and suggests monitoring thyroid hormone levels for outcome prediction and treatment guidance. Further research is needed to optimize NTI management in critically ill children. What is Known: • Non-thyroidal illness syndrome (NTIS) is a condition observed in critically ill patients. • There has been limited research on NTI in children, and existing studies have generated conflicting results regarding the relationship between thyroid hormones and clinical outcomes in cases of sepsis and septic shock. What is New: • The study has revealed dynamic changes in free triiodothyronine (FT3) levels during the process of shock reversal and recovery in children who experienced shock. • A significant negative correlation was found between the Pediatric Index of Mortality 2 (PIM2) score and several thyroid hormone levels, including FT3 on admission and T4, FT3, and FT4 on shock reversal.
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Affiliation(s)
- Ahmed El-Nawawy
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt
| | | | - Ahmed Khalil Abouahmed
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt
| | - Rehab Atef Rasheed
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt
| | - Omneya Magdy Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt.
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Shafique MA, Shaikh NA, Haseeb A, Mussarat A, Mustafa MS. Sodium bicarbonate Ringer's solution for hemorrhagic shock: A meta-analysis comparing crystalloid solutions. Am J Emerg Med 2024; 76:41-47. [PMID: 37988980 DOI: 10.1016/j.ajem.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The choice of fluid resuscitation in Traumatic Hemorrhagic shock (THS) remains a critical aspect of patient management. Bicarbonated Ringers solution (BRS) has shown promise due to its composition resembling human Extracellular Fluid and its potential benefits on hemodynamics. OBJECTIVE To evaluate the efficacy, mortality rates, hemodynamic effects, and adverse outcomes of Sodium Bicarbonate Ringer's Solution in the treatment of hemorrhagic shock, as compared to other relevant interventions. METHOD A comprehensive examination of the available literature was performed by conducting systematic searches in prominent databases such as Cochrane, EMBASE, MEDLINE, and PubMed. The process employed predefined criteria to extract relevant data and evaluate the quality of the studies. The outcome measures considered encompassed survival rates, mortality, mean arterial pressure (MAP), heart rate (HR), and adverse events. RESULT The meta-analysis of three studies showed that compared to the other crystalloids, the use of BRS had an odds ratio for survival of 1.86 (95% CI: 0.94, 3.71; p = 0.08; I2 = 0%), an odds ratio for total adverse events of 0.14 (95% CI: 0.06, 0.35; p < 0.0001; I2 = 22%), a mean difference in heart rate of -4.49 (95% CI: -7.55, -1.44; p = 0.004; I2 = 13%), and a mean difference in mean arterial pressure of 2.31 (95% CI: -0.85, 5.47; p = 0.15; I2 = 66%). CONCLUSION BRS demonstrated a significant reduction in complications, including adult respiratory distress syndrome (ARDS), Multiple Organ Dysfunction (MODS), and Total Adverse Effects, when compared to other solutions in the treatment of THS. Additionally, THS patients resuscitated with BRS experienced a notable decrease in heart rate. The findings suggest BRS may contribute to organ stability and potential survival improvement due to its similarity to human Extracellular Fluid and minimal impact on the liver.
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Affiliation(s)
| | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Pakistan
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Prager R, Walser E, Balta KY, Anton Nikouline MD, Leeper WR, Vogt K, Parry N, Arntfield R. Resuscitative transesophageal echocardiography during the acute resuscitation of trauma: A retrospective observational study. J Crit Care 2024; 79:154426. [PMID: 37757671 DOI: 10.1016/j.jcrc.2023.154426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Resuscitative transesophageal echocardiography (TEE) is an emerging POCUS modality that can be used to guide trauma resuscitation. METHODS Trauma patients who underwent TEE within 24 h of admission from 2013 to 2022 were prospectively identified. We retrospectively analyzed resuscitative TEE reports and patient charts in duplicate. RESULTS 29 providers performed TEE for 54 acute trauma patients. 28 (52%) died in hospital; 33 (61%) required operative intervention (<24 h). Median injury severity score was 29 [IQR 22-43]. The most common indications for TEE were hemodynamic instability (34, 63%), inadequate windows for transthoracic echocardiography (14, 26%) and cardiac arrest (11, 20%). There were no identified complications. A new diagnosis was made in 31 (57%) cases: most commonly right ventricular dysfunction (10, 19%), pericardial effusion (9, 17%), and hypovolemia (6, 11%). TEE ruled out major cardiac injury in 83% of cases. TEE changed resuscitative strategy, in 17 (32%) patients, diagnostic imaging approach in 6 (11%) patients, procedural or operative approach in 5 (9%) patients and disposition from the trauma bay in 4 (7%) patients. CONCLUSION Resuscitative TEE during acute trauma care has an additional diagnostic yield to existing diagnostic pathways and may impact definitive management for some patients in the trauma bay.
