Journal of Critical Care Medicine最新文献

{"title":"Understanding the Difficulties in Diagnosing Neonatal Sepsis: Assessing the Role of Sepsis Biomarkers.","authors":"Nicoleta Lungu, Ana-Maria-Cristina Jura, Daniela-Eugenia Popescu, Florin George Horhat, Aniko Maria Manea, Marioara Boia","doi":"10.2478/jccm-2024-0039","DOIUrl":"10.2478/jccm-2024-0039","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis is a serious condition with high rates of morbidity and mortality, caused by the rapid growth of microorganisms that trigger a systemic reaction. Symptoms can range from mild to severe presentations. The causative microorganism is usually transmitted from mothers, especially from the urogenital tract, or can originate from the community or hospital.</p><p><strong>Methods: </strong>Our retrospective study assessed 121 newborns, including both preterm and term infants, divided into three groups within the first 28 days of life: early-onset sepsis (35), late-onset sepsis (39), and a control group (47). Blood samples and cultures were obtained upon admission or at the onset of sepsis (at 24 and 72 hours). The study aimed to evaluate the limitations of commonly used biomarkers and new markers such as lactate dehydrogenase and ferritin in more accurately diagnosing neonatal sepsis.</p><p><strong>Results: </strong>Our study revealed a significant difference between the initial and final measures of lactate dehydrogenase (LDH) and ferritin in the early-onset sepsis (EOS) and late-onset sepsis (LOS) groups.</p><p><strong>Conclusion: </strong>Ferritin and LDH may serve as potential markers associated with systemic response and sepsis in cases of both early and late-onset sepsis. Monitoring these biomarkers can aid in the timely detection and management of sepsis, potentially improving patient outcomes.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 4","pages":"316-328"},"PeriodicalIF":0.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Correlation of Hemostatic Parameters with the Development of Early Sepsis-Associated Encephalopathy. A Retrospective Observational Study.","authors":"Florin Scarlatescu, Ecaterina Scarlatescu, Dana Rodica Tomescu, Daniela Bartos","doi":"10.2478/jccm-2024-0040","DOIUrl":"10.2478/jccm-2024-0040","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis-associated encephalopathy (SAE) is one of the most common complications seen both in early and late stages of sepsis, with a wide spectrum of clinical manifestations ranging from mild neurological dysfunction to delirium and coma. The pathophysiology of SAE is still not completely understood, and the diagnosis can be challenging especially in early stages of sepsis and in patients with subtle symptoms.</p><p><strong>Aim of the study: </strong>The objective of this study was to assess the coagulation profile in patients with early SAE and to compare the hemostatic parameters between septic patients with and without SAE in the first 24 hours from sepsis diagnosis.</p><p><strong>Material and methods: </strong>This retrospective observational study included 280 patients with sepsis in the first 24 hours after sepsis diagnosis. A complete blood count was available in all patients; a complex hemostatic assessment including standard coagulation tests, plasmatic levels of coagulation factors, inhibitors, D-dimers, and Rotation thromboelastometry (ROTEM, Instrumentation Laboratory) was performed in a subgroup of patients.</p><p><strong>Results: </strong>Early SAE was diagnosed in 184 patients (65.7%) and was correlated with a higher platelet count, after adjusting for age and leucocyte count. Compared to patients without neurological dysfunction, patients with early SAE presented a more active coagulation system revealed by faster propagation phase, increased clot firmness and elasticity with a higher platelet contribution to clot strength. The initiation of coagulation and clot lysis were not different between the groups.</p><p><strong>Conclusion: </strong>In the early stages of sepsis, the development of SAE is correlated with increased systemic clotting activity where platelets seem to have an important role. More research is needed to investigate the role of platelets and the coagulation system in relation to the development of early SAE.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 4","pages":"329-336"},"PeriodicalIF":0.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracheoesophageal Iatrogenic Fistulas in ICU: Still a Pandora's Box?","authors":"Radu Stoica","doi":"10.2478/jccm-2024-0044","DOIUrl":"https://doi.org/10.2478/jccm-2024-0044","url":null,"abstract":"","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 4","pages":"289-290"},"PeriodicalIF":0.