-
PloS One 2024To investigate the correlation between oxygen saturation index (OSI) and oxygenation index (OI) for evaluating the blood oxygenation status in neonates with respiratory... (Comparative Study)
Comparative Study
OBJECTIVE
To investigate the correlation between oxygen saturation index (OSI) and oxygenation index (OI) for evaluating the blood oxygenation status in neonates with respiratory failure requiring mechanical ventilation support and to assess the predictive capability of OSI in determining clinically relevant OI cutoffs.
METHODS
A prospective study was conducted on neonates who received invasive mechanical ventilation at the neonatal intensive care unit of tertiary hospital in Vietnam. Bland-Altman analysis was utilized to evaluate the agreement between OSI and OI.
RESULTS
A total of 123 neonates, including both term and preterm infants, were included in the study. A high agreement rate of 94.3% within the 95% limits of agreement (between OI and OSI), with a narrow similarity value of 3.3 (95% CI: -5.1 to 11.8) and high correlation coefficient (r = 0.791, p<0.001) was observed. The OSI cut-off value for predicting an OI of >15 was determined to be 7.45, with a sensitivity of 100% and a specificity of 87.4% (AUC 0.955; 95% CI: 0.922-0.989, p < 0.05). Similarly, an OSI cutoff value of 9.9 corresponded to an OI of 25, displaying a sensitivity of 100% and specificity of 87.4% (AUC 0.92). The receiver operating characteristic (ROC) curves for OSI exhibited statistically significant results (p < 0.05).
CONCLUSION
The findings demonstrate a strong correlation between OSI and OI in neonates with respiratory failure. Furthermore, OSI, as a non-invasive method, can serve as a substitute for OI to evaluate the severity of hypoxic respiratory failure and lung injury in neonates.
Topics: Humans; Infant, Newborn; Respiration, Artificial; Respiratory Insufficiency; Male; Female; Prospective Studies; Oxygen Saturation; Hypoxia; Oxygen; Intensive Care Units, Neonatal; Infant, Premature; ROC Curve
PubMed: 38814919
DOI: 10.1371/journal.pone.0304278 -
The Turkish Journal of Pediatrics May 2024Acute respiratory failure is a prevalent condition in childhood with a high rate of mortality. Invasive mechanical ventilation support may be required for the management...
BACKGROUND
Acute respiratory failure is a prevalent condition in childhood with a high rate of mortality. Invasive mechanical ventilation support may be required for the management of these patients. Extracorporeal membrane oxygenation (ECMO) is a method used when ventilation support is insufficient. However, the less invasive extracorporeal carbon dioxide removal method can be used as an alternative in cases of hypercapnic respiratory failure.
CASE
A 9-year-old patient with cystic fibrosis presented to the hospital with acute respiratory failure due to pneumonia. Bilateral patchy areas of consolidation were evident in the chest x-ray. Invasive mechanical ventilation support was consequently provided to treat severe hypercapnia. Although peak and plateau pressure levels exceeded 32 cmH₂O (49 cmH₂O) and 28 cmH₂O (35 cmH₂O), respectively, the patient continued to have severe respiratory acidosis. Therefore extracorporeal carbon dioxide removal support was initiated to provide lung-protective ventilation. By Day 10, venovenous ECMO support was initiated due to deteriorating oxygenation.
CONCLUSION
In cases where conventional invasive mechanical ventilation support is insufficient due to acute hypercapnic respiratory failure, extracorporeal carbon dioxide removal support, which is less invasive compared to ECMO, should be considered as an effective and reliable alternative method. However, it should be noted that extracorporeal carbon dioxide removal support does not affect oxygenation; it functions solely as a carbon dioxide removal system.
Topics: Humans; Cystic Fibrosis; Respiratory Insufficiency; Extracorporeal Membrane Oxygenation; Hypercapnia; Child; Carbon Dioxide; Male; Acute Disease; Respiration, Artificial
PubMed: 38814300
DOI: 10.24953/turkjpediatr.2024.4588 -
Critical Care Explorations Jun 2024To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU.