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Affiliation(s)
- Ross Prager
- Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
| | - Eric Walser
- Western University, Department of Surgery, Division of Critical Care Medicine, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria HospitalLondon Health Sciences Centre, 800 Commissioners Road, East PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Kaan Y Balta
- Western University, Faculty of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
| | - M D Anton Nikouline
- Western University, Division of Emergency Medicine, Division of Critical Care Medicine, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria HospitalLondon Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - William R Leeper
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Kelly Vogt
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Neil Parry
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Robert Arntfield
- Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
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Lengquist M, Varadarajan A, Alestam S, Friberg H, Frigyesi A, Mellhammar L. Sepsis mimics among presumed sepsis patients at intensive care admission: a retrospective observational study. Infection 2024:10.1007/s15010-023-02158-w. [PMID: 38280062 DOI: 10.1007/s15010-023-02158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Diagnosing sepsis remains a challenge because of the lack of gold-standard diagnostics. Since there are no simple, broadly accepted criteria for infection, there is a risk of misclassifying sepsis patients (sepsis mimics) among patients with organ failure. The main objective of this study was to investigate the proportion of non-infected patients (sepsis mimics) in ICU patients with presumed sepsis at intensive care unit (ICU) admission. METHODS Adult patients were screened retrospectively during 3.5 years in four ICUs in Sweden for fulfilment of the sepsis-3 criteria at ICU admission (presumed sepsis). Proxy criteria for suspected infection were sampled blood culture(s) and concomitant antibiotic administration. Culture-negative presumed sepsis patients were screened for infection according to the Linder-Mellhammar Criteria of Infection (LMCI). Sepsis mimics were defined as without probable infection according to the LMCI. Confirmed sepsis was defined as presumed sepsis after the exclusion of sepsis mimics. RESULTS In the ICU presumed sepsis cohort (2664 patients), 25% were considered sepsis mimics. The most common reasons for ICU admission among sepsis mimics were acute heart failure and unspecific respiratory failure. Comparing sepsis mimics and confirmed sepsis showed that confirmed sepsis patients were slightly more severely ill but had similar mortality. C-reactive protein had modest discriminatory power (AUROC 0.71) with confirmed sepsis as the outcome. CONCLUSIONS One-fourth of a presumed ICU sepsis population identified with the sepsis-3 criteria could be considered sepsis mimics. The high proportion of sepsis mimics has a potential dilutional effect on the presumed sepsis population, which threatens the validity of results from sepsis studies using recommended sepsis criteria.
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Affiliation(s)
- Maria Lengquist
- Department of Clinical Medicine, Lund University, Lund, Sweden.
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.
| | - Anjali Varadarajan
- Department of Clinical Medicine, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Shiva Alestam
- Department of Clinical Medicine, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Medicine, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Malmö, Sweden
| | - Attila Frigyesi
- Department of Clinical Medicine, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Lisa Mellhammar
- Department of Clinical Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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Fukumi A, Tanaka M, Sugae A, Ishida Y, Yamamoto H, Watanabe T, Fukushima C, Miyauchi M, Teragaki M, Maeda K, Takami Y, Iwanari S, Ikeda M, Takeoka H. Hypereosinophilia-associated acute intradialytic hypotension: a report of three cases and literature review. CEN Case Rep 2024:10.1007/s13730-024-00850-w. [PMID: 38277067 DOI: 10.1007/s13730-024-00850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/31/2023] [Indexed: 01/27/2024] Open
Abstract
Occasionally, patients undergoing dialysis develop acute severe hypotension that requires interruption of dialysis within minutes of initiating every dialysis session. Although the underlying causes of recurrent intradialytic hypotension are evaluated extensively, including dialysis-associated allergic reactions or other possible causes, the definitive cause is sometimes missed. Dialysis is a life-sustaining procedure; therefore, prompt identification and management of the underlying cause of dialysis intolerance are crucial. Herein, we report three cases of patients undergoing dialysis who presented with hypereosinophilia-associated acute intradialytic hypotension. All three patients developed acute severe hypotension within minutes after the start of every dialysis session. The prescriptions for dialysis were changed, but episodes of intradialytic hypotension persisted. Pretreatment with methylprednisolone given intravenously before the dialysis session was also ineffective. All patients had hypereosinophilia (> 1500/μL) of different etiology. Eosinophil-lowering therapy with 0.5 mg/kg of prednisolone given orally daily was initiated, and all of them could restart dialysis without any hypotensive episodes within a few days. Our case report and literature review indicated that hypereosinophilia, regardless of its etiology, could result in severe acute hypotension shortly after the start of dialysis session. The oral administration of prednisolone daily was highly effective on hypereosinophilia-associated intradialytic hypotension, while pretreatment with intravenous corticosteroid therapy just before dialysis had no effect. Hypereosinophilia-associated acute intradialytic hypotension is an under-recognized condition; therefore, clinicians need to be aware of this clinical entity and initiate effective treatment strategies. We also provide a brief summary of previously published cases.
