rss_2.0Sciendo RSS Feed for The Journal of Critical Care Medicinehttps://sciendo.com/journal/JCCMhttps://www.sciendo.comhttps://sciendo-parsed.s3.eu-central-1.amazonaws.com/64720d38215d2f6c89dba2d3/cover-image.jpghttps://sciendo.com/journal/JCCM140216https://sciendo.com/article/10.2478/jccm-2024-0028<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Early and accurate identification of high-risk patients with peripheral intravascular catheter (PIVC)-related phlebitis is vital to prevent medical device-related complications.</p> </sec> <sec><title style='display:none'>Aim of the study</title> <p>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> </sec> <sec><title style='display:none'>Materials and methods</title> <p>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> </sec> <sec><title style='display:none'>Results</title> <p>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> </sec> <sec><title style='display:none'>Conclusions</title> <p>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> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00282024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0030<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Current guidelines recommend limiting the rate of correction in patients with severe hyponatremia to avoid severe neurologic complications such as osmotic demyelination syndrome (ODS). However, published data have been conflicting. We aimed to evaluate the association between rapid sodium correction and ODS in patients with severe hyponatremia.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to November 2023. The primary outcome was ODS and the secondary outcomes were in-hospital mortality and length of hospital stay.</p> </sec> <sec><title style='display:none'>Results</title> <p>We identified 7 cohort studies involving 6,032 adult patients with severe hyponatremia. Twenty-nine patients developed ODS, resulting in an incidence rate of 0.48%. Seventeen patients (61%) had a rapid correction of serum sodium in the first or any 24-hour period of admission. Compared with a limited rate of sodium correction, a rapid rate of sodium correction was associated with an increased risk of ODS (RR, 3.91 [95% CI, 1.17 to 13.04]; I² = 44.47%; p = 0.03). However, a rapid rate of sodium correction reduced the risk of in-hospital mortality by approximately 50% (RR, 0.51 [95% CI, 0.39 to 0.66]; I² = 0.11%; p &lt; 0.001) and the length of stay by 1.3 days (Mean difference, −1.32 [95% CI, −2.54 to −0.10]; I² = 71.47%; p = 0.03).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Rapid correction of serum sodium may increase the risk of ODS among patients hospitalized with severe hyponatremia. However, ODS may occur in patients regardless of the rate of serum sodium correction.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00302024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0025<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim of the study</title> <p>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> </sec> <sec><title style='display:none'>Material and methods</title> <p>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> </sec> <sec><title style='display:none'>Results</title> <p>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> </sec> <sec><title style='display:none'>Conclusions</title> <p>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> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00252024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0024<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>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> </sec> <sec><title style='display:none'>Case presentation</title> <p>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> </sec> <sec><title style='display:none'>Conclusions</title> <p>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> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00242024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0029ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00292024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0022<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>COVID-19 leads to severe clinical complications that culminate in respiratory failure and acute respiratory distress syndrome (ARDS). Despite reports of some comorbidities that contribute to the development of COVID-19-mediated ARDS, there is great variation in mortality rates among critical COVID-19 patients in the world. To date, no studies have described the incidence and comorbidities associated with ARDS due to COVID-19 in the northeastern region of Mexico.</p> </sec> <sec><title style='display:none'>Aim of the study</title> <p>To describe patients diagnosed with ARDS due to COVID-19 in the northeastern region of Mexico, as well as its variations in comparison with other regions of the country.</p> </sec> <sec><title style='display:none'>Material and Methods</title> <p>We conducted a prospective and observational study in a tertiary care center in Northeastern Mexico. All patients diagnosed with SARS-CoV-2 infection and requiring management in the intensive care unit were included. We developed a database that was updated daily with the patients' demographic information, pre-existing diseases, disease severity, and clinical variables.</p> </sec> <sec><title style='display:none'>Results</title> <p>The incidence of ARDS secondary to COVID-19 in HRAEV was high in comparison with other reports. Diabetes mellitus was the risk factor most associated with COVID-19-mediated ARDS.