OBJECTIVES
To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU.
DESIGN
A retrospective cohort study.
SETTING
Five university hospitals in the Netherlands between 2002 and 2015.
PATIENTS
A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model's generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal-external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59-65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal-external validation across centers (-statistic 0.70; 95% CI, 0.63-0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (-statistic 0.61; 95% CI, 0.57-0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60-100% predicted 1-year mortality.
CONCLUSIONS
Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.
Topics: Humans; Hematologic Neoplasms; Intensive Care Units; Male; Retrospective Studies; Middle Aged; Female; Aged; Netherlands; Adult; APACHE; Cohort Studies
PubMed: 38813435
DOI: 10.1097/CCE.0000000000001093 -
Turkish Journal of Medical Sciences 2023Immunosuppressive and immunomodulatory treatments developed in recent years as a result of a better understanding of the pathophysiology of systemic rheumatic diseases...
BACKGROUND/AIM
Immunosuppressive and immunomodulatory treatments developed in recent years as a result of a better understanding of the pathophysiology of systemic rheumatic diseases (SRDs) improve the prognosis. Despite medical advances, individuals with SRDs at any stage may require intensive care and have a high mortality rate. The aim of this study was to investigate the demographic and clinical characteristics of patients with rheumatic diseases admitted to the intensive care unit (ICU), and the factors associated with the risk of mortality.
MATERIALS AND METHODS
This was a retrospective, cross-sectional study that included patients with rheumatic diseases in the medical ICU. Factors of ICU 28-day mortality were identified by multiple-variable logistic analysis.
RESULTS
A total of 127 patients with SRDs admitted to the medical ICU were enrolled. Systemic lupus erythematosus (SLE) (32.3%) was the most common diagnosis of SRDs in patients admitted to the ICU. The reasons for admission to the ICU were combined infection and primary SRD flare-up (35.4%), primary SRD flare-up (22%), SRD-unrelated reasons (22%), infection (17.3%), drug side effects (3.9%), and SRD-related complications (0.8%). The most common organ dysfunctions before (49.6%) and during (77.2%) admission to ICU were in the respiratory system. The 28-day mortality was 78 (61.4%). While the maximum procalcitonin, serum lactate, and blood urea nitrogen (BUN) levels were higher in the nonsurvivor group, the platelet and serum albumin levels were statistically significantly lower than those in the survivor group (p < 0.05). Acute respiratory failure (ARF), the presence of septic shock, the need for invasive mechanical ventilation (IMV), BUN level, and low platelet-lymphocyte ratio (PLR) were significant in the final multiple-variable model.
CONCLUSION
Significant predictors of mortality in patients with rheumatic diseases may include ARF, septic shock, the need for IMV, and high BUN and low PLR levels.
Topics: Humans; Male; Female; Retrospective Studies; Intensive Care Units; Middle Aged; Cross-Sectional Studies; Rheumatic Diseases; Adult; Aged; Hospital Mortality; Lupus Erythematosus, Systemic
PubMed: 38813000
DOI: 10.55730/1300-0144.5673 -
SAGE Open Medical Case Reports 2024A 33-year-old female was admitted for community-acquired pneumonia. On presentation, she was tachypneic and tachycardic and leukocytosis at 28,900/µL. Chest imaging...
A 33-year-old female was admitted for community-acquired pneumonia. On presentation, she was tachypneic and tachycardic and leukocytosis at 28,900/µL. Chest imaging showed dense consolidation on the right upper lobe. Due to refractory worsening respiratory failure, she was intubated with mechanical ventilation. Initial bronchoscopy with culture data was negative. Extracorporeal membrane oxygenation was pursued on the fourth day. Repeat bronchoscopy revealed targetoid ulcerative lesions with erythema in the right middle, lower lobes and left lower lobe. We describe a case of herpes simplex virus pneumonia in an immunocompetent patient that occurred in the setting of acute bacterial infection.