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Affiliation(s)
- Awaisshafiq Fukumi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Mari Tanaka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Akane Sugae
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yuki Ishida
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroko Yamamoto
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Tomoka Watanabe
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Chiho Fukushima
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Miho Miyauchi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Mariko Teragaki
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kotaro Maeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yohtaro Takami
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Sachio Iwanari
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Masaki Ikeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroya Takeoka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
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Dong JG, Lin GD, Qiu ZW. [Research progress on the application of non-nutritional effects of fat emulsion in the treatment of poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2024; 42:73-77. [PMID: 38311957 DOI: 10.3760/cma.j.cn121094-20221210-00588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Fat emulsion is a drug commonly used clinically for parenteral nutrition support in critically ill patients.With the development of the pharmaceutical industry, fat emulsion has formed a variety of different formulations, among which different types of fat emulsion have their own metabolic and body energy supply characteristics, and the application indications are also different. In addition to providing the supply of nutrients, the role of fat emulsion in anti-toxicity, immune regulation, anti-inflammatory, anti-shock, cardiopulmonary resuscitation and other aspects has gradually been discovered. This article reviews the existing evidence-based medical evidence and expounds the mechanism and therapeutic role of fat emulsion in the treatment of critically ill patients with poisoning. Its value in the treatment of critically ill patients with poisoning was discussed, and some references were provided for the application of non-nutritional functions of fat emulsion in the future.
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Affiliation(s)
- J G Dong
- Department of Critical Care Medicine, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin 300100, China
| | - G D Lin
- Department of Intensive Medicine, General Hospital of the Southern Theater Command of the Chinese People's Liberation Army, Guangzhou 510010, China Department of Chemical Injury Treatment, Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100071, China
| | - Z W Qiu
- Department of Chemical Injury Treatment, Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100071, China
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Battista S, Bima P, Forno D, Luzzi D, Pizzolato E, Ianniello A, Ponzetto F, Rumbolo F, Settanni F, Mengozzi G, Morello F, Lupia E. Plasma soluble suppression of tumorigenesis 2 measured in the emergency department for diagnosis and outcome prediction of sepsis: A single-center prospective study. Clin Chim Acta 2024; 553:117710. [PMID: 38141937 DOI: 10.1016/j.cca.2023.117710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND AIMS The diagnostic and prognostic performance of soluble Suppression of Tumorigenicity 2 (sST2) in suspected septic patients presenting to the Emergency Department (ED) is largely unknown. MATERIALS AND METHODS Patients were included in this prospective study if there was high suspicion of sepsis. The plasma level of sST2 was measured during initial ED evaluation. Outcomes were the evaluation of (1) sST2 diagnostic performance (alone and in combination with procalcitonin [PCT]), and (2) sST2 ability to predict 30-day and 90-day all-cause mortality. RESULTS Among 569 patients included, 481 (84.5 %) had sepsis or septic shock. Plasma sST2 levels were more elevated in septic patients (159 [71-331] vs 50 [31-103] ng/mL, P < 0.001). The AUC of sST2 for sepsis diagnosis was lower than the AUC of PCT (0.76 vs 0.85, P = 0.03). The best cut-off for sST2 was 61.7 ng/mL, with a sensitivity of 79.9 % and a specificity of 70.6 %. sST2 was able to correctly reclassify septic patients with PCT <0.5 (NRI 28.9 % [P = 0.02]). sST2 level was an independent predictor of 30-day mortality in a model including clinical variables (aHR 2.03 [1.24-3.33], C-index 0.69). CONCLUSION sST2 could be a useful adjunct in diagnosing sepsis and in all-cause mortality prediction.
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Affiliation(s)
- Stefania Battista
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Paolo Bima
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy; Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Daniela Forno
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Demetrio Luzzi
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Elisa Pizzolato
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Alice Ianniello
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Federico Ponzetto
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Francesca Rumbolo
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fabio Settanni
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Giulio Mengozzi
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fulvio Morello
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Enrico Lupia
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
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Olney KC, de Ávila C, Todd KT, Tallant LE, Barnett JH, Gibson KA, Hota P, Pandiane AS, Durgun PC, Serhan M, Wang R, Lind ML, Forzani E, Gades NM, Thomas LF, Fryer JD. Commonly disrupted pathways in brain and kidney in a pig model of systemic endotoxemia. J Neuroinflammation 2024; 21:9. [PMID: 38178237 PMCID: PMC10765757 DOI: 10.1186/s12974-023-03002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Sepsis is a life-threatening state that arises due to a hyperactive inflammatory response stimulated by infection and rarely other insults (e.g., non-infections tissue injury). Although changes in several proinflammatory cytokines and signals are documented in humans and small animal models, far less is known about responses within affected tissues of large animal models. We sought to understand the changes that occur during the initial stages of inflammation by administering intravenous lipopolysaccharide (LPS) to Yorkshire pigs and assessing transcriptomic alterations in the brain, kidney, and whole blood. Robust transcriptional alterations were found in the brain, with upregulated responses enriched in inflammatory pathways and downregulated responses enriched in tight junction and blood vessel functions. Comparison of the inflammatory response in the pig brain to a similar mouse model demonstrated some overlapping changes but also numerous differences, including oppositely dysregulated genes between species. Substantial changes also occurred in the kidneys following LPS with several enriched upregulated pathways (cytokines, lipids, unfolded protein response, etc.) and downregulated gene sets (tube morphogenesis, glomerulus development, GTPase signal transduction, etc.). We also found significant dysregulation of genes in whole blood that fell into several gene ontology categories (cytokines, cell cycle, neutrophil degranulation, etc.). We observed a strong correlation between the brain and kidney responses, with significantly shared upregulated pathways (cytokine signaling, cell death, VEGFA pathways) and downregulated pathways (vasculature and RAC1 GTPases). In summary, we have identified a core set of shared genes and pathways in a pig model of systemic inflammation.
