Journal of Critical Care Medicine最新文献

{"title":"The Predictive Potential of Elevated Serum Inflammatory Markers in Determining the Need for Intubation in CoVID-19 Patients","authors":"S. Windham, Kellen Hirsch, R. Peterson, David Douin, Lakshmi Chauhan, Lauren M Heery, Connor Fling, Nemanja Vukovic, F. Holguin, Shanta Zimmer, Kristine M. Erlandson","doi":"10.2478/jccm-2021-0035","DOIUrl":"https://doi.org/10.2478/jccm-2021-0035","url":null,"abstract":"Abstract Introduction The predictive potential of demographics, clinical characteristics, and inflammatory markers at admission to determine future intubation needs of hospitalised CoVID-19 patients is unknown. The study aimed to determine the predictive potential of elevated serum inflammatory markers in determining the need for intubation in CoVID-19 Patients. Methods In a retrospective cohort study of hospitalised SARS-CoV2 positive patients, single and multivariable regression analyses were used to determine covariate effects on intubation odds, and a minimax concave penalty regularised logistic regression was used to build a predictive model. A second prospective independent cohort tested the model. Results Systemic inflammatory markers obtained at admission were higher in patients that required subsequent intubation, and adjusted odds of intubation increased for every standard deviation above the mean for c-reactive protein (CRP) OR:2.8 (95% CI 1.8-4.5, p<0.001) and lactate dehydrogenase OR:2.1 (95% CI 1.33.3, p=0.002). A predictive model incorporating C-reactive protein, lactate dehydrogenase, and diabetes status at the time of admission predicted intubation status with an area under the curve (AUC) of 0.78 with corresponding sensitivity of 86%, specificity of 63%. This predictive model achieved an AUC of 0.83, 91% sensitivity, and 41% specificity on the validation cohort. Conclusion In patients hospitalised with CoVID-19, elevated serum inflammatory markers measured within the first twenty-four hours of admission are associated with an increased need for intubation. Additionally, a model of C-reactive protein, lactate dehydrogenase, and the presence of diabetes may play a predictive role in determining the future need for intubation.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"8 1","pages":"14 - 22"},"PeriodicalIF":1.1,"publicationDate":"2021-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47472400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. the Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: a Case Report","authors":"Sarah A. Bachman, Ryan S. Peterson, P. Burrage, Leigh C. Hickerson","doi":"10.2478/jccm-2021-0038","DOIUrl":"https://doi.org/10.2478/jccm-2021-0038","url":null,"abstract":"Abstract Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"8 1","pages":"55 - 60"},"PeriodicalIF":1.1,"publicationDate":"2021-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43478679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Medicine and its Role in the Treatment of Sepsis: A Personalised View","authors":"A. Lazăr, A. Georgescu, A. Vitin, L. Azamfirei","doi":"10.2478/jccm-2019-0017","DOIUrl":"https://doi.org/10.2478/jccm-2019-0017","url":null,"abstract":"Abstract In recent years, a new form of medicine has become increasingly significant, namely, personalised medicine (PM). PM is a form of care in which treatment is tailored for an individual patient. PM is about using multiple data sets to create a digital human mapping. A person’s biological traits are determined by the interactions of hundreds of genes and gene networks, as well as external factors such as diet and exercise. Combining and then investigating these multiple databases with powerful statistical tools, allows a new understanding of how genetic intricacy drives health and disease and so leads to a closer personalised medical approach that targets each individual’s unique genetic make-up. Sepsis is a systemic inflammatory response to infection, ranging from systemic inflammatory response syndrome (SIRS) to septic shock and multiple organ dysfunction syndromes (MODS). Sepsis is the most common cause of death in intensive care patients. Treatments in an ICU may need to be adapted to the continuous and rapid changes of the disease, making it challenging to identify a single target. PM is thus seen as the future of sepsis treatment in the ICU. The fact that individual patients respond differently to treatment should be regarded as a starting point in the approach to providing treatment. The disease itself comes secondary to this concept.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"5 1","pages":"90 - 96"},"PeriodicalIF":1.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2478/jccm-2019-0017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48035225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Management of a Thirteen Weeks Pregnant Woman Rendered Brain-Dead Following a Ruptured Aneurysm","authors":"Iwona Pikto-Pietkiewicz, Antoni Okniński, Rafał Wójtowicz, M. Wojtowicz","doi":"10.2478/jccm-2019-0015","DOIUrl":"https://doi.org/10.2478/jccm-2019-0015","url":null,"abstract":"Abstract Introduction The current lack of clear guidelines on how to manage cases of brain-dead pregnant patients makes this topic controversial and extremely difficult to deal with for both medical and ethical reasons. This report deals with such a situation. Case presentation A twenty-seven years old woman, thirteen weeks pregnant, with a ruptured brain aneurysm was admitted to an Intensive Care Unit. She presented with loss of all brain functions, but somatic support was sustained to enable the delivery of her baby. Conclusion The case report gives a detailed account of the management of the mother before the successful delivery of her baby. It indicates the need for ongoing contributions to the debate on this delicate subject area to establish guidelines on how to manage brain-dead pregnant patients.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"5 1","pages":"111 - 114"},"PeriodicalIF":1.