Journal of emergency and critical care medicine (Hong Kong, China)最新文献

{"title":"Restarting propofol following successful management of propofol infusion syndrome: a case report","authors":"K. Durr, Brent Herritt, Naomi Niznick, J. Hooper, K. Kyeremanteng, G. D’Egidio","doi":"10.21037/JECCM-20-145","DOIUrl":"https://doi.org/10.21037/JECCM-20-145","url":null,"abstract":": Propofol infusion syndrome (PRIS) is a rare and potentially fatal complication seen in high-dose (>5 mg/kg/h) or prolonged (>48 h) propofol infusions. PRIS presents as a constellation of symptoms, including anion-gap metabolic acidosis, elevated lactate, cardiogenic shock, rhabdomyolysis, arrhythmia, among other biochemical abnormalities. The current standard of care focuses on early recognition, propofol cessation, and supportive management. Case reports have shown evidence for several novel therapeutic interventions, including plasmapheresis, dialysis, and extracorporeal membrane oxygenation. There has yet to be a documented case demonstrating a trial of reinitiating propofol following successful PRIS management. We present the case of a previously healthy 20-year-old male that presented to the emergency department with new-onset refractory status epilepticus, secondary to suspected autoimmune encephalitis. Despite multiple immunomodulators, anesthetic therapies, and anti-epileptic agents, he exhibited ongoing refractory seizure activity on continuous electroencephalogram monitoring. Propofol boluses were the only therapy to offer seizure burst suppression, prompting uptitration of the infusion. The patient subsequently developed hemodynamic instability and multiple biochemical abnormalities consistent with PRIS. He was managed with one round of plasmapheresis, later followed by a session of sustained-low efficiency dialysis (SLED). This therapeutic combination was successful in managing PRIS and restoring hemodynamic stability. After stopping the propofol infusion, he developed near constant electrographic seizures, with breakthrough clinical seizures despite multiple other therapeutic interventions. Propofol was later restarted for seizure control, with no further recurrence of PRIS. This case provides support for novel therapeutic modalities, plasmapheresis and SLED, when managing PRIS. This case also marks the first successful attempt at restarting propofol following PRIS.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46231158","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":"Factors associated with mortality among Asian patients diagnosed with acute pulmonary embolism in the Emergency Department","authors":"Jie Er Janice Soo, K. Takashima, L. Tiah, Bao Yu Geraldine Leong","doi":"10.21037/JECCM-20-96","DOIUrl":"https://doi.org/10.21037/JECCM-20-96","url":null,"abstract":"Acute pulmonary embolism (PE) is a potentially lifethreatening condition that carries a high risk of morbidity and mortality (1). A recent observational study in Canada has estimated the 30-day and 1-year mortality rates from this disease to be 3.9% and 12.9% respectively (2). A systematic review of the global disease burden of thrombosis has also found venous thromboembolism, a closelylinked precursor to PE, to be one of the leading sources of disability-adjusted life years lost globally (1). While early diagnosis and management have been shown to improve survival rates, diagnosis of the disease is notoriously difficult, particularly in the emergency department (ED) (3). The early signs and symptoms of PE are nonspecific and often overlap with those of other cardiopulmonary conditions (2). Clinical screening Original Article","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":"25 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41267506","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":"Non applicability of validated predictive models for intensive care admission and death of COVID-19 patients in a secondary care hospital in Belgium","authors":"N. Parisi, A. Janier-Dubry, E. Ponzetto, C. Pavlopoulos, Gaetan Bakalli, R. Molinari, S. Guerrier, N. Mili","doi":"10.1101/2020.11.06.20205799","DOIUrl":"https://doi.org/10.1101/2020.11.06.20205799","url":null,"abstract":"Objective To set up simple and reliable predictive scores for intensive care admissions and deaths in COVID-19 patients. These scores adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guidelines. Design Monocentric retrospective cohort study run from early March to end of May in Clinique Saint-Pierre Ottignies, a secondary care hospital located in Ottignies-Louvain-la-Neuve, Belgium. The outcomes of the study are (i) admission in the Intensive Care Unit and (ii) death. Data sources All patients admitted in the Emergency Department with a positive RT-PCR SARS-CoV-2 test were included in the study. Routine clinical and laboratory data were collected at their admission and during their stay. Chest X-Rays and CT-Scans were performed and analyzed by a senior radiologist. Methods A recently published predictive score conducted on a large scale was used as a benchmark value (Liang score)1. Logistic regressions were used to develop predictive scores for (i) admission to ICU among emergency ward patients; (ii) death among ICU patients on 40 clinical variables. These models were based on medical intuition and simple model selection tools. Their predictive capabilities were then compared to Liang score. Results Our results suggest that Liang score may not provide reliable guidance for ICU admission and death. Moreover, the performance of this approach is clearly outperformed by models based on simple markers. For example, a logistic regression considering only the LDH yields to similar