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Affiliation(s)
- Kimberly C Olney
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Camila de Ávila
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Kennedi T Todd
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Lauren E Tallant
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA
| | - J Hudson Barnett
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA
- MD/PhD Training Program, Mayo Clinic, Scottsdale, AZ, USA
| | - Katelin A Gibson
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Piyush Hota
- Division of Nephrology & Hypertension, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | | | - Pinar Cay Durgun
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Michael Serhan
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Ran Wang
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Mary Laura Lind
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Erica Forzani
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Naomi M Gades
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Leslie F Thomas
- Division of Nephrology & Hypertension, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA.
| | - John D Fryer
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA.
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA.
- MD/PhD Training Program, Mayo Clinic, Scottsdale, AZ, USA.
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Najarro M, Briceño W, Rodríguez C, Muriel A, González S, Castillo A, Jara I, Rali P, Toma C, Bikdeli B, Jiménez D. Shock score for prediction of clinical outcomes among stable patients with acute symptomatic pulmonary embolism. Thromb Res 2024; 233:18-24. [PMID: 37988846 DOI: 10.1016/j.thromres.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/13/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The Composite Pulmonary Embolism Shock (CPES) score has been developed to identify normotensive patients with acute pulmonary embolism (PE) and a low cardiac index (referred to as normotensive shock). We aimed to externally assess the validity of this model for predicting a complicated course among hemodynamically stable patients with acute PE. METHODS Using prospectively collected data from the PROgnosTic valuE of Computed Tomography scan (PROTECT) study, we calculated the CPES score for each patient and the proportion of patients with a score > 3. We calculated the test performance characteristics to predict a complicated course (i.e., death from any cause, hemodynamic collapse, or recurrent PE) and the discriminatory power using the area under the receiver operating characteristic curve. RESULTS Sixty-three of the 848 (7.4 %) patients had a complicated course during the 30-day follow-up period. Of the 848 enrolled patients, the CPES score was positive (i.e., score > 3) in 78 (9.2 %). The specificity was 92.1 % (723/785), the positive predictive value was 20.5 % (16/78), and the positive likelihood ratio was 3.22 for a complicated course. The areas under the receiver operating characteristic curve for a complicated course were 0.71 (95 % confidence interval [CI], 0.65-0.78). With the higher score risk classification threshold (cutoff score > 4), the proportion of patients designated as positive was 2.1 %, and the specificity was 98.1 %. When echocardiographic right ventricle (RV) dysfunction was replaced by computed tomographic RV enlargement, the specificity was 85.4 %, the positive predictive value was 14.2 %, and the positive likelihood ratio was 2.06 for a complicated course. When analyses were restricted to the subgroup of patients with intermediate-risk PE, the specificity and the positive predictive value for a complicated course were identical to the overall cohort. CONCLUSIONS The CPES score has acceptable C-statistic, excellent specificity, and low positive predictive value for identification of hemodynamic deterioration in normotensive patients with PE. CLINICALTRIALS gov number: NCT02238639.
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Affiliation(s)
- Marta Najarro
- Emergency Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Winnifer Briceño
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Carmen Rodríguez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sara González
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ana Castillo
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ignacio Jara
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA.; Cardiovascular Research Foundation, New York, USA
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain; Medicine Department, Universidad de Alcalá, Madrid, Spain.
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Sanchez T, Coisy F, Grau-Mercier L, Occelli C, Ajavon F, Claret PG, Markarian T, Bobbia X. Is the shock index correlated with blood loss? An experimental study on a controlled hemorrhagic shock model in piglets. Am J Emerg Med 2024; 75:59-64. [PMID: 37922831 DOI: 10.1016/j.ajem.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The quantification of blood loss in a severe trauma patient allows prognostic quantification and the engagement of adapted therapeutic means. The Advanced Trauma Life Support classification of hemorrhagic shock, based in part on hemodynamic parameters, could be improved. The search for reproducible and non-invasive parameters closely correlated with blood depletion is a necessity. An experimental model of controlled hemorrhagic shock allowed us to obtain hemodynamic and echocardiographic measurements during controlled blood spoliation. The primary aim was to demonstrate the correlation between the Shock Index (SI) and blood depletion volume (BDV) during the hemorrhagic phase of an experimental model of controlled hemorrhagic shock in piglets. The secondary aim was to study the correlations between blood pressure (BP) values and BDV, SI and cardiac output (CO), and pulse pressure (PP) and stroke volume during the same phase. METHODS We analyzed data from 66 anesthetized and ventilated piglets that underwent blood spoliation at 2 mL.kg-1.min-1 until a mean arterial pressure (MAP) of 40 mmHg was achieved. During this bleeding phase, hemodynamic and echocardiographic measurements were performed regularly. RESULTS The correlation coefficient between the SI and BDV was 0.70 (CI 95%, [0.64; 0.75]; p < 0.01), whereas between MAP and BDV, the correlation coefficient was -0.47 (CI 95%, [-0.55; -0.38]; p < 0.01). Correlation coefficient between SI and CO and between PP and stroke volume were - 0.45 (CI 95%, [-0.53; -0.37], p < 0.01) and 0.62 (CI 95%, [0.56; 0.67]; p < 0.01), respectively. CONCLUSIONS In a controlled hemorrhagic shock model in piglets, the correlation between SI and BDV seemed strong.
