Sindrom nakon boravka u jedinici intenzivne njege kod kirurških pacijenata – pilot studija

Aim. The retrospective observational study aimed to determine whether there is a defined syndrome after intensive care after less than 14 days of stay in the intensive care unit. Material and methods. Patients who stayed in the intensive care unit of the Clinical Hospital Center “Dr. Dragiša Mišović – Dedinje” in Belgrade during the May 2022 were examined. Data from the health information system and therapeutic lists were used, and the questionnaire on quality of life was filled out during telephone conversations with patients. In the end, the data were statistically processed. Results. Of 16 patients, the average stay in the intensive care unit was 4.7 days (from 2 to 10). In eight of them, a certain level of change in the general state of health was shown in the last year (which includes the period of hospitalization), and in two of them this change was significant. The general health was significantly impaired in four of them, primarily related to male sex, age and ASA status. In these four patients, the length of stay in the intensive care unit was eight days at maximum. Conclusion. The results of this pilot study indicate the occurrence of the syndrome after intensive treatment in our sample of patients. As the sample is small, more extensive studies are needed to confirm or refute the claim that even a stay shorter than 14 days in intensive care units can lead to a significant change in health status and the emergence of post-intensive care syndrome in critically ill patients.Cilj. Retrospektivna opservaciona studija imala je za cilj utvrditi postojanje definiranog sindroma nakon intenzivne njege kod pacijenata sa boravkom kraćim od 14 dana u jedinici intenzivne njege Materijal i metode. Ispitani su pacijenti koji su boravili u jedinici intenzivne njege Kliničkog bolničkog centra “Dr. Dragiša Mišović – Dedinje” u Beogradu tijekom svibnja 2022. godine. Korišteni su podaci iz zdravstvenog informacijskog sustava i terapijskih lista, te je upitnik o kvaliteti života popunjen tijekom telefonskih razgovora sa pacijentima. Na kraju su podaci bili statistički obrađeni. Rezultati. Od 16 pacijenata, prosječan boravak u jedinici intenzivne njege iznosio je 4,7 dana (od 2 do 10). Kod osam pacijenata zabilježena je određena promjena općeg zdravstvenog stanja tijekom posljednje godine (uključujući period hospitalizacije), a kod dvoje je ta promjena bila značajna. Opće zdravlje značajno je bilo narušeno kod četvero pacijenata, uglavnom u vezi sa muškim spolom, dobi i ASA status. U ovih četvero pacijenata, najduže trajanje boravka u jedinici intenzivne njege bilo je osam dana. Zaključak. Rezultati ove pilot studije ukazuju na pojavu sindroma nakon intenzivnog liječenja na našem uzorku pacijenata. S obzirom na malen uzorak, potrebno je provesti opsežnije studije kako bi se potvrdila ili opovrgla tvrdnja da čak i boravak kraći od 14 dana u jedinicama intenzivne njege može dovesti do značajne promjene zdravstvenog stanja i pojave sindroma nakon intenzivne njege kod kritično bolesnih pacijenata

Liječenje i ishod trudnoća kompliciranih infekcijom COVID-19: deskriptivna studija jednog centra