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Based on our findings and those previously reported in the literature, there are differences that we discuss between northeastern and central Mexico, and analyze other areas evaluated around the world.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00222024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0033<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>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> </sec> <sec><title style='display:none'>Case presentation</title> <p>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> </sec> <sec><title style='display:none'>Conclusions</title> <p>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> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00332024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0031<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Pediatric bronchopneumonia is a prevalent life-threatening disease, particularly in developing countries. Affordable and accessible blood biomarkers are needed to predict disease severity which can be based on the Duration of Hospitalization (DOH).</p> </sec> <sec><title style='display:none'>Aim of the Study</title> <p>To assess the significance and correlation between differential blood profiles, especially the Neutrophil-Lymphocyte Ratio (NLR), and the DOH in bronchopneumonia children.</p> </sec> <sec><title style='display:none'>Material and Methods</title> <p>A record-based study was conducted at a secondary care hospital in Indonesia. After due ethical permission, following inclusion and exclusion criteria, 284 children with confirmed diagnoses of bronchopneumonia were included in the study. Blood cell counts and ratios were assessed with the DOH as the main criterion of severity. Mann-Whitney test and correlation coefficient were used to draw an analysis.</p> </sec> <sec><title style='display:none'>Results</title> <p>Study samples were grouped into DOH of ≤ 4 days and &gt; 4 days, focusing on NLR values, neutrophils, lymphocytes, and leukocytes. The NLR median was higher (3.98) in patients hospitalized over 4 days (P&lt;0.0001). Lymphocyte medians were significantly higher in the opposite group (P&lt;0.0001). Thrombocyte medians were similar in both groups (P=0.44481). The overall NLR and DOH were weakly positively correlated, with a moderate positive correlation in total neutrophils and DOH, and a moderate negative correlation in total lymphocytes and DOH. The correlation between the DOH ≤ 4 days group with each biomarker was stronger, except for leukocyte and thrombocyte. Analysis of the longer DOH group did not yield enough correlation across all blood counts.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Admission levels of leukocyte count, neutrophil, lymphocyte, and NLR significantly correlate with the DOH, with NLR predicting severity and positively correlated with the DOH.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00312024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0026<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Malposition is a relatively rare complication associated with peripherally inserted central catheters (PICCs), particularly in cases of superficial femoral vein (SFV) catheterization. To the best of our knowledge, we are the first to report this rare case of SFV PICC malposition in the contralateral renal vein.</p> </sec> <sec><title style='display:none'>Case presentation</title> <p>An 82-year-old woman underwent bedside cannulation of the SFV for PICC under ultrasound guidance. Subsequent radiographic examination revealed an unexpected misplacement, with the catheter tip positioned toward the contralateral renal vein. After pulling out the catheter on the basis of the X-ray result, it was observed that the catheter retained its function.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Although rare, tip misplacement should be considered in SFV PICC placement. Prompt correction of the tip position is crucial to prevent catheter malfunction and further catastrophic consequences. For critical patients receiving bedside SFV PICC insertion, postoperational X-ray is crucial for enhancing safety.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00262024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0034ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00342024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0023<abstract> <title style='display:none'>Abstract</title> <p>Effective pain management is vital for critically ill patients, particularly post-surgery or trauma, as it can mitigate the stress response and positively influence morbidity and mortality rates. The suboptimal treatment of pain in Intensive Care Unit (ICU) patients is often due to a lack of education, apprehensions about side effects, and improper use of medications. Hence, the engagement of pain management and anesthesiology experts is often necessary.</p> <p>While opioids have been traditionally used in pain management, their side effects make them less appealing. Local anesthetics, typically used for anesthesia and analgesia in surgical procedures, have carved out a unique and crucial role in managing pain and other conditions in critically ill patients. This work aims to offer a comprehensive overview of the role, advantages, challenges, and evolving practices related to the use of local anesthetics in ICUs. The ability to administer local anesthetics continuously makes them a suitable choice for controlling pain in the upper and lower extremities, with fewer side effects.