Wyniki wyszukiwania - Biblioteka Nauki

1

Lactate / albumin ratio as prognostic tool for risk stratification in septic patients admitted to ICU

100%

Mourya V. , Gupta R. , Yadav A. , Yadav R.

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tom 6

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nr 4

11-22

EN

INTRODUCTION: Sepsis stands as the primary cause behind intensive care unit (ICU) admissions. The most critical parameters in sepsis management have been shown to be early recognition. Management delays have been associated with increased mortality and morbidity The aim of this study is to study the lactate/albumin (L/A) ratio as prognostic tool for risk stratification in septic patients admitted to ICU. MATERIALS AND METHODS: This prospective observational study was conducted with100 patients. Admitted in ICU with sepsis and septic shock were studied. Serum lactate/albumin ratio was calculated at the time of admission. Apache 2 and SOFA score was calculated at admission. All patients received initial treatment according standard protocol. All patients were followed up till discharge. An adverse outcome in terms of in hospital mortality, length of ICU stays and inotropic support was used in this study. RESULTS: Lactate/albumin ratio >1.5(AUC 0.89) correctly predicted in-hospital mortality among 27% patients with sensitivity and specificity of 90% and 78.6% respectively (p value =0.001). Lactate/albumin ratio <1.50 (AUC 0.73) correctly predicted length of ICU stays <72 hours among 17% patients with sensitivity and specificity of 85% and 58.8% respectively (p value =0.001). Lactate/albumin ratio >1.50 (AUC 0.91) correctly predicted requiring inotropic support among 36% patients with sensitivity and specificity of 83.7% and 89.5% respectively (p value =0.001). CONCLUSIONS: We concluded that lactate/albumin ratio was a stronger parameter than lactate, albumin, APACHE score and SOFA alone in predicting mortality, length of ICU stay and requiring noradrenaline inotropic support among sepsis patients in the ICU.

2

Emergency bronchoscopy in a child with critical airway stenosis after tracheostomy: a case report.

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Shubhra S. , Yadav A. , Yadav R.

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nr 2

55-60

EN

Tracheal stenosis can develop as a consequence of prolonged endotracheal intubation or tracheostomy. A 14-year-old child had a history of left frontotemporal craniotomy after a fall from height one month later and tracheostomy was performed on the sixth postoperative day and decannulation was performed 20 days later. On the fifth day of post-decannulation, the child came to the emergency department with a complaint of difficulty breathing since three days. The patient was immediately moved to emergency operation theater. The patient was intubated with a 6 mm endotracheal tube, but no adequate tidal volume was delivered. Bronchoscopy was performed in the operating room. It showed a smooth, circumferential web 2 cm above the carina (supracarinal stenosis). To achieve ventilatory goals, a 6 mm endotracheal tube was removed and a microlayrngoscopy tube (MLS) of size 5.5 mm was negotiated with deflated cuff. Since the MLS tube was longer, it reached the proximal limit of the narrowed portion of the trachea. There was improvement in ventilation. To achieve proper ventilation, circumferential web was planned. The patient underwent emergency balloon dilation of trachea through rigid bronchoscopy. The balloon catheter was introduced into the bronchoscope, and the balloon was then inflated. As the balloon was inflated, it leads to stretching of the soft tissue and widening of the supracarinal space. The dilatation procedure / ballooning improved the ventilation dynamics. An endotracheal tube of 6mm size was inserted, and endotracheal tube was fixed beyond the stenotic segment above the carina to prevent recurrence of narrowing due to edema after the procedure. After balloon dilation, the patient was shifted to intensive care unit (ICU). The patient was extubated 24 hours after surgery. On the second postoperative day, the patient shifts from the ICU to the ward and on the fifth postoperative day, the patient was discharged from the hospital with the advice that repeated dilation may be required and dates for future follow-up. We present a case of emergency bronchoscopy in a child with critical airway stenosis after tracheostomy that was successfully managed.