sensitivity and greater specificity. Finally, all models considered in this study lead to levels of specificity under or equal to 50%. Conclusions In our experience, the results of a predictive score based on a large-scale Chinese study cannot be applied in the Belgian population. However, in our small cohort it appears that LDH above 579 UI/L and venous lactate above 3.02 mmol/l may be considered as good predictive biological factors for ICU admission. With regard to death risk, NLR above 22.1, tobacco abuse status and 80 % of respiratory impairment appears to be relevant predictive factors. A predictive score for admission to ICU or death is desperately needed in secondary hospitals. Optimal allocation of resources guided by evidence-based indicators will best guide patients at time of admission and avoid futile treatments in intensive care units.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62317066","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":"Outcomes of patients requiring prolonged mechanical ventilation in Singapore","authors":"Sharlene Ho, C. J. Lim, S. Puah, S. Lew","doi":"10.21037/JECCM-20-61","DOIUrl":"https://doi.org/10.21037/JECCM-20-61","url":null,"abstract":"Background: Patients requiring prolonged mechanical ventilation (PMV) represent an emerging challenge for the healthcare system. These patients survive the acute stage of critical illness but have persistent organ dysfunction and remain dependent on mechanical ventilator. Methods: This was a single centre cohort study of patients admitted to medical intensive care unit (ICU) between 2012 and 2015 who required mechanical ventilation for ≥ 21 days. Primary outcome was 180-day mortality. Results: A total of 128 patients who required PMV were included in the study. Median [interquartile range (IQR)] age was 66 [58–75] years old. The primary reason for ICU admission was predominantly respiratory cause (n=106, 82.8%). 180-day mortality was 64.1%. Multivariate analysis using Cox proportional hazards regression found that age, comorbidity of hyperlipidemia and day 21 thrombocytopenia (platelets ≤ 150×10 9 /L) predicted 180-day mortality, with a hazard ratio of 1.02 [1.00–1.04]; 1.60 [1.03–2.49]; and 3.72 [2.34–5.91] respectively. Other secondary outcomes include: ICU mortality of 29.7%; in-hospital mortality of 61.7%; and 1-year mortality of 71.1%. Of the 46 patients that were discharged, 28 (60.9%) went home, 6 (13.0%) were transferred to community hospital or rehabilitation facility, 4 (8.7%) to nursing home, 3 (6.5%) to other hospitals and 5 (10.9%) required long term home mechanical ventilation. Twelve (26.1%) were dependent in activities of daily living and 13 (28.3%) were bedbound at discharge. Conclusions: Patients requiring PMV represent a distinct cohort of ICU patients with high mortality and high burden of care.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44663447","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":"Possible advances in vasopressors and inotropes support in shock","authors":"P. Evora","doi":"10.21037/JECCM-20-123","DOIUrl":"https://doi.org/10.21037/JECCM-20-123","url":null,"abstract":"© Journal of Emergency and Critical Care Medicine. All rights reserved. J Emerg Crit Care Med 2021;5:10 | http://dx.doi.org/10.21037/jeccm-20-123 In a recent publication, Manolopoulos and colleagues (1) review the current use and advances in vasopressors and inotropes support in shock. Besides a concise pathophysiological review, the authors aimed “to describe recent advances (both experimental and clinical) that could hold a critical role for the near future regarding patient management.” Over the last 25 years, I am convinced that the cGMP/ NO pathway has been underestimated (2). The medical literature, currently available worldwide, suggests a lack of regulatory approval, cost considerations, and, thirdly, no prospective data trials supporting this approach. In the absence of new drugs to block this pathway, I have been working with methylene blue. I am sure that trying to present my clinical and experimental experience, I am becoming obsessive, repetitive, and indeed this obsession should my uncountable “Letters to the Editor” be a critical target. However, when I read excellent texts as the doctor Manolopoulos presentation, I have to share my complementary opinion that blocking the nitric oxide pathway nowadays already has a critical role. Therefore, one more repetitive conceptual letter including well established key concepts (3,4) and a new approach to be considered for the distributive shock we defined as a “vasoplegic endothelium dysfunction.” Since 1994, the blockade of guanylate cyclase by MB in distributive shock has been the study object in our Endothelial Function Laboratory. It has been used clinically by the Cardiovascular Surgery Group, both from the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP). We published personal statements in 2009 and 2015, including twenty years of questions, answers, doubts, and certainties (3,4). Some observations can be considered. (I) MB is safe at the recommended doses (the lethal dose is 40 mg/kg). (II) The use of MB does not cause endothelial dysfunction. (III) The MB effect appears in cases of positive NO regulation. (IV) MB itself is not a vasoconstrictor, by blocking the cGMP pathway releases the cAMP pathway, facilitating the vasoconstrictor effect of epinephrine. (V) The MB may act through this mechanism of “crosstalk,” and its use as a first choice medication may not be correct. (VI) The most used dosage is 2 mg/kg in IV bolus, followed by the same continuous infusion, as plasma concentrations decrease markedly in the first 40 minutes. (VII) Although