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Analgesic Effect of Morphine on Peripheral Opioid Receptors: An Experimental Research.","authors":"Nader-Mugurel Jafal, Smaranda Stoleru, Aurelian Zugravu, Carmen Orban, Mihai Popescu, Ruxandra Cristina Marin, Ion-Gigel Fulga","doi":"10.2478/jccm-2024-0042","DOIUrl":"10.2478/jccm-2024-0042","url":null,"abstract":"<p><p>Opioids represent one of the key pillars in postoperative pain management, but their use has been associated with a variety of serious side effects. Thus, it is crucial to investigate the timing and course of opioid administration in order to ensure a best efficacy to side-effect profile. The aim of our article was to investigate the analgesic effects of locally administered morphine sulfate (intraplantar) in a carrageenan-induced inflammation model in rats. After carrageenan administration, the rats were divided into 10 equal groups and were injected with either morphine 5 mg/kg or 0.9% saline solution at different time intervals, depending on the assigned group. The analgesic effect was assessed through thermal stimulation. Our results showed that paw withdrawal time was significantly higher in rats treated with morphine compared to those in the control group 9.18 ± 3.38 compared to 5.14 ± 2.21 seconds, p=0.012). However, differences were more pronounced at certain time intervals post-carrageenan administration (at 180 minutes compared to 360 minutes, p=0.003 and at 180 minutes compare to 1440 minutes p<0.001), indicating that efficacy varies depending on the timing of treatment. In conclusion, our findings support the hypothesis that locally administered morphine may alleviate pain under inflammatory conditions and underscores the importance of considering treatment timing when evaluating the analgesic effect.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 4","pages":"337-344"},"PeriodicalIF":0.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Quetiapine in the Prevention of ICU Delirium in Elderly Patients at a High Risk.","authors":"Walid Y Kamel, Heba Y Kamel, Ibrahim M Elsherif","doi":"10.2478/jccm-2024-0032","DOIUrl":"10.2478/jccm-2024-0032","url":null,"abstract":"<p><strong>Background: </strong>The aim of the present study was to denote the effectiveness of Quetiapine as additive to preventive bundle of delirium in elderly patients with multiple risks for delirium.</p><p><strong>Patients and methods: </strong>The study was performed on 90 elderly patients over 60 years. The patients were divided into Group Q (Quetiapine) and Group C (No Quetiapine). Delirium was assessed using Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the ICU (CAM-ICU).</p><p><strong>Results: </strong>The incidence of delirium was significantly higher in group C. The severity of delirium was higher among group C; however, it was not statistically significant. The dominant type of delirium was hypoactive in group Q whereas hyperactive in group C. The interrater reliability between CAM-ICU-7 and ICDSE showed a kappa 0.98 denoting excellent correlation between the two scores. Somnolence was the most common side effect of Quetiapine (25%) followed by dry mouth (18%).</p><p><strong>Conclusions: </strong>Prophylactic low dose of Quetiapine in elderly population in the preventive bundle could reduce the incidence of delirium with a low incidence of a major side effect, as well as CAM-ICU-7 is as effective as ICDSC in monitoring and early diagnosis of delirium.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 4","pages":"361-367"},"PeriodicalIF":0.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine Disorders in Critically Ill Patients - The Smooth Criminal?","authors":"Bianca-Liana Grigorescu, Raluca Ștefania Fodor","doi":"10.2478/jccm-2024-0034","DOIUrl":"10.2478/jccm-2024-0034","url":null,"abstract":"","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 3","pages":"195-197"},"PeriodicalIF":0.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Efficiency of the Newly Developed Needle in Emergency Room: A Single-Center Observational Study.","authors":"Yuki Kishihara, Hideto Yasuda, Masahiro Kashiura, Takatoshi Oishi, Yutaro Shinzato, Takashi Moriya","doi":"10.2478/jccm-2024-0025","DOIUrl":"10.2478/jccm-2024-0025","url":null,"abstract":"<p><strong>Aim of the study: </strong>Peripheral intravascular catheter (PIVC) insertion is frequently performed in the emergency room (ER) and many failures of initial PIVC insertion occur. To reduce the failures, new needles were developed. This study aimed to investigate whether the use of the newly developed needle reduced the failure of initial PIVC insertion in the ER compared with the use of the existing needle.