世界危重病急救学杂志(英文版)最新文献

{"title":"Driving pressure: A useful tool for reducing postoperative pulmonary complications.","authors":"Domenico Posa, Fabio Sbaraglia, Giuliano Ferrone, Marco Rossi","doi":"10.5492/wjccm.v13.i3.96214","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.96214","url":null,"abstract":"<p><p>The operating room is a unique environment where surgery exposes patients to non-physiological changes that can compromise lung mechanics. Therefore, raising clinicians' awareness of the potential risk of ventilator-induced lung injury (VILI) is mandatory. Driving pressure is a useful tool for reducing lung complications in patients with acute respiratory distress syndrome and those undergoing elective surgery. Driving pressure has been most extensively studied in the context of single-lung ventilation during thoracic surgery. However, the awareness of association of VILI risk and patient positioning (prone, beach-chair, park-bench) and type of surgery must be raised.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302139","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":"Why do thoracic epidurals fail? A literature review on thoracic epidural failure and catheter confirmation.","authors":"Kamal Kumar, Fuhazia Horner, Mohamed Aly, Gopakumar S Nair, Cheng Lin","doi":"10.5492/wjccm.v13.i3.94157","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.94157","url":null,"abstract":"<p><p>Thoracic epidural anesthesia (TEA) has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries. However, misplaced or displaced catheters, along with other factors such as technical challenges, equipment failure, and anatomic variation, lead to a high incidence of unsatisfactory analgesia. This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters. A literature search of PubMed, Medline, Science Direct, and Google Scholar was done. The search results were limited to randomized controlled trials. Literature suggests techniques such as electrophysiological stimulation, epidural waveform monitoring, and x-ray epidurography for identifying thoracic epidural placement, but there is no one particular superior confirmation method; clinicians are advised to select techniques that are practical and suitable for their patients and practice environment to maximize success.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302162","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":"Reimagining critical care: Trends and shifts in 21^st century medicine.","authors":"Sai Doppalapudi, Bilal Khan, Muhammad Adrish","doi":"10.5492/wjccm.v13.i3.94020","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.94020","url":null,"abstract":"<p><p>Critical care medicine has undergone significant evaluation in the 21^st century, primarily driven by advancements in technology, changes in healthcare delivery, and a deeper understanding of disease processes. Advancements in technology have revolutionized patient monitoring, diagnosis, and treatment in the critical care setting. From minimally invasive procedures to advances imaging techniques, clinicians now have access to a wide array of tools to assess and manage critically ill patients more effectively. In this editorial we comment on the review article published by Padte S <i>et al</i> wherein they concisely describe the latest developments in critical care medicine.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302145","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":"Impact of different intravenous bolus rates on fluid and electrolyte balance and mortality in critically ill patients.","authors":"Mutaz I Othman, Emad M Mustafa, Moayad Alfayoumi, Mohamad Y Khatib, Abdulqadir J Nashwan","doi":"10.5492/wjccm.v13.i3.95781","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.95781","url":null,"abstract":"<p><p>The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care. Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status, but there is limited information available on the specifics of when, how much, and at what rate fluids should be administered during these challenges. The aim of this review is to thoroughly examine the relationship between intravenous bolus rates, fluid-electrolyte balance, and mortality and to analyze key research findings and methodologies to understand these complex dynamics better. Fluid challenges are commonly employed in managing hemodynamic status in this population, yet there is limited information on the optimal timing, volume, and rate of fluid administration. Utilizing a narrative review approach, the analysis identified nine relevant studies that investigate these variables. The findings underscore the importance of a precise and individualized approach in clinical settings, highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes. This review provides valuable insights that can inform and optimize clinical practices in critical care, emphasizing the necessity of meticulous and exact strategies in fluid administration.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302141","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":"Outcome of COVID-19 infection in patients on antihypertensives: A cross-sectional study.","authors":"Sakthivadivel Varatharajan, Gopal K Bohra, Pradeep K Bhatia, Satyendra Khichar, Mahadev Meena, Naveenraj Palanisamy, Archana Gaur, Mahendra K Garg","doi":"10.5492/wjccm.v13.i3.96882","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.96882","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronavirus disease 2019 (COVID-19) infection frequently have hypertension as a co-morbidity, which is linked to adverse outcomes. Antihypertensives may affect the outcome of COVID-19 infection.