PubMed: 38812833
DOI: 10.1177/2050313X241256858 -
Turkish Journal of Medical Sciences 2024In open heart surgery, sternotomy causes inflammation in tissues, and inflammation causes postoperative pain. This study aims to examine the effects of bilateral erector...
BACKGROUND/AIM
In open heart surgery, sternotomy causes inflammation in tissues, and inflammation causes postoperative pain. This study aims to examine the effects of bilateral erector spinae plane (ESP) blocks on postoperative extubation time and laboratory parameters in open heart surgery.
MATERIALS AND METHODS
The study was managed using retrospective data from 85 patients who underwent open-heart surgery. Patients who received intravenous analgesia and were transferred to the intensive care unit with intubation were included in the study. Two groups were formed: those who received preoperative bilateral ESP block (ESB) and those nonblock (NB). Statistical significance was investigated between ESB and NB in terms of extubation time and laboratory parameters.
RESULTS
The postoperative extubation time for group NB was significantly longer at 360 (300-420) min compared to the observed 270 (240-390) min for ESB (p: 0.006). The length of stay in the intensive care unit was also longer for group NB at 4 (3-5) days compared to 3 (3-4) days for ESB (p: 0.001). Ejection fraction values, cardiopulmonary bypass, and aortic cross-clamp times were similar in both groups. Postoperative 24 h troponin I levels were higher for group NB at 0.94 (0.22-2.70) mcg/L compared to 0.16 (0.06-1.40) mcg/L for group ESB (p: 0.016).
CONCLUSION
It would be useful for anesthesiologists to know that erector spinae plane blocks applied in the preoperative period in cardiac surgeries not only shorten the mechanical ventilation and hospitalization times but also provide lower troponin values in the postoperative period patient follow-ups.
Topics: Humans; Retrospective Studies; Male; Female; Nerve Block; Middle Aged; Cardiac Surgical Procedures; Airway Extubation; Aged; Paraspinal Muscles; Pain, Postoperative; Length of Stay
PubMed: 38812637
DOI: 10.55730/1300-0144.5772 -
Turkish Journal of Medical Sciences 2024In this prospective observational study, our goal was to investigate the relationship between serum levels of oxidative stress (OS) parameters and regional cerebral... (Observational Study)
Observational Study
BACKGROUND/AIM
In this prospective observational study, our goal was to investigate the relationship between serum levels of oxidative stress (OS) parameters and regional cerebral oxygen saturation (rSO) in addition to evaluating postoperative clinical outcomes among patients undergoing coronary artery bypass graft surgery (CABG).
MATERIALS AND METHODS
This study comprised 64 adult patients undergoing elective CABG (on-pump [n = 48] and off-pump [n = 16]) procedures. Serum OS levels and rSO values were measured intraoperatively at three specific time points: T1 (after induction), T2 (15 min before aortic cross-clamp removal or the final distal anastomosis), and T3 (15 min after aortic cross-clamp removal or the last distal anastomosis).
RESULTS
Serum OS and lactate values demonstrated higher levels at T2 and T3 (p < 0.001), while rSO values were lower at T2 (p = 0.024) in the on-pump CABG group compared to the off-pump CABG group. The rSO values at T2 exhibited a negative correlation with OS parameters, lactate levels at T2 and T3, aortic clamp time, postoperative mechanical ventilation time, and intensive care unit stay length. In the multivariate linear regression analysis (R2 = 0.181, p = 0.001), lactate values at T2 emerged as the sole factor affecting the OS index at T2 (t = 2.843, p = 0.006).
CONCLUSION
In our study, we observed elevated OS values and relatively low rSO values during on-pump CABG procedures, with rSO showing an association with increased OS parameters. Close monitoring of the OS response level and rSO during CABG could potentially enhance postoperative clinical outcomes.