PL

Zwężenie tchawicy może rozwinąć się w wyniku długotrwałej intubacji dotchawiczej lub tracheostomii. U 14-letniego dziecka miesiąc później wykonano kraniotomię czołowo-skroniową lewą po upadku z wysokości, a w szóstej dobie po operacji wykonano tracheostomię, a 20 dni później wykonano dekaniulację. W piątej dobie po dekaniulacji dziecko zgłosiło się na oddział ratunkowy z powodu utrzymujących się od trzech dni trudności w oddychaniu. Pacjenta natychmiast przewieziono na blok operacyjny. Pacjenta zaintubowano rurką dotchawiczą o średnicy 6 mm, lecz nie zapewniono odpowiedniej objętości oddechowej. Bronchoskopię wykonano na sali operacyjnej. Wykazywał gładką, obwodową sieć 2 cm nad ostrogą (zwężenie nadgardłowe). Aby osiągnąć cele wentylacyjne, usunięto rurkę dotchawiczą o średnicy 6 mm i zainstalowano rurkę do mikrolarynskopii (MLS) o rozmiarze 5,5 mm z opróżnionym mankietem. Ponieważ rurka MLS była dłuższa, sięgała do bliższego krańca zwężonej części tchawicy. Nastąpiła poprawa wentylacji. Aby zapewnić odpowiednią wentylację, zaplanowano środnik obwodowy. U pacjenta wykonano pilne poszerzenie tchawicy balonem metodą sztywnej bronchoskopii. Do bronchoskopu wprowadzono cewnik balonowy, a następnie napełniono balon. Nadmuchanie balonu prowadzi do rozciągnięcia tkanek miękkich i poszerzenia przestrzeni nadgardłowej. Zabieg dylatacji/balonowania poprawił dynamikę wentylacji. Wprowadzono rurkę dotchawiczą o średnicy 6 mm i umocowano rurkę dotchawiczą poza odcinkiem zwężającym powyżej ostrogi, aby zapobiec ponownemu zwężeniu spowodowanemu obrzękiem po zabiegu. Po rozszerzeniu balonu pacjent został przeniesiony na oddział intensywnej terapii (OIOM). Pacjenta ekstubowano 24 godziny po operacji. W drugiej dobie pooperacyjnej pacjent zostaje przeniesiony z OIOM-u na oddział, a w piątej dobie pooperacyjnej zostaje wypisany ze szpitala z zastrzeżeniem, że może być konieczne ponowne rozszerzenie i terminami przyszłych kontroli. Przedstawiamy przypadek bronchoskopii w trybie nagłym u dziecka z krytycznym zwężeniem dróg oddechowych po udanej tracheostomii.

3

Association of glycosylated hemoglobin with mortality of patients in intensive care unit: a prospective observation study

100%

Kumar D. S. , Wasnik S. B. , Yadav A. , Yadav R.

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tom 7

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nr 1

24-33

EN

INTRODUCTION: Glycated hemoglobin (HbA1c) is the most commonly used clinical test to estimate mean blood glucose during the past 2 to 3 months. In addition to diagnostic purposes, the HbA1c level also predicts diabetes complications. The aim of this study was to determine the association of glycosylated hemoglobin with mortality in intensive care unit (ICU). MATERIALS AND METHODS: A prospective observational study was conducted in the ICU with a total of 281 patients. These patients were classified into two groups based on their HbA1c levels: one group with HbA1c level < 6.5 % and another group with HbA1c level ≥ 6.5%. The following data were collected during the study period. Clinical details and scores such as the APACHE II score (Acute Physiology and Chronic Health Assessment) and daily SOFA (Sequential Organ Failure Assessment) scores for the period of stay in the ICU. ICU morbidities as the need for mechanical ventilation, the use of inotropes / vasopressors, the length of stay in the ICU, and the requirement of renal replacement therapy (RRT). The outcome measures were ICU mortality and 28-day mortality. RESULTS: Of 281 patients admitted to the ICU for more than 48 hours, 157 patients (55.9%) had HbA1c levels < 6.5%, with the remaining 124 (44.1%) had levels ≥ 6.5%. ICU mortality was present in 107 (38.07%) cases. ICU mortality was higher in patients in the HbA1c ≥ 6.5% group compared to the HbA1c < 6.5% group. This was statistically significant (p-value <0.001). Mortality at 28 days was observed in 125 (44.48%) cases. Patients with an HbA1c value ≥ 6.5%, there was a higher mortality at 28 days compared to patients with an HbA1c value < 6.5%. This was found to be statistically significant (p-value <0.001). CONCLUSIONS: The study showed that glycated hemoglobin levels (HbA1c) levels ≥ 6.5% had a significantly higher mortality rate compared to the patient in the HbA1c level < 6.5%.