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Affiliation(s)
- Thomas Sanchez
- University of Montpellier, Research Unit IMAGINE, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France.
| | - Fabien Coisy
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laura Grau-Mercier
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Céline Occelli
- University of Côte d'Azur, Faculty of Medecine, Transporter in Imaging and Radiotherapy in Oncology Laboratory, Basic Research Direction - Department of Emergency Medicine, Nice University Hospital, Nice, France
| | - Florian Ajavon
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- University of Aix-Marseille, UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE - Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Xavier Bobbia
- University of Montpellier, Research Unit IMAGINE, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Narayanaswamy V, Harohalli A V, Swamy RS, Nagesh N K. Correlation of Plethysmograph Variability Index with Inferior Vena Cava Index in Spontaneously Breathing Neonates - A Cross Sectional Study. Indian J Pediatr 2024; 91:81-83. [PMID: 37428310 DOI: 10.1007/s12098-023-04738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023]
Abstract
Inferior vena cava (IVC) indices are commonly used to assess the need for fluid bolus during shock. It needs expertise and is difficult to do during surgical procedures. Plethysmograph variability index (PVI) is a simpler non-invasive tool used to measure fluid responsiveness in adults. However, the data on PVI in neonates is limited. This cross-sectional observational study was done at a tertiary level NICU to correlate PVI and IVC among spontaneously breathing neonates. The PVI was documented using the Masimo Radical 7 pulse oximeter. The IVC collapsibility index (IVC CI) was determined by bedside ultrasound. The Spearman correlation coefficient was analyzed. The PVI showed strong positive correlation with IVC CI (rho = 0.64, 95% CI: 0.474-0.762) (p <0.001). Thus, PVI can be a useful tool for hemodynamic monitoring of neonates. However, further studies are needed before applying it to clinical use.
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Affiliation(s)
| | | | - Ravi Shankar Swamy
- Department of Neonatology, Manipal Hospital, Bangalore-560017, Karnataka, India
| | - Karthik Nagesh N
- Department of Neonatology, Manipal Hospital, Bangalore-560017, Karnataka, India.
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Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe dengue in the intensive care unit. J Intensive Med 2024; 4:16-33. [PMID: 38263966 PMCID: PMC10800775 DOI: 10.1016/j.jointm.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 01/25/2024]
Abstract
Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
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Affiliation(s)
- Alexandre Mestre Tejo
- Intensive Care Unit, Department of Intensive Medicine of the Cancer Institute of the State of São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Toshie Hamasaki
- Transfusion Medicine and Cell Therapy Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Letícia Mattos Menezes
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Choi D, Park JW, Kwak YH, Kim DK, Jung JY, Lee JH, Jung JH, Suh D, Lee HN, Lee EJ, Kim JH. Comparison of age-adjusted shock indices as predictors of injury severity in paediatric trauma patients immediately after emergency department triage: A report from the Korean multicentre registry. Injury 2024; 55:111108. [PMID: 37858444 DOI: 10.1016/j.injury.2023.111108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Shock index paediatric-adjusted (SIPA) was presented for early prediction of mortality and trauma team activation in paediatric trauma patients. However, the derived cut-offs of normal vital signs were based on old references. We established alternative SIPAs based on the other commonly used references and compared their predictive values. METHODS We performed a retrospective review of all paediatric trauma patients aged 1-15 years in the Emergency Department (ED)-based Injury In-depth Surveillance (EDIIS) database from January 1, 2011 to December 31, 2019. A total of 4 types of SIPA values were obtained based on the references as follows: uSIPA based on the Nelson textbook of paediatrics 21st ed., SIATLS based on the ATLS 10th guideline, SIPALS based on the PALS 2020 guideline, and SIPA. In each SIPA group, the cut-off was established by dividing the group into 4 subgroups: toddler (age 1-3), preschooler (age 4-6), schooler (age 7-12), and teenager (age 13-15). We performed an ROC analysis and calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to compare the predicted values of each SIPA in mortality, ICU admission, and emergent surgery or intervention. RESULTS A total of 332,271 patients were included. The proportion of patients with an elevated shock index was 14.9 % (n = 49,347) in SIPA, 22.8 % (n = 75,850) in uSIPA, 0.3 % (n = 1058) in SIATLS, and 4.3 % (n = 14,168) in SIPALS. For mortality, uSIPA achieved the highest sensitivity (57.0 %; 95 % confidence interval 56.9 %-57.2 %) compared to SIPA (49.4 %, 95 % CI 49.2 %-49.5 %), SIATLS (25.5 %, 95 % CI 25.4 %-25.7 %), and SIPALS (43.8 %, 95 % CI 43.7 %-44.0 %), but there were no significant differences in the negative predictive value (NPV) or area under the curve (AUC). The positive predictive value (PPV) was highest in SIATLS (5.7 %, 95 % CI 5.6 %-5.8 %) compared to SIPA (0.2 %, 95 % CI 0.2 %-0.3 %), uSIPA (0.2 %, 95 % CI 0.2 %-0.2 %), and SIPALS (0.7 %, 95 % CI 0.7 %-0.8 %). The same findings were presented in ICU admission and emergent operation or intervention. CONCLUSION The ATLS-based shock index achieved the highest PPV and specificity compared to SIPA, uSIPA, and SIPALS for adverse outcomes in paediatric trauma.