</p> <p>Epidural analgesia is likely the most used regional analgesic technique in the ICU setting. It is primarily indicated for major abdominal and thoracic surgeries, trauma, and oncology patients. However, it has contraindications and complications, so its use must be carefully weighed. Numerous challenges exist regarding critically ill patients, including renal and hepatic failure, sepsis, uremia, and the use of anticoagulation therapy, which affect the use of regional anesthesia for pain management. Appropriate timing and indication are crucial to maximizing the benefits of these methods.</p> <p>The advent of new technologies, such as ultrasonography, has improved the safety and effectiveness of neuraxial and peripheral nerve blocks, making them feasible options even for heavily sedated patients in ICUs.</p> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00232024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0027<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Haloperidol and dexmedetomidine are used to treat delirium in the intensive care unit (ICU). The effects of these drugs on the corrected QT (QTc) interval have not been compared before. It was aimed to compare the effects of haloperidol and dexmedetomidine treatment on QTc intervals in patients who developed delirium during ICU follow-up.</p> </sec> <sec><title style='display:none'>Method</title> <p>The study is single-center, randomized, and prospective. Half of the patients diagnosed with delirium in the ICU were treated with haloperidol and the other half with dexmedetomidine. The QTc interval was measured in the treatment groups before and after drug treatment. The study’s primary endpoints were maximal QT and QTc interval changes after drug administration.</p> </sec> <sec><title style='display:none'>Results</title> <p>90 patients were included in the study, the mean age was 75.2±12.9 years, and half were women. The mean time to delirium was 142+173.8 hours, and 53.3% of the patients died during their ICU follow-up. The most common reason for hospitalization in the ICU was sepsis (%37.8.). There was no significant change in QT and QTc interval after dexmedetomidine treatment (QT: 360.5±81.7, 352.0±67.0, p= 0.491; QTc: 409.4±63.1, 409.8±49.7, p=0.974). There was a significant increase in both QT and QTc interval after haloperidol treatment (QT: 363.2±51.1, 384.6±59.2, p=0.028; QTc: 409.4±50.9, 427.3±45.9, p=0.020).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Based on the results obtained from the study, it can be concluded that the administration of haloperidol was associated with a significant increase in QT and QTc interval. In contrast, the administration of dexmedetomidine did not cause a significant change in QT and QTc interval.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00272024-07-31T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0018<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Critical illness polyneuropathy (CIP) is a complex disease commonly occurring in septic patients which indicates a worse prognosis. Herein, we investigated the characteristics of cerebrospinal fluid (CSF) in septic patients with CIP.</p></sec> <sec><title style='display:none'>Methods</title><p>This retrospective study was conducted between Match 1, 2018, and July 1, 2022. Patients with sepsis who underwent a CSF examination and nerve electrophysiology were included. The levels of protein, glucose, lipopolysaccharide, white blood cell (WBC), interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF) α in CSF were measured. The fungi and bacteria in CSF were also assessed.</p></sec> <sec><title style='display:none'>Results</title><p>Among the 175 septic patients, 116 (66.3%) patients were diagnosed with CIP. 28-day Mortality in CIP patients was higher than that in non-CIP patients (25.0% vs. 10.2%, P = 0.02) which was confirmed by survival analysis. The results of propensity score matching analysis (PSMA) indicated a significant difference in the level of protein, WBC, IL-1, IL-6, IL-8, and TNFα present in the CSF between CIP patients and non-CIP patients. The results of the receiver operating characteristic (ROC) analysis showed that IL-1, WBC, TNFα, and their combined indicator had a good diagnostic value with an AUC &gt; 0.8.</p></sec> <sec><title style='display:none'>Conclusion</title><p>The increase in the levels of WBC, IL-1, and TNFα in CSF might be an indicator of CIP in septic patients.</p></sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00182024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0013<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title><p>NIV (Non-invasive ventilation) and HFNC (High Flow nasal cannula) are being used in patients with acute respiratory failure. HACOR score has been exclusively calculated for patients on NIV, on other hand ROX index is being used for patients on HFNC. This is first study where ROX index has been used in patients on NIV to predict failure.</p></sec> <sec><title style='display:none'>Aim of the study</title><p>This study investigates the comparative diagnostic performance of HACOR score and ROX index to predict NIV failure.</p></sec> <sec><title style='display:none'>Methods</title><p>We performed a retrospective cohort study of non-invasively ventilated COVID-19 patients admitted between 1st April 2020 to 15th June 2021 to ICU of a tertiary care teaching hospital located in Central India. We assessed factors responsible for NIV failure, and whether these scores HACOR/ROX index have discriminative capacity to predict risk of invasive mechanical ventilation.