</p><p><strong>Aim: </strong>To assess the effects of antihypertensive agents on the outcomes of COVID-19 infection.</p><p><strong>Methods: </strong>A total of 260 patients were included, and their demographic data and clinical profile were documented. The patients were categorized into nonhypertensive, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), calcium channel blocker (CCB), a combination of ACEI/ARB and CCB, and beta-blocker groups. Biochemical, hematological, and inflammatory markers were measured. The severity of infection, intensive care unit (ICU) intervention, and outcome were recorded.</p><p><strong>Results: </strong>The mean age of patients was approximately 60-years-old in all groups, except the nonhypertensive group. Men were predominant in all groups. Fever was the most common presenting symptom. Acute respiratory distress syndrome was the most common complication, and was mostly found in the CCB group. Critical cases, ICU intervention, and mortality were also higher in the CCB group. Multivariable logistic regression analysis revealed that age, duration of antihypertensive therapy, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and interleukin 6 were significantly associated with mortality. The duration of antihypertensive therapy exhibited a sensitivity of 70.8% and specificity of 55.7%, with a cut-off value of 4.5 years and an area under the curve of 0.670 (0.574-0.767; 95% confidence interval) for COVID-19 outcome.</p><p><strong>Conclusion: </strong>The type of antihypertensive medication has no impact on the clinical sequence or mortality of patients with COVID-19 infection. However, the duration of antihypertensive therapy is associated with poor outcomes.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302144","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":"Traumatic brain injury and variants of shock index.","authors":"Sai Doppalapudi, Muhammad Adrish","doi":"10.5492/wjccm.v13.i3.93478","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.93478","url":null,"abstract":"<p><p>Traumatic Brain Injury is a major cause of death and long-term disability. The early identification of patients at high risk of mortality is important for both management and prognosis. Although many modified scoring systems have been developed for improving the prediction accuracy in patients with trauma, few studies have focused on prediction accuracy and application in patients with traumatic brain injury. The shock index (SI) which was first introduced in the 1960s has shown to strongly correlate degree of circulatory shock with increasing SI. In this editorial we comment on a publication by Carteri <i>et al</i> wherein they perform a retrospective analysis studying the predictive potential of SI and its variants in populations with severe traumatic brain injury.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302147","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":"Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure.","authors":"Mahmoud Ismail Allam Eissa, Rasha Kaddoura, Danial Hassan, Cornelia S Carr, Samy Hanoura, Yasser Shouman, Abdulwahid Almulla, Amr Salah Omar","doi":"10.5492/wjccm.v13.i3.92658","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.92658","url":null,"abstract":"<p><strong>Background: </strong>Delayed sternal closure (DSC) can be a lifesaving approach for certain patients who have undergone cardiac surgery. The value of the type of prophylactic antibiotics in DSC is still debatable.</p><p><strong>Aim: </strong>To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.</p><p><strong>Methods: </strong>This was a retrospective observational single-center study. Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included. Patients were subjected to two regimens of antibiotics: Narrow-spectrum and broad-spectrum regimens.</p><p><strong>Results: </strong>The main outcome measures were length of hospital and intensive care unit (ICU) stay, duration of mechanical ventilation, and mortality. Of the 53 patients, 12 (22.6%) received narrow-spectrum antibiotics, and 41 (77.4%) received broad-spectrum antibiotics. The mean age was 59.0 ± 12.1 years, without significant differences between the groups. The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrow-spectrum group (11.9 ± 8.7 <i>vs</i> 3.4 ± 2.0 d , <i>P</i> < 0.001). The median duration of open chest was 3.0 (2.0-5.0) d for all patients, with no difference between groups (<i>P</i> = 0.146). The median duration of mechanical ventilation was significantly longer in the broad-spectrum group [60.0 (Δ interquartile range (IQR) 170.0) h <i>vs</i> 50.0 (ΔIQR 113.0) h, <i>P</i> = 0.047]. Similarly, the median length of stay for both ICU and hospital were significantly longer in the broad-spectrum group [7.5 (ΔIQR 10.0) d <i>vs</i> 5.0 (ΔIQR 5.0) d, <i>P</i> = 0.008] and [27.0 (ΔIQR 30.0) d <i>vs</i> 19.0 (ΔIQR 21.0) d, <i>P</i> = 0.031]. Five (9.8%) patients were readmitted to the ICU and 18 (34.6%) patients died without a difference between groups.</p><p><strong>Conclusion: </strong>Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration, length of ICU and hospital stays <i>vs</i> narrow-spectrum antibiotics.