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Affiliation(s)
- Dongmuk Choi
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Hee Lee
- Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, Seong-Nam, 13620, Republic of Korea
| | - Jin Hee Jung
- Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Dongbum Suh
- Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, Seong-Nam, 13620, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Sa S, Li X, Liu X, Zhang M. Nursing care of severe splenic rupture in a patient with multiple injuries and rupture of papillary muscle and chordae tendinae of tricuspid valve caused by blunt chest trauma. Asian J Surg 2024; 47:707-709. [PMID: 37879986 DOI: 10.1016/j.asjsur.2023.09.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Shiying Sa
- Department of Intensive Care Unit, Shanghai East Hospital of Tongji University, China International Emergency Medical Team (Shanghai), Shanghai, 200123, China
| | - Xiaoqi Li
- Department of Intensive Care Unit, Shanghai East Hospital of Tongji University, China International Emergency Medical Team (Shanghai), Shanghai, 200123, China
| | - Xinyu Liu
- Department of Intensive Care Unit, Shanghai East Hospital of Tongji University, China International Emergency Medical Team (Shanghai), Shanghai, 200123, China
| | - Meiying Zhang
- Department of Intensive Care Unit, Shanghai East Hospital of Tongji University, China International Emergency Medical Team (Shanghai), Shanghai, 200123, China.
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Yu ZB, Cui N, Zhang N, Su D, Wu JQ, Xi XM. Prediction of fluid responsiveness for patients in shock using a ventilator disconnection test combined with the pulse contour-derived cardiac index. Technol Health Care 2024; 32:629-638. [PMID: 37522231 DOI: 10.3233/thc-220799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Finding a simple and reliable method to predict and assess fluid responsiveness has long been of clinical interest. OBJECTIVE To investigate the predictive value of a ventilator disconnection (DV) test combined with the pulse contour-derived cardiac output (PiCCO) index on fluid responsiveness for patients in shock. METHODS Thirty-two patients were chosen for the study. Patients who were in shock, received mechanical ventilation, and met the inclusion criteria were selected. Patients were divided into a fluid-responsive group (14 patients) and fluid-unresponsive group (18 patients) based on whether the increase in cardiac index (Δ CI) was > 10% or not, respectively, following the fluid challenge test. Changes in heart rate, pulse oximeter-measured oxygen saturation, mean arterial pressure (MAP), and CI before and after passive leg raising (PLR), DV, and fluid challenge tests were observed. We used Pearson's correlation coefficient to analyze an increase in the MAP (Δ MAP) and Δ CI before and after the PLR, DV, and fluid challenge tests; the sensitivity and specificity of the Δ MAP and Δ CI in the PLR and DV tests for predicting fluid response were also analyzed by plotting the receiver operating characteristic (ROC) curves. RESULTS CI results in the PLR and DV tests, as well as the fluid challenge test, were significantly higher in the fluid-responsive group compared with before the test (P< 0.05). The Δ CI before and after the PLR, DV, and fluid challenge tests were positively correlated among patients in the fluid-responsive group. The area under the ROC curve for the post-PLR test CI and the post-DV CI for predicting fluid responsiveness was 0.869 (95% confidence interval (CI) [0.735-1.000, P= 0.000]) and 0.937 (95% CI [0.829-1.000, P= 0.000]), respectively, in patients in the fluid-responsive group. The sensitivity and specificity of the post-DV CI for predicting fluid responsiveness in all patients was 100.0% and 88.9%, respectively, using a 5% increase as the cut-off value. CONCLUSION Application of DV, combined with PiCCO, has a high predictive value for fluid responsiveness among patients in shock.