</p></sec> <sec><title style='display:none'>Results</title><p>Of the 441 patients included in the current study, 179 (40.5%) recovered, while remaining 262 (59.4%) had NIV failure. On multivariable analysis, ROX index &gt; 4.47 was found protective for NIV-failure (OR 0.15 (95% CI 0.03–0.23; p&lt;0.001). Age &gt; 60 years and SOFA score were other significant independent predictors of NIV-failure. The AUC for prediction of failure rises from 0.84 to 0.94 from day 1 to day 3 for ROX index and from 0.79 to 0.92 for HACOR score in the same period, hence ROX score was non-inferior to HACOR score in current study. DeLong's test for two correlated ROC curves had insignificant difference expect day-1 (D1: 0.03 to 0.08; p=3.191e-05, D2: −0.002 to 0.02; p = 0.2671, D3: −0.003 to 0.04; p= 0.1065).</p></sec> <sec><title style='display:none'>Conclusion</title><p>ROX score of 4.47 at day-3 consists of good discriminatory capacity to predict NIV failure. Considering its non-inferiority to HACOR score, the ROX score can be used in patients with acute respiratory failure who are on NIV.</p></sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00132024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0017<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>The utilization of extracorporeal membrane oxygenation (ECMO) in adult patients experiencing septic shock is a subject of ongoing debate within the medical community. This study aims to comprehensively address this issue through a systematic review conducted in accordance with the PRISMA guidelines.</p> </sec> <sec><title style='display:none'>Aim of Study</title> <p>The primary objective of this study is to assess the outcomes of ECMO utilization in adult patients diagnosed with septic shock, thereby providing insights into the potential benefits and uncertainties associated with this treatment modality.</p> </sec> <sec><title style='display:none'>Materials and Methods</title> <p>Our research encompassed a thorough search across electronic databases for relevant English-language articles published up until April 2023. The inclusion criteria were based on studies reporting on ECMO usage in adult patients with septic shock. Among the eligible studies meeting these criteria, a total of eleven were included in our analysis, involving a cohort of 512 patients. The mean age of the participants was 53.4 years, with 67.38% being male.</p> </sec> <sec><title style='display:none'>Results</title> <p>In the pooled analysis, the mean survival rate following ECMO treatment was found to vary significantly across different ECMO modalities. Patients receiving venovenous-ECMO (VV-ECMO) and veno-venous-arterial ECMO (VVA-ECMO) demonstrated higher survival rates (44.5% and 44.4%, respectively) compared to those receiving venoarterial-ECMO (VA-ECMO) at 25% (p&lt;0.05). A chi-square test of independence indicated that the type of ECMO was a significant predictor of survival (χ²(2) = 6.63, p=0.036). Additionally, patients with septic shock stemming from respiratory failure demonstrated survival rates ranging from 39% to 70%. Predictors of mortality were identified as older age and the necessity for cardiopulmonary resuscitation (CPR).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>In septic shock patients, ECMO outcomes align with established indications like respiratory and cardiogenic shock. VV-ECMO and VVA-ECMO suggest better prognoses, though the optimal mode remains uncertain. Patient selection should weigh age and CPR need. Further research is vital to determine ECMO's best approach for this population.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00172024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0019<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title><p>Airway ultrasound has been increasingly used in correct positioning of endotracheal tube. We hypothesize that a safe distance between endotracheal tube tip and carina can be achieved with the aid of ultrasound.</p></sec> <sec><title style='display:none'>Aim of the study</title><p>Our primary objective was to determine whether ultrasound guided visualisation of proximal end of endotracheal tube cuff is better when compared to conventional method in optimal positioning of tube tip. The secondary objective was to find the optimal endotracheal tube position at the level of incisors in adult Indian population.</p></sec> <sec><title style='display:none'>Materials and Methods</title><p>There were 25 patients each in the conventional group and the ultrasound group. Conventional method includes auscultation and end tidal capnography. In the ultrasound group the upper end of the endotracheal tube cuff was positioned with an intent to provide 4 cm distance from the tube tip to the carina. X ray was used in both groups for confirmation of tip position and comparison between the two groups. Further repositioning of the tube was done if indicated and the mean length of the tube at incisors was then measured.</p></sec> <sec><title style='display:none'>Results</title><p>After x ray confirmation, endotracheal tube repositioning was required in 24% of patients in the USG group and 40 % of patients in the conventional group. However, this result was not found to be statistically significant (p = 0.364). The endotracheal tube length at the level of teeth was 19.4 ± 1.35 cm among females and 20.95 ± 1.37 cm among males.