</p><p><strong>Material and methods: </strong>This single-centre, prospective observational study was conducted in Japan between April 1, 2022, and February 2, 2023. We included consecutive patients who visited our hospital by ambulance as a secondary emergency on a weekday during the day shift (from 8:00 AM to 5:00 PM). The practitioners for PIVC insertion and assessors were independent. The primary and secondary outcomes were the failure of initial PIVC insertion and number of procedures, respectively. We defined the difficulty of titrating, leakage, and hematoma within 30 s after insertion as failures. To evaluate the association between the outcomes and the use of newly developed needles, we performed multivariate logistic regression and multiple regression analyses by adjusting for covariates.</p><p><strong>Results: </strong>In total, 522 patients without missing data were analysed, and 81 (15.5%) patients showed failure of initial PIVC insertion. The median number of procedures (interquartile range) was 1 (1-1). Multivariate logistic regression analysis revealed no significant association between the use of newly developed PIVCs and the failure of initial PIVC insertion (odds ratio, 0.79; 95% confidence interval, [0.48-1.31]; p = 0.36). Moreover, multiple regression analysis revealed no significant association between the use of newly developed PIVCs and the number of procedures (regression coefficient, -0.0042; 95% confidence interval, [-0.065-0.056]; p = 0.89).</p><p><strong>Conclusions: </strong>Our study did not show a difference between the two types of needles with respect to the failure of initial PIVC insertion and the number of procedures.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 3","pages":"213-221"},"PeriodicalIF":0.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Calculous Cholecystitis Associated with Leptospirosis: Which is the Emergency? A Case Report and Literature Review.","authors":"Renata Moriczi, Mircea Gabriel Muresan, Radu Neagoe, Daniela Sala, Arpad Torok, Tivadar Bara, Ioan Alexandru Balmos, Razvan Ion, Anca Meda Vasiesiu","doi":"10.2478/jccm-2024-0033","DOIUrl":"10.2478/jccm-2024-0033","url":null,"abstract":"<p><strong>Introduction: </strong>Leptospirosis is a bacterium with a worldwide distribution and belongs to the group of zoonoses that can affect both humans and animals. Most cases of leptospirosis present as a mild, anicteric infection. However, a small percentage of cases develop Weil's disease, characterized by bleeding and elevated levels of bilirubin and liver enzymes. It can also cause inflammation of the gallbladder. Acute acalculous cholecystitis has been described as a manifestation of leptospirosis in a small percentage of cases; however, no association between leptospirosis and acute acalculous cholecystitis has been found in the literature.</p><p><strong>Case presentation: </strong>In this report, we describe the case of a 66-year-old patient who presented to the emergency department with a clinical picture dominated by fever, an altered general condition, abdominal pain in the right hypochondrium, nausea, and repeated vomiting. Acute calculous cholecystitis was diagnosed based on clinical, laboratory, and imaging findings. During preoperative preparation, the patient exhibited signs of liver and renal failure with severe coagulation disorders. Obstructive jaundice was excluded after performing an abdominal ultrasound and computed tomography scan. The suspicion of leptospirosis was then raised, and appropriate treatment for the infection was initiated. The acute cholecystitis symptoms went into remission, and the patient had a favorable outcome. Surgery was postponed until the infection was treated entirely, and a re-evaluation of the patient's condition was conducted six-week later.</p><p><strong>Conclusions: </strong>The icterohemorrhagic form of leptospirosis, Weil's disease, can mimic acute cholecystitis, including the form with gallstones. Therefore, to ensure an accurate diagnosis, leptospirosis should be suspected if the patient has risk factors. However, the order of treatments is not strictly established and will depend on the clinical picture and the patient's prognosis.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 3","pages":"271-278"},"PeriodicalIF":0.