Prognostic nutritional index to predicting mortality in surgical intensive care patients

INTRODUCTION: It is known that immuno-nutritional status affects clinical outcomes in intensive care (ICU) patients. This study aimed to evaluate the relationship of the Prognostic Nutritional Index (PNI) with mortality in surgical ICU patients.MATERIAL AND METHODS: The single-center, retrospective, observational study was conducted in a 17-bed surgical ICU. Patients over the age of 18 who were hospitalized between May 1, 2018, and May 1, 2019, were evaluated.RESULTS: 217 patients followed in the surgical ICU were evaluated. The mean age of the study population was 51.84 ± 21.25 years, and 150 (69.10%) patients were male. ICU mortality was calculated as 16.10%. Trauma was the most common reason for hospitalization in both groups, and there was no difference between the two groups in terms of hospitalization reasons. The PNI score was found to be significantly lower in the non-survivor group compared to the survivors (p < 0.001). The PNI cut-off value in predicting mortality was found to be 32.01 with a sensitivity of 0.829 and a specificity of 0.956 [AUC = 0.957 (95% CI from 0.929 to 0.984); p < 0.001].CONCLUSIONS: PNI is a cost-effective scoring system that can be calculated with a simple formulation. In our study, in which surgical ICU cases were evaluated, lower PNI values were found in patients with mortality compared to those who survived. We believe that PNI can be used in the prediction of mortality in surgical ICU cases, and our study will shed light on future studies on this subject

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Early Against Classic Extubation Outcomes Following Cardiac Surgery and Correlation With Rapid Shallow Breath Index

AbstractBackground/Aims:Overnight postoperative ventilation following cardiovascular surgery was a routine procedure since 1960 and the usage of high-dose opioid anesthetic techniques strengthens the need. However early extubation of postcardiac patients has been claimed as safer and more cost-effective approach. Rapid shallow breath index (RSBI) is used widely to standardize weaning from Mechanical ventilatory support (MVS) and to predict failure of attempt. The aim of this retrospective study was to determine the impact of early extubation on post-cardiovasular surgery patients and the possible correlations of RSBI values.  Methods:This retrospective analysis was performed including 230 consecutive patients -who underwent cardiac surgery from September 2017 to January 2018 in a tertiary state hospital.Results:There was significant difference between early extubated group and conventional group in the prevalence of comorbidities, duration of surgery, LOS in hospital and in the ICU. There was no significant difference between groups either in mechanical ventilation parameters including RSBI, mortality or morbidity.Conclusions: Early extubation offers a substantial advantage in terms of accelerated recovery, shorter intensive care unit, and hospital stay, suggesting that efforts to reduce extubation times are cost-effective. Early Extubation following cardiac surgery can be managed in a successful manner and comparing to conventional practices it saves valuable hours of patients. RSBI, in the original cut-off point, was found useless as a weaning parameter while the threshold value for weaning failure was 31

Does Microalbuminuria Affect Resistin and Cardiometabolic Risk Factors in Hypertensive Non-Diabetic Females?

Aim: Hypertension, obesity, insulin resistance and lipid levels are risk factors for cardiovascular disease. The association of cardiovascular risk with C-reactive protein and homocysteine has been debated for decades. Resistin and microalbuminuria are presumed to be associated with diabetes mellitus, insulin resistance and cardiovascular disease. The objective of our study was to investigate the relationship of microalbuminuria with antropometric and metabolic parameters, C-reactive protein, homocyteine and resistin in non-diabetic hypertensive females. Methods: We conducted a randomized study including 37 female non-diabetic hypertensives without microalbuminuria and 47 female non-diabetic hypertensive patients with microalbuminuria. We made comparisons of anthropometric and metabolic parameters, C-reactive protein, homocysteine, insulin resistance index and resistin between the groups. Results: C-reactive protein, homocysteine, resistin, insulin levels and homeostasis model assessment of insulin resistance were higher in hypertensives with microalbuminuria than in hypertensives without microalbuminuria (all p<0.05). Conclusion: We found that microalbuminuria may have an influence on C-reactive protein, homocysteine and resistin levels in non-diabetic hypertensives. We also think that insulin and insulin resistance may also be related with microalbuminuria in non-diabetic hypertensive female patients. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 172-6

Combined portal, splenic and mesenteric venous thrombosis in inactive ulcerative colitis with heterozygous mutation in MTHFR gene: A rare case of thrombophilia