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48685238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Care for Organ Transplant Recipient: Time for Paradigm Shift","authors":"A. Vitin","doi":"10.2478/jccm-2019-0016","DOIUrl":"https://doi.org/10.2478/jccm-2019-0016","url":null,"abstract":"* Correspondence to: Alexander A. Vitin, Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle WA 98195 USA . E-mail: vitin@uw.edu Transplantation medicine, one of the emerging major medical disciplines, encompasses a wide variety of clinical subspecialties. The concept of replacing organs which are failing or showing insufficiency, with single or multiple organs, either artificial or from donors, is accepted in literally every clinical field There is explosive growth in the transplant sector driven by an ever-increasing patient demand fuelled by the already well-proven efficiency of organ transplantation as an ultimate treatment for end-stage organs failure and the ever-expanding infrastructure of the transplantation industry. The foundation of this industry rests on two pillars: transplantation medicine and transplantation science. The sheer magnitude of the progress within the transplantation industry, as it stands today, maybe best illustrated by impressive statistics and facts, accomplishments and ongoing research trends. Today, organ and tissue transplantation operations are being performed in more than one hundred and eleven countries, encompassing about 81 % of the world’s population. New countries are joining this club every year. Close to 140,000 organs are being transplanted every year worldwide. According to the most recently published OPTN data, in the USA alone, from January 1, 1988, to April 30, 2019, 451,847 kidney, 166,383 liver, 73,216 heart 38,989 lung, 23,959 kidneypancreas and numerous other organ transplantations have been performed in the more than eighty transplant programs. The current trend indicates an exponential increase in these numbers [1,2]. Fifteen international and more than 140 national organizations worldwide are ceaselessly promoting and coordinating research outcomes as well as implementing, developing and improving all practical aspects of organ donation and transplantation procedures. Ever since the very first successful solid organ transplants, transplantation-related science has exhibited an exponential growth. Physicians and researchers from many specialities are getting more involved in transplantation medicine, which has outgrown the boundaries of any one speciality and must now be considered a whole new field of medical science in its own right. Results of clinical and experimental research provide imposing and useful data for publication in a myriad of specialist publications worldwide. There are more than seventy-five periodic issues, among which more than forty high-impact journals which publish results of research. A PubMed search returned about 800,000 titles of the indexed publications pertinent to the field of transplantation. Perioperative care of organ transplant candidates or recipients is an exceedingly complex and multifaceted undertaking. It comprises three main components. Pre-operative care includes the selection of the proper candidate. At this ","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"5 1","pages":"87 - 89"},"PeriodicalIF":1.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48505883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of Cut-off Serum Values for Resistin and S100B Protein in Patients Who Survived a Cardiac Arrest","authors":"Raluca M. Tat, A. Golea, Ș. Vesa, D. Ionescu","doi":"10.2478/jccm-2019-0018","DOIUrl":"https://doi.org/10.2478/jccm-2019-0018","url":null,"abstract":"Abstract Introduction In an attempt to identify patients who have successfully survived a resuscitated cardiac arrest (CA), attention is drawn to resistin and S100B protein, two biomarkers that have been studied in relation to CA. Aim The study aimed to identify the potential cut-off serum values for resistin and S100B in patients who had CA, compared to healthy volunteers, given that, currently, none of the markers have normal and pathological reference range limits for human assay levels related to this pathology. Materials and Methods Forty patients, resuscitated after out-of-hospital CA and forty healthy controls, were included in the study. All patients were followed up for seventy-two hours after CA or until death. Blood samples for biomarkers were collected on admission to the ED (0-time interval) and at 6, 12, 24, 48 and 72 hours following resuscitation. Only one blood sample was collected from the controls. The serum concentrations of biomarkers were measured. Results For each time interval, median serum levels of resistin and S100 B were significantly higher in patients with CA compared to healthy controls. The cut-of value for resistin in patients with CA, at the 12-hours versus controls, was > 8.2 ng/ml. The cut-of value for S100B in patients with CA versus controls recorded at 6 hours, was > 11.6 pg/ml. Conclusion Serum levels of resistin and S100B are higher among resuscitated CA patients compared to controls.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"5 1","pages":"97 - 102"},"PeriodicalIF":1.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43062460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locked-In Syndrome Following Cervical Manipulation by a Chiropractor: A Case Report","authors":"G. Orsini, G. Metaxas, V. Legros","doi":"10.2478/jccm-2019-0014","DOIUrl":"https://doi.org/10.2478/jccm-2019-0014","url":null,"abstract":"Abstract Introduction Vertebrobasilar occlusion poses difficult diagnostic issues and even when properly diagnosed has a poor prognosis. Newer studies highlight a better outcome when thrombectomy was carried out between six and twenty-four hours after an initial diagnosis of stroke. This paper reports a case where a patient suffered a vertebrobasilar stroke secondary to a traumatic bilateral vertebral arteries dissection was treated with late thrombectomy. Case presentation A 34-year-old woman was manipulated on the cervical spinal column by a chiropractor. Following three weeks of cervical pain, she presented with severe aphasia and quadriplegia (NIHSS = 28). An MRI scan indicated ischemia of the vertebrobasilar system. Thirty-one hours after the onset of these symptoms, a thrombectomy was performed. After one month, the patient could move her head and the proximal part of her limbs but remained confined to bed (NIHSS = 13). Conclusion The current case illustrates the benefit of late mechanical thrombectomy for a posterior cerebral circulation infarct. Although there was a delay in treatment, partial recovery ensued.