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302140","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":"Optic nerve sheath diameters in nontraumatic brain injury: A scoping review and role in the intensive care unit.","authors":"Madhura Bhide, Deven Juneja, Omender Singh, Shakya Mohanty","doi":"10.5492/wjccm.v13.i3.97205","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.97205","url":null,"abstract":"<p><strong>Background: </strong>Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure (ICP) modalities or unstable to transport for imaging. Ultrasonography-based optic nerve sheath diameter (ONSD) is an attractive option as it is reliable, repeatable and easily performed at the bedside. It has been sufficiently validated in traumatic brain injury (TBI) to be incorporated into the guidelines. However, currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.</p><p><strong>Aim: </strong>To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.</p><p><strong>Methods: </strong>PubMed, Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP. Studies from 2010 to 2024 in English languages were included.</p><p><strong>Results: </strong>We found 37 articles relevant to our search. The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm. Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter. ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke, intracerebral bleeding and intracranial infection. However, ONSD is of doubtful utility in septic metabolic encephalopathy, dysnatremias and aneurysmal subarachnoid haemorrhage.</p><p><strong>Conclusion: </strong>ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302143","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":"Low T3 <i>vs</i> low T3T4 euthyroid sick syndrome in septic shock patients: A prospective observational cohort study.","authors":"Mirza Kovacevic, Visnja Nesek-Adam, Semir Klokic, Ekrema Mujaric","doi":"10.5492/wjccm.v13.i3.96132","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.96132","url":null,"abstract":"<p><strong>Background: </strong>Both phases of euthyroid sick syndrome (ESS) are associated with worse prognosis in septic shock patients. Although there are still no indications for supplementation therapy, there is no evidence that both phases (initial and prolonged) are adaptive or that only prolonged is maladaptive and requires supplementation.</p><p><strong>Aim: </strong>To analyze clinical, hemodynamic and laboratory differences in two groups of septic shock patients with ESS.</p><p><strong>Methods: </strong>A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups. The analysis included demographic data, mortality scores, intensive care unit stay, mechanical ventilation length and 28-day survival and laboratory with hemodynamics.</p><p><strong>Results: </strong>The Simplified Acute Physiology Score II score (<i>P</i> = 0.029), dobutamine (<i>P</i> = 0.003) and epinephrine requirement (<i>P</i> = 0.000) and the incidence of renal failure and multiple organ failure (MOF) (<i>P</i> = 0.000) were significantly higher for the low T3T4. Hypoalbuminemia (<i>P</i> = 0.047), neutrophilia (<i>P</i> = 0.038), lymphopenia (<i>P</i> = 0.013) and lactatemia (<i>P</i> = 0.013) were more pronounced on T2 for the low T3T4 group compared to the low T3 group. Diastolic blood pressure at T0 (<i>P</i> = 0.017) and T1 (<i>P</i> = 0.007), as well as mean arterial pressure at T0 (<i>P</i> = 0.037) and T2 (<i>P</i> = 0.033) was higher for the low T3 group.</p><p><strong>Conclusion: </strong>The low T3T4 population is associated with higher frequency of renal insufficiency and MOF, with worse laboratory and hemodynamic parameters. These findings suggest potentially maladaptive changes in the chronic phase of septic shock.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302142","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":"Remimazolam in intensive care unit: Potential applications and considerations.","authors":"Praveen Reddy Elmati, Teja Nagaradona, Gowthami Sai Kogilathota Jagirdhar, Salim Surani","doi":"10.5492/wjccm.v13.i3.96877","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.96877","url":null,"abstract":"<p><p>This manuscript explores the potential use of Remimazolam in the intensive care unit (ICU) and critical care units, considering its pharmacological characteristics, clinical applications, advantages, and comparative effectiveness over current sedatives and anesthetics. We reviewed existing PubMed and Google Scholar literature to find relevant studies on Remimazolam in ICU. We created search criteria using a combination of free text words, including Remimazolam, critical care, intensive care, sedation, anesthesia, pharmacokinetics, and pharmacodynamics. Relevant articles published in the English language were analyzed and incorporated. Remimazolam is an ultra-short-acting benzodiazepine derivative promising for sedation and anesthesia. It is a safer option for hemodynamically unstable, elderly, or liver or kidney issues. It also has comparable deep sedation properties to propofol in the ICU. Furthermore, it reduces post-procedural delirium and patient comfort and reduces the need for additional sedatives in pediatric patients. In conclusion, Remimazolam is an excellent alternative to current sedatives and anesthetics in the ICU. Its cost is comparable to that of current medications. Further research on its long-term safety in the ICU and its broader application and incorporation into routine use is necessary.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302146","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}