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11294982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Machine Learning-Based Model for Predicting the Incidence of Peripheral Intravenous Catheter-Associated Phlebitis.","authors":"Hideto Yasuda, Claire M Rickard, Olivier Mimoz, Nicole Marsh, Jessica A Schults, Bertrand Drugeon, Masahiro Kashiura, Yuki Kishihara, Yutaro Shinzato, Midori Koike, Takashi Moriya, Yuki Kotani, Natsuki Kondo, Kosuke Sekine, Nobuaki Shime, Keita Morikane, Takayuki Abe","doi":"10.2478/jccm-2024-0028","DOIUrl":"10.2478/jccm-2024-0028","url":null,"abstract":"<p><strong>Introduction: </strong>Early and accurate identification of high-risk patients with peripheral intravascular catheter (PIVC)-related phlebitis is vital to prevent medical device-related complications.</p><p><strong>Aim of the study: </strong>This study aimed to develop and validate a machine learning-based model for predicting the incidence of PIVC-related phlebitis in critically ill patients.</p><p><strong>Materials and methods: </strong>Four machine learning models were created using data from patients ≥ 18 years with a newly inserted PIVC during intensive care unit admission. Models were developed and validated using a 7:3 split. Random survival forest (RSF) was used to create predictive models for time-to-event outcomes. Logistic regression with least absolute reduction and selection operator (LASSO), random forest (RF), and gradient boosting decision tree were used to develop predictive models that treat outcome as a binary variable. Cox proportional hazards (COX) and logistic regression (LR) were used as comparators for time-to-event and binary outcomes, respectively.</p><p><strong>Results: </strong>The final cohort had 3429 PIVCs, which were divided into the development cohort (2400 PIVCs) and validation cohort (1029 PIVCs). The c-statistic (95% confidence interval) of the models in the validation cohort for discrimination were as follows: RSF, 0.689 (0.627-0.750); LASSO, 0.664 (0.610-0.717); RF, 0.699 (0.645-0.753); gradient boosting tree, 0.699 (0.647-0.750); COX, 0.516 (0.454-0.578); and LR, 0.633 (0.575-0.691). No significant difference was observed among the c-statistic of the four models for binary outcome. However, RSF had a higher c-statistic than COX. The important predictive factors in RSF included inserted site, catheter material, age, and nicardipine, whereas those in RF included catheter dwell duration, nicardipine, and age.</p><p><strong>Conclusions: </strong>The RSF model for the survival time analysis of phlebitis occurrence showed relatively high prediction performance compared with the COX model. No significant differences in prediction performance were observed among the models with phlebitis occurrence as the binary outcome.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 3","pages":"232-244"},"PeriodicalIF":0.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Multifactorial Deep Vein Thrombosis in an Adolescent: A Complex Case Report.","authors":"Măriuca Mănescu, Alina Grama, Andreea Ligia Dincă, Mihaela Chinceșan","doi":"10.2478/jccm-2024-0024","DOIUrl":"10.2478/jccm-2024-0024","url":null,"abstract":"<p><strong>Introduction: </strong>Although rarely diagnosed in the pediatric population, deep vein thrombosis (DVT) is experiencing a growing incidence, while continuously acquiring different nuances due to the widening range of risk factors and lifestyle changes in children and adolescents.</p><p><strong>Case presentation: </strong>A 17-year-old female within four weeks after child delivery was admitted to our clinic due to a six-month history of pain in the left hypochondriac region. After a thorough evaluation, the presence of a benign splenic cyst was revealed, which was later surgically removed. Following the intervention, the patient developed secondary thrombocytosis and bloodstream infection which, together with pre-existing risk factors (obesity, compressive effect of a large cyst, the postpartum period, the presence of a central venous catheter, recent surgery, and post-operative mobilization difficulties) led to the occurrence of extensive DVT, despite anticoagulant prophylaxis and therapy with low-molecular-weight heparin.</p><p><strong>Conclusions: </strong>DVT raises many challenges for the pediatrician, requiring a personalized approach. Although rare, pediatric patients with multiple concomitant high-risk factors should benefit from interdisciplinary care as DVT may not respond to standard therapy in such cases and rapidly become critical. Continual efforts to better understand and treat this condition will contribute to improved outcomes for pediatric patients affected by DVT.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"10 3","pages":"261-265"},"PeriodicalIF":0.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}