Thrombophilia is a rare but potentially catastrophic phenomenon occurring in patients having tendency of thrombosis. It may lead to serious complications. The etiology of thrombophilia is thought to be multifactorial and related to both acquired and inherited factors. Inflammatory bowel disease is an acquired cause of thrombophilia. Thromboembolic events are seen during inflammatory bowel disease, especially during the active period of the disease. In inflammatory bowel disease, thrombus formation in portal, splenic and mesenteric veins are not common. Besides, the association of genetic disorders related to metabolism of homocysteine with inflammatory bowel disease has been evidenced, especially in Crohn disease and rarely in ulcerative colitis. We present a rare case of ulcerative colitis in association with combined portal, splenic and mesenteric vein thrombosis. The patient was recently diagnosed with the disease which was in the inactive period. Interestingly, our patient was also heterozygous for the mutation in methylenetetrahydrofolate reductase (MTHFR) gene

Our interventional lung assist experience with tracheoesophageal fistula in intensive care unit: A case report

A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus. Acquired TEF is a rare but serious clinical entity. Here, we report the treatment of a patient with interventional lung assist (ILA) in the course of TEF -related hipercarbia and respiratory acidosis as a result of failure of protective ventilation strategy and his outcome after treatment. iLA contains a specially designed low resistance lung membrane, which uses the pressure difference between the arterial and venous circulation. This system enables the use of high airway pressures for oxygenation in combination with very low tidal volumes to avoid ventilator-induced lung injury and this gives time to patient for lung recovery. [Med-Science 2018; 7(1.000): 238-242

Effectiveness of Mesenchymal Stem Cell Therapy for COVID-19 Patients in the Intensive Care Unit: A Case-Control Study

©Copyright 2022 by Turkish Society of Hematology | Turkish Journal of Hematology, Published by Galenos Publishing HouseObjective: Many methods are used in the treatment of coronavirus disease 2019 (COVID-19), which causes acute respiratory distress syndrome (ARDS), and there are conflicting reports in the literature regarding the results of mesenchymal stem cell (MSC) therapy, which is one of those methods. The aim of our study is to evaluate the effect of MSC treatment applied together with standard treatments on survival. Materials and Methods: This retrospective case-control study evaluates the survival effect of MSC treatment administered to patients treated in intensive care after the development of ARDS due to COVID-19 between March 2020 and March 2021. The age, gender, comorbid disease status, APACHE II score, and overall and comorbidity-based survival rates were compared between patients who received standard medical treatment (SMT) and patients who received MSC treatment together with SMT. Results: There were 62 patients in the group receiving only SMT and 81 patients in the group receiving SMT and MSC. No difference was observed between the groups in terms of age, gender, presence of comorbid diseases, or APACHE II scores. There were also no differences according to Kaplan-Maier analysis for the survival statuses of the groups. There was no serious adverse effect due to MSC treatment among these patients. Conclusion: Our study presents the largest case series in the literature, and it was observed that MSC treatment may not significantly affect overall survival or comorbid disease-based survival, in contrast to many other studies in the literature. Amaç: Akut solunum sıkıntısı sendromuna (ARDS) neden olan koronavirüs hastalığı 2019 (COVID-19) tedavisinde birçok yöntem kullanılmakta olup, literatürde mezenkimal kök hücre (MSC) tedavisinin sonuçları ile ilgili çelişkili yayınlar bulunmaktadır. Çalışmamızın amacı standart tedavilerle birlikte uygulanan MSC tedavisinin sağkalım üzerine etkisini değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif olgu kontrol çalışması, Mart 2020 ile Mart 2021 arasında COVID-19’a bağlı ARDS gelişmesi sonrası yoğun bakımda tedavi edilen hastalara uygulanan MSC tedavisinin sağkalım etkisini değerlendirmektedir. Çalışmada, standart medikal tedavi (SMT) alan hastalar ile SMT ile birlikte MSC tedavisi alan hastalar arasında yaş, cinsiyet, komorbid hastalık durumu, APACHE II skoru, genel ve komorbiditeye dayalı sağkalım oranları karşılaştırıldı. Bulgular: Sadece SMT kullanan grupta 62 hasta, SMT ve MSC kullanan grupta 81 hasta vardı. Gruplar arasında yaş, cinsiyet, eşlik eden hastalık varlığı, Apache II skorları açısından fark gözlenmedi. Ayrıca grupların hayatta kalma durumları için Kaplan-Maier analizine göre herhangi bir farklılık yoktu. Hastalar arasında MSC tedavisine bağlı ciddi bir yan etki görülmedi. Sonuç: Çalışmamız literatürdeki en geniş olgu serisine sahip olup, literatürdeki birçok çalışmadan farklı olarak MSC tedavisinin hem genel sağkalıma hem de komorbid hastalık temelli sağkalıma anlamlı bir etkisi olmadığı görülmüştür