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Affiliation(s)
- Zhan-Biao Yu
- Intensive Care Unit, Fu Xing Hospital, Capital Medical University, Beijing, China
- Intensive Care Unit, Affiliated Hospital of HeBei University, Baoding, Hebei, China
| | - Na Cui
- Intensive Care Unit, Affiliated Hospital of HeBei University, Baoding, Hebei, China
| | - Nan Zhang
- Intensive Care Unit, Affiliated Hospital of HeBei University, Baoding, Hebei, China
| | - Dan Su
- Intensive Care Unit, Affiliated Hospital of HeBei University, Baoding, Hebei, China
| | - Jia-Qian Wu
- Intensive Care Unit, Affiliated Hospital of HeBei University, Baoding, Hebei, China
| | - Xiu-Ming Xi
- Intensive Care Unit, Fu Xing Hospital, Capital Medical University, Beijing, China
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46
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Zhang H, Xu Y, Huang X, Yang S, Li R, Wu Y, Zou X, Yu Y, Shang Y. Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom. J Intensive Med 2024; 4:62-72. [PMID: 38263962 PMCID: PMC10800772 DOI: 10.1016/j.jointm.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 01/25/2024]
Abstract
Sepsis and septic shock remain the leading causes of death in intensive care units. Some patients with sepsis fail to respond to routine treatment and rapidly progress to refractory respiratory and circulatory failure, necessitating extracorporeal membrane oxygenation (ECMO). However, the role of ECMO in adult patients with sepsis has not been fully established. According to existing studies, ECMO may be a viable salvage therapy in carefully selected adult patients with sepsis. The choice of venovenous, venoarterial, or hybrid ECMO modes is primarily determined by the patient's oxygenation and hemodynamics (distributive shock with preserved cardiac output, septic cardiomyopathy (left, right, or biventricular heart failure), or right ventricular failure caused by acute respiratory distress syndrome). Veno-venous ECMO can be used in patients with sepsis and severe acute respiratory distress syndrome when conventional mechanical ventilation fails, and early application of veno-arterial ECMO in patients with sepsis-induced refractory cardiogenic shock may be critical in improving their chances of survival. When ECMO is indicated, the choice of an appropriate mode and determination of the optimal timing of initiation and weaning are critical, particularly in an experienced ECMO center. Furthermore, some special issues, such as ECMO flow, anticoagulation, and antibiotic therapy, should be noted during the management of ECMO support.
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Affiliation(s)
- Hongling Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
- Department of Intensive Care Unit, Affiliated Lu'an Hospital, Anhui Medical University, Lu'an, Anhui, 237000, China
| | - Youdong Xu
- Department of Intensive Care Unit, Affiliated Lu'an Hospital, Anhui Medical University, Lu'an, Anhui, 237000, China
| | - Xin Huang
- Department of Intensive Care Unit, Affiliated Lu'an Hospital, Anhui Medical University, Lu'an, Anhui, 237000, China
| | - Shunyin Yang
- Department of Intensive Care Unit, Affiliated Lu'an Hospital, Anhui Medical University, Lu'an, Anhui, 237000, China
| | - Ruiting Li
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Yongran Wu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Xiaojing Zou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Yuan Yu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
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47
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Kim DJ, Atkinson P, Sheppard G, Chenkin J, Thavanathan R, Lewis D, Bell CR, Jelic T, Lalande E, Buchanan IM, Heslop CL, Burwash-Brennan T, Myslik F, Olszynski P. POCUS literature primer: key papers on POCUS in cardiac arrest and shock. CAN J EMERG MED 2024; 26:15-22. [PMID: 37996693 DOI: 10.1007/s43678-023-00611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The objective of this study is to identify the top five most influential papers published on the use of point-of-care ultrasound (POCUS) in cardiac arrest and the top five most influential papers on the use of POCUS in shock in adult patients. METHODS An expert panel of 14 members was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. The members of the panel are ultrasound fellowship trained or equivalent, are engaged in POCUS research, and are leaders in POCUS locally and nationally in Canada. A modified Delphi process was used, consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers for the use of POCUS in cardiac arrest and shock. RESULTS The panel identified 39 relevant papers on POCUS in cardiac arrest and 42 relevant papers on POCUS in shock. All panel members participated in all three rounds of the modified Delphi process, and we ultimately identified the top five most influential papers on POCUS in cardiac arrest and also on POCUS in shock. Studies include descriptions and analysis of safe POCUS protocols that add value from a diagnostic and prognostic perspective in both populations during resuscitation. CONCLUSION We have developed a reading list of the top five influential papers on the use of POCUS in cardiac arrest and shock to better inform residents, fellows, clinicians, and researchers on integrating and studying POCUS in a more evidence-based manner.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rajiv Thavanathan
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Ian M Buchanan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Claire L Heslop
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Talia Burwash-Brennan
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Hsu CW, Chang CC, Lin CS. Intraoperative cardiogenic shock induced by refractory coronary artery spasm in a patient with myasthenia gravis: A case report. World J Clin Cases 2023; 11:8589-8594. [PMID: 38188219 PMCID: PMC10768507 DOI: 10.12998/wjcc.v11.i36.8589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Coronary artery spasm (CAS) is a rare but critical condition during surgery. Clinical manifestations can vary from only subtle electrocardiography change to sudden death. In this case report, we present the case of a patient with myasthenia gravis (MG) who developed refractory CAS-related cardiogenic shock during thymoma surgery. CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed. Three months ago, he suffered from coronary spasms, with three vessels involved, after surgery for cervical spine injury. He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests, and computed tomography declared a thymoma in the anterior mediastinum. After the symptoms of MG subsided, he was referred for thymectomy. The operation was uneventful until the closing of the sternal wound. Electrocardiography showed sudden onset ST elevation, followed by ventricular tachycardia and severe hypotension. Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation, extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock, and the patient was transferred to an angiography room. Angiography showed diffuse CAS with three vessels involved. Intracoronary isosorbide dinitrate and adenosine were administered, and then the patient was transferred to the intensive care unit. CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vasodilators.