there are no definitive multicenter studies, the MB used in the treatment of VS cardiac surgery is currently the best, safest, and cheapest option. (VIII) However, there is possible precocious ‘window of opportunity’ for MB’s effectiveness. We believe that there are at least five aspects to this investigation: (I) Lack of consideration of existing guidelines or evidence-based medicine about the accepted treatment options ","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47873764","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":"Current use and advances in vasopressors and inotropes support in shock","authors":"P. Manolopoulos, Ioannis Boutsikos, P. Boutsikos, N. Iacovidou, K. Ekmektzoglou","doi":"10.21037/JECCM.2019.12.03","DOIUrl":"https://doi.org/10.21037/JECCM.2019.12.03","url":null,"abstract":"Fluid resuscitation, vasopressors and inotropes are the first line medication for the different types of shock due to their mechanism of action and their well-established clinical outcome. However, as experimental research and clinical trials are constantly being published, new suggestions appear regarding alterations and novelties in the use of these medications in the management of shock. The purpose of this review is to address both the current use of vasopressors and inotropes support in shock (thereby, offering a concise review of the pathophysiology behind shock alongside a helpful clinical reference tool for the emergency physician) as well as to describe recent advances (both experimental and clinical) that could hold a critical role for the near future regarding patient management.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.12.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44130973","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":"Successful removal of cranial migrated intravitreal perfluorocarbon through a lumbar puncture","authors":"Lin Chen, Wentao Bao, Qing Wang, Yizhan Guo, Binbin Ren, H. Ni","doi":"10.21203/rs.2.21567/v1","DOIUrl":"https://doi.org/10.21203/rs.2.21567/v1","url":null,"abstract":"\u0000 Background: Perfluorocarbon migrating into subarachnoid was very rare let alone its further removing from central nervous system. Case presentation: We report a case of migration of intravitreal perfluorocarbon into cranial space and further removed through a lumbar puncture treatment. The patient showed a sudden onset of hypoxemia and hypotension during an ocular surgery, which was highly suspected as neurogenic pulmonary edema caused by the migrated perfluorocarbon. The patient's symptoms improved after extracorporeal membrane oxygenation (ECMO). The perfluorocarbon gradually descended through subarachnoid space to lumbar cisterna and finally drained by a lumbar puncture. Conclusions: Perfluorocarbon could enter the cranial space during ocular surgery and threaten the life of patient. Further migrating through subarachnoid space provide the opportunity to remove it.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45559914","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":"Echocardiographic approach to shock","authors":"D. Backer, S. Giglioli","doi":"10.21037/JECCM.2019.07.06","DOIUrl":"https://doi.org/10.21037/JECCM.2019.07.06","url":null,"abstract":"Echocardiography can be used to evaluate the full hemodynamic pattern of patients with shock. Accordingly, echocardiography can rapidly identify the type of shock, helping to guide therapeutic interventions aiming at treat its cause. But echocardiography also provides important information on preload responsiveness, right and left filling pressures, function of the left and right ventricle (RV). Thank to this comprehensive hemodynamic evaluation, echocardiography is nowadays the preferred hemodynamic tool to initially assess a patient with shock, and is thus recommended for this purpose in several consensus documents. Interestingly, echocardiography also allows to perform serial measurements, which is particularly useful to evaluate changes over time as well as the response to therapy. Implementation of echocardiography as a guide to therapy in patients with shock seems to be associated with improved outcomes in observational studies. In this narrative review, we will report on how echocardiography can be used for the management of patients with circulatory failure.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.07.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43744281","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":"Application of the CARE guideline as reporting standard in the Journal of Emergency and Critical Care Medicine","authors":"","doi":"10.21037/jeccm.2019.10.06","DOIUrl":"https://doi.org/10.21037/jeccm.2019.10.06","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43480600","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":"Remote cerebellar hemorrhage with acute hydrocephalus after supratentorial surgery","authors":"Sylvain Diop, P. Borius, V. Degos","doi":"10.21037/jeccm.2019.08.13","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.13","url":null,"abstract":"We report the case of a 57-year-old man without previous medical history undergoing left frontotemporal meningioma surgery ( Figure 1 ). The neurosurgical procedure was performed under general anesthesia using a target-controlled infusion of remifentanil and propofol. Intra-operative course went well without hemodynamic instability or surgical complication. In early post-operative period, our patient presented no sign of awakening.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.13","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43339226","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}