</p></sec> <sec><title style='display:none'>Conclusions</title><p>Ultrasonography is a reliable method to determine ETT position in the trachea. There was no statistically significant difference when compared to the conventional method. The average length of ETT at the level of incisors was 19.5 cm for females and 21 cm for males.</p></sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00192024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0021ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00212024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0014<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Aortic dissection (AD) is a critical heart condition with potentially severe outcomes. Our study aimed to investigate the existence of a “weekend effect” in AD by examining the correlation between patient outcomes and whether their treatment occurred on weekdays versus weekends.</p></sec> <sec><title style='display:none'>Methods</title><p>Specifically, we prospectively analysed the effect of weekday and weekend treatment on acute AD patient outcomes, both before surgical intervention and during hospitalization, for 124 patients treated from 2019–2021, as well as during 6 months of follow-up.</p></sec> <sec><title style='display:none'>Results</title><p>The mean age of the study population was 62.5 years, and patient age exhibited a high degree of variability. We recorded a mortality rate before surgery of 8.65% for the weekend group and 15% for the weekday group, but this difference was not statistically significant. During hospitalization, mortality was 50% in the weekend group and 25% in the weekday group, but this difference was not statistically significant. Discharge mortality was 9.61% in the weekend group and 5% in the weekday group.</p></sec> <sec><title style='display:none'>Conclusions</title><p>Our findings suggest that there was no significant difference in mortality rates between patients admitted to the hospital on weekends versus weekdays. Therefore, the period of the week when a patient presents to the hospital with AD appears not to affect their mortality.</p></sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00142024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0020<abstract> <title style='display:none'>Abstract</title> <p>Rheumatoid arthritis, an inflammatory rheumatic disease predominantly affecting small limb joints, frequently compromises the cervical spine, resulting in spinal instability and the potential surgical necessity. This may result in severe complications, such as ventriculitis, often associated with a high mortality rate and multidrug-resistant organisms. A major challenge lies in achieving therapeutic antimicrobial concentrations in the central nervous system.</p> <p>The authors present a case of a 65-year-old female, with cervical myelopathy due to severe rheumatoid arthritis. Following surgery, the patient developed ventriculitis caused by an extensively drug-resistant <italic>Pseudomonas Aeruginosa</italic>. Early diagnosis and prompt treatment played a crucial role in facilitating neurological and cognitive recovery.</p> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00202024-04-30T00:00:00.000+00:00https://sciendo.com/article/10.2478/jccm-2024-0015<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background and aim</title> <p>Sepsis is the major cause of morbidity and mortality for patients admitted to an intensive care unit worldwide. Currently, procalcitonin (PCT) is a widely used prognostic marker for sepsis. The high cost of estimating Procalcitonin limits its utility in all health facilities. Lipid profile, being a frequently done routine investigation, is studied in sepsis patients to predict the prognosis of sepsis. This study was aimed to assess the association between lipid profile parameters, procalcitonin and clinical outcomes in patients with sepsis.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>It is a prospective observational study conducted in a tertiary care hospital in the Department of Biochemistry in collaboration with the Intensive Care Unit (ICU). We included 80 sepsis patients from medical and surgical ICUs. Among them, 59 (74%) survived and 21 (26%) expired. Serum lipid profile, procalcitonin and variables required for APACHE II score are measured at two intervals, one during admission and on day 5. All the parameters were compared between the survivors and the non-survivors.</p> </sec> <sec><title style='display:none'>Results</title> <p>Serum PCT levels were reduced on day 5 [3.32 (1.27–11.86)] compared to day 0 [13.42 (5.77–33.18)] in survivors. In survivors, Total Cholesterol, LDL-C and Non-HDL-C were significantly elevated on day 5 compared to day 0. In non-survivors, HDL-C significantly decreased on day 5. Between survivors and non-survivors, HDL-C significantly decreased on day 5 (23.88 ± 10.19 vs 16.67 ± 8.27 mg/dl). A Negative correlation was observed between HDL-C &amp; PCT.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Serum Lipid profile levels, namely Total cholesterol, HDL-C and LDL-C, have possible associations with the severity of sepsis. HDL-C have a negative association with the clinical scoring system in sepsis patients. Overall, the findings from our study suggest that lipid profile parameters have possible implications in predicting the outcome of patients with sepsis.</p> </sec> </abstract>ARTICLEtruehttps://sciendo.com/article/10.2478/jccm-2024-00152024-04-30T00:00:00.000+00:00en-us-1