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Affiliation(s)
- Cheng-Wei Hsu
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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Dong H, Ding Y, Lai J, Yu L, Shen X. Fulminant type 1 diabetes with Shock rescue: a case report. Endocrine 2023:10.1007/s12020-023-03646-7. [PMID: 38145440 DOI: 10.1007/s12020-023-03646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/03/2023] [Indexed: 12/26/2023]
Abstract
The shock in diabetes often requires rapid and adequate fluid administration, however, we report an anomalous case of fulminant type 1 diabetes mellitus (FT1DM) in which the patient's condition worsened following fluid administration. In May 2020, a 29-year-old male presented with blood glucose of 89.8 mmol/L and diabetic ketoacidosis after a week of gastroenteritis. The diagnosis was finalized after C-peptide and Hemoglobin A1c (HbA1c) measurement. The patient was admitted with shock and received a positive fluid balance of 2800 ml in 5 h, but his condition deteriorated and progressed to multi-organ failure. This study attempts to explain the possible mechanisms and focuses on high-risk factors associated with FT1DM. Therefore, meticulous monitoring and individualized fluid administration strategies are crucial for the management of FT1DM. This case provides beneficial insights for clinical treatment of this condition.
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Affiliation(s)
- Hongliang Dong
- Department of Critical Care Medicine, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
| | - Yingying Ding
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China.
| | - Jiawei Lai
- Department of Critical Care Medicine, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
| | - Linfeng Yu
- Department of Critical Care Medicine, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
| | - Xiaoyuan Shen
- Department of Critical Care Medicine, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
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50
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Nishihira K, Honda S, Takegami M, Kojima S, Takahashi J, Itoh T, Watanabe T, Yamashita J, Saji M, Tsujita K, Takayama M, Sumiyoshi T, Kimura K, Yasuda S. Percutaneous coronary intervention for ST-elevation myocardial infarction complicated by cardiogenic shock in a super-aging society. Eur Heart J Acute Cardiovasc Care 2023; 12:847-855. [PMID: 37724765 DOI: 10.1093/ehjacc/zuad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
AIMS ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMICS) is associated with substantial mortality. As life expectancy increases, percutaneous coronary intervention (PCI) is being performed more frequently, even in elderly patients with acute myocardial infarction (AMI). This study sought to investigate the characteristics and impact of PCI on in-hospital mortality in patients with STEMICS. METHODS AND RESULTS The Japan AMI Registry (JAMIR) is a retrospective, nationwide, real-world database. Among 46 242 patients with AMI hospitalized in 2011-2016, 2760 patients with STEMICS (median age, 72 years) were studied. We compared 2396 (86.8%) patients who underwent PCI with 364 (13.2%) patients who did not. The percentage of mechanical circulatory support use in patients with STEMICS was 69.3% and in-hospital mortality was 34.6%. Compared with patients who did not undergo PCI, patients undergoing PCI were younger and had a higher rate of intra-aortic balloon pump use. A higher proportion was male or current smokers. In-hospital mortality was significantly lower in the PCI group than in the no-PCI group (31.3% vs. 56.0%, P < 0.001). Percutaneous coronary intervention was independently associated with lower in-hospital mortality [adjusted odds ratio (OR), 0.508; 95% confidence interval (CI), 0.347-0.744]. In 789 (28.6%) patients aged ≥80 years, PCI was associated with fewer in-hospital cardiac deaths (adjusted OR, 0.524; 95% CI, 0.281-0.975), but was not associated with in-hospital mortality (adjusted OR, 0.564; 95% CI, 0.300-1.050). CONCLUSION In Japan, PCI was effective in reducing in-hospital cardiac death in elderly patients with STEMICS. Age alone should not preclude potentially beneficial invasive therapy.
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Affiliation(s)
- Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital, 1173 Arita, Miyazaki 880-2102, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sunao Kojima
- Department of Cardiology, Sakura-jyuji Yatsushiro Rehabilitation Hospital, Kumamoto, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomonori Itoh
- Division of Community Medicine, Department of Medical Education/Division of Cardiology, Department of Medicine, Iwate Medical University, Morioka, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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