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"5 1","pages":"107 - 110"},"PeriodicalIF":1.1,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2478/jccm-2019-0014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48999164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serratia marcescens Sepsis in a Child with Deep Venous Thrombosis – A Case Report","authors":"Iulia Armean, C. Duicu, C. Aldea, L. Meliț","doi":"10.2478/jccm-2018-0004","DOIUrl":"https://doi.org/10.2478/jccm-2018-0004","url":null,"abstract":"Abstract Introduction: Venous thromboembolism is a rare condition in paediatrics that included both deep venous thrombosis and pulmonary embolism. Serratia marcescens is a gram-negative bacterium that belongs to the Enterobacteriaceae family and tends to affect immunocompromised hosts. Case report: We report the case of an 11-year-old boy, admitted in the Pediatric Clinic I from Emergency County Hospital Tîrgu Mureș, Romania with intense pain, swelling, cyanosis and claudication of the left foot. His personal history revealed a recent appendectomy. A close family was reported to have had a deep venous thrombosis. The laboratory tests, performed on the day of admission, revealed increased inflammatory biomarkers and D-dimer. Coagulation tests gave a low activated partial thromboplastin time (APTT). Doppler venous ultrasound and CT-exam established a diagnosis of deep venous thrombosis. Anticoagulant therapy was initiated, but on the tenth day of admission, the patient developed signs and symptoms of sepsis, and the blood culture revealed Serratia marcescens. After antibiotic and anticoagulant therapy, the patient progressed favourably. The patient was a carrier of the heterozygous form of Factor V Leiden. Conclusions: The association between deep venous thrombosis and Serratia marcescens sepsis can compromise a condition in pediatric patients.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"4 1","pages":"29 - 33"},"PeriodicalIF":1.1,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69216336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Pneumonectomy ARDS and Ogilvie Syndrome – A Case Report","authors":"R. Stoica, I. Cordoș, A. Macri","doi":"10.2478/jccm-2018-0007","DOIUrl":"https://doi.org/10.2478/jccm-2018-0007","url":null,"abstract":"Abstract Introduction: The Acute Respiratory Distress Syndrome (ARDS) is a severe hypoxemic acute lung injury that may complicate lung resections. Reported mortality is very high, up to 50%. This report covers an ARDS case occurring post left pneumonectomy, with a favorable outcome, despite association with an acute colonic pseudo-obstruction syndrome (Ogilvie syndrome) that required abdominal surgery for decompression. Case report: A 60-year old Caucasian male, diagnosed with a stage IIIA left lung tumor underwent a left pneumonectomy. On the second postoperative day, the patient developed ARDS, requiring ventilatory support. Two days later, as the multiple organ dysfunction worsened, a bowel obstruction occurred. With an acute colonic pseudo-obstruction diagnosis, the decision was to perform laparotomy and a temporary cecostomy. A subsequent improvement in the respiratory parameters and vital functions resulted in weaning from ventilator 8 days after the onset of the ARDS and transfer to the surgery ward 14 days after pneumonectomy.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"4 1","pages":"34 - 37"},"PeriodicalIF":1.1,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69216410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus","authors":"N. Yener, M. Paksu, Ö. Köksoy","doi":"10.2478/jccm-2018-0005","DOIUrl":"https://doi.org/10.2478/jccm-2018-0005","url":null,"abstract":"Abstract Introduction: Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of brain death, donation rates and occurrence of central diabetes insipidus accompanying brain death in children. Methods: This retrospective study was conducted at a twelve-bed tertiary-care combined medical and surgical pediatric intensive care unit of the Ondokuz Mayıs University Medical School, Samsun, Turkey. In 37 of 341 deaths (10.8%), a diagnosis of brain death was identified. The primary insult causing brain death was post-cardiorespiratory arrest in 8 (21.6%), head trauma in 8 (21.6%), and drowning in 4 (18.9%). In all patients, transcranial Doppler ultra-sound was utilised as an ancillary test and test was repeated until it was consistent with brain death. Results: In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The four patients not diagnosed with CDI had acute renal failure, and renal replacement treatment was carried out. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. Conclusion: In the current study the consent rate for organ donation is relatively low compared to the rest of the world. The prevalence of central diabetes insipidus in this pedaitric brain death population is higher than reports in the literature, and acute renal failure accounted for the lack of central diabetes insipidus in four patients with brain death. Further studies are needed to explain normouria in brain-dead patients.","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"4 1","pages":"12 - 16"},"PeriodicalIF":1.1,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2478/jccm-2018-0005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69216346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}