Topics: Humans; Male; Female; Prospective Studies; Middle Aged; Coronary Artery Bypass, Off-Pump; Oxidative Stress; Aged; Coronary Artery Bypass; Brain; Oxygen; Oxygen Saturation
PubMed: 38812632
DOI: 10.55730/1300-0144.5770 -
BMC Musculoskeletal Disorders May 2024This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19...
BACKGROUND
This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19 infection.
METHODS
A literature search for eligible articles was conducted using MEDLINE/Pubmed, Global Health, and Scopus databases (January 12th, 2023), including all case reports and case series from any country and language. The criteria for inclusion in this review were cases of COVID-19 infection subsequently developing heterotopic ossification.
RESULTS
This systematic review analysed 15 reports (n = 20 patients) documenting cases of heterotopic ossification following COVID-19 infection. 80% of the patients were male, with a median age of 59 years. All patients required intensive care unit stay with an average duration of 48.5 days. Mechanical ventilation was necessary for all patients and 30% of them underwent tracheostomy. Common symptoms included stiffness and pain, most frequently affecting multiple locations (70%), with the hips and shoulders being predominantly involved. X-rays were the most commonly used imaging modality, followed by computed tomography. Although treatment was given, some of the patients continued to experience symptoms, particularly stiffness.
CONCLUSION
20 patients who developed heterotopic ossification after COVID-19 have been reported, the majority of which had at least two independent risk factors for this condition. The link between those two clinical entities is therefore uncertain, requiring further investigation. It is nonetheless important to suspect heterotopic ossification in patients with severe COVID-19 infection, prolonged immobilisation, mechanical ventilation, who develop joint pain and stiffness, as this condition can significantly impact patients' quality of life.
PROTOCOL REGISTRATION
CRD42023393516.
Topics: Humans; Ossification, Heterotopic; COVID-19; Male; Middle Aged; Female; Respiration, Artificial; Aged; SARS-CoV-2; Adult
PubMed: 38811925
DOI: 10.1186/s12891-024-07537-4 -
Critical Care Science 2024To discuss the strengths and limitations of ventilator-free days and to provide a comprehensive discussion of the different analytic methods for analyzing and...
OBJECTIVE
To discuss the strengths and limitations of ventilator-free days and to provide a comprehensive discussion of the different analytic methods for analyzing and interpreting this outcome.
METHODS
Using simulations, the power of different analytical methods was assessed, namely: quantile (median) regression, cumulative logistic regression, generalized pairwise comparison, conditional approach and truncated approach. Overall, 3,000 simulations of a two-arm trial with n = 300 per arm were computed using a two-sided alternative hypothesis and a type I error rate of α = 0.05.
RESULTS
When considering power, median regression did not perform well in studies where the treatment effect was mainly driven by mortality. Median regression performed better in situations with a weak effect on mortality but a strong effect on duration, duration only, and moderate mortality and duration. Cumulative logistic regression was found to produce similar power to the Wilcoxon rank-sum test across all scenarios, being the best strategy for the scenarios of moderate mortality and duration, weak mortality and strong duration, and duration only.
CONCLUSION
In this study, we describe the relative power of new methods for analyzing ventilator-free days in critical care research. Our data provide validation and guidance for the use of the cumulative logistic model, median regression, generalized pairwise comparisons, and the conditional and truncated approach in specific scenarios.
Topics: Humans; Critical Care; Respiration, Artificial; Logistic Models; Time Factors; Computer Simulation; Ventilator Weaning
PubMed: 38808905
DOI: 10.62675/2965-2774.20240246-en -
Critical Care Science 2024
Topics: Humans; Ventilator Weaning; Intensive Care Units; Diaphragm; Tracheostomy; Quadriceps Muscle; Male; Female; Middle Aged; Aged
PubMed: 38808904
DOI: 10.62675/2965-2774.20240131-en