This study aims to describe the clinical characteristics, radiological and laboratory results, therapy and outcome of pregnancies complicated by COVID-19 infection. Methodology. A retrospective descriptive study included all pregnant women with COVID-19 who gave birth in our hospital from April 2020 to January 2022. Exclusion criteria were: incomplete or unclear medical documentation, suspected COVID-19 infection without confirmation by PCR or rapid Ag test, previously diagnosed autoimmune diseases, positive history of malignant diseases, and started oxygen support in another institution before admission to our hospital. Results. Our study included 186 pregnant women who gave birth at KBC “Dr. Dragiša Mišović – Dedinje” in the mentioned period. Of these, 69 had no symptoms of COVID-19 infection, and 67 developed a milder clinical picture. In comparison, 41 pregnant women were diagnosed with bilateral pneumonia. A total of 38 pregnant women were admitted to the intensive care unit, of which 32 pregnant women needed oxygen support, 20 pregnant women were on an oxygen mask, 2 of them on a high-flow nasal canal, four pregnant women on non-invasive mechanical ventilation and six pregnant women on invasive mechanical ventilation. Of the total number of patients, 111 had a natural vaginal delivery, while 75 underwent cesarean section. Of 111 pregnant women who had a vaginal delivery, 92 (83%) received epidural analgesia, while 19 (17%) did not. Among pregnant women undergoing cesarean section, nine pregnant women (12%) received epidural anesthesia, 51 of them (68) received spinal anesthesia, while a cesarean section in 15 pregnant women (20%) was performed under general balanced anesthesia. Of 186 hospitalized and delivered pregnant women, 183 (98.4%) were discharged home in good general condition, while three (1.6%) had a fatal outcome. Conclusion. The clinical manifestations of pregnant women suffering from COVID-19 infection corresponded to the symptoms of the general population to the greatest extent. In contrast, the excessive use of antibiotics, even for asymptomatic patients, is very worrying.Ovo istraživanje ima za cilj opisati kliničke karakteristike, radiološke i laboratorijske nalaze, terapiju i ishod trudnoća kompliciranih infekcijom COVID-19. Metodologija. Retrospektivna deskriptivna studija obuhvatila je sve trudnice s COVID-19 koje su rodile u našoj bolnici od travnja 2020. do siječnja 2022. Kriteriji za isključenje bili su: nepotpuna ili nejasna medicinska dokumentacija, sumnja na infekciju COVID-19 bez potvrde PCR-om ili brzim Ag testom, prethodno dijagnosticirane autoimune bolesti, pozitivna anamneza malignih bolesti, te započeta potpora kisikom u drugoj ustanovi prije prijema u našu bolnicu. Rezultati. Našim istraživanjem obuhvaćeno je 186 trudnica koje su se u navedenom periodu porodile u KBC “Dr. Dragiša Mišović – Dedinje”. Od toga 69 nije imalo simptome infekcije COVID-19, a 67 je razvilo blažu kliničku sliku. Za usporedbu, kod 41 trudnice dijagnosticirana je obostrana upala pluća. Ukupno 38 trudnica primljeno je na jedinicu intenzivne njege, od čega su 32 trudnice trebale kisikovu potporu, 20 trudnica je bilo na kisikovoj maski, od toga 2 na visokoprotočnoj nazalnoj njezi, četiri trudnice na neinvazivnoj. mehaničkom ventilacijom i šest trudnica na invazivnoj mehaničkoj ventilaciji. Od ukupnog broja pacijentica, 111 je imalo prirodni vaginalni porod, a 75 je podvrgnuto carskom rezu. Od 111 trudnica koje su imale vaginalni porod, 92 (83%) dobile su epiduralnu analgeziju, a 19 (17%) nije. Od trudnica podvrgnutih carskom rezu, devet trudnica (12%) dobilo je epiduralnu anesteziju, njih 51 (68) spinalnu anesteziju, dok je carski rez u 15 trudnica (20%) obavljen u općoj uravnoteženoj anesteziji. Od 186 hospitaliziranih i porodilja, 183 (98,4%) otpuštene su kući u dobrom općem stanju, dok su tri (1,6%) imale smrtni ishod. Zaključak. Kliničke manifestacije trudnica oboljelih od infekcije COVID-19 u najvećoj su mjeri odgovarale simptomima opće populacije. Nasuprot tome, pretjerana uporaba antibiotika, čak i kod asimptomatskih pacijenata, vrlo je zabrinjavajuća

Откривање хипотензије током спиналне анестезије за царски рез континуираним неинвазивним праћењем артеријског притиска и интермитентним осцилометријским праћењем крвног притиска код болесница третираних ефедрином или фенилефрином

Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, noninvasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during threeminute intervals, starting from SA, by the end of the surgery. Results. In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we detected 31 (81.6%) hypotensive patients in E group and significantly lower number, 20 (52.6%), with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP only 18 (47.3%), p = 0.001. By monitoring CNAP, we detected significantly higher number of hypotensive intervals in E and P groups (pУвод/Циљ Упркос честим нежељеним ефектима као што је хипотензија, спинална анестезија је и даље техника избора за планирани царски рез. Интермитентно неинвазивно праћење крвног притиска често не детектује хипотензивне епизоде. Циљ ове студије је био да се упореди континуирано неинвазивно праћење артеријског притиска са интермитентним неинвазивним праћењем крвног притиска у смислу ефикасности у откривању хипотензије.Методе Упоређивани су системи за континуирано неинвазивно праћење артеријског притиска и интермитентно неинвазивно праћење крвног притиска ради детекције хипотензије код 76 болесница подељених у две групе од по 38 болесница, третираних ефедрином (Е) или фенилефрином (Ф), на свака три минута, почевши од спиналне анестезије па све до краја операције.Резултати У групи Е су детектоване знатно ниже средње вредности систолног крвног притиска континуираним неинвазивним праћењем артеријског притиска у поређењу са интермитентним неинвазивним праћењем крвног притиска (p = 0,008). Континуираним неинвазивним праћењем артеријског притиска детектована је 31 (81,6%) хипотензивна болесница у групи Е и знатно мањи број, 20 (52,6%) болесница, интермитентним неинвазивним праћењем крвног притиска (p = 0,001), док је у групи Ф континуираним неинвазивним праћењем артеријског притиска детектована хипотензија код 34 болеснице (89,5%), а интермитентним неинвазивним праћењем крвног притиска код 18 (47,3%) болесница, p = 0,001. Континуираним неинвазивним праћењем артеријског притиска детектован је знатно већи број хипотензивних епизода у групама Е и Ф (p < 0,001). pH вредности умбиликалне крви биле су значајно ниже код хипотензивних у односу на нормотензивне болеснице у групама Е и Ф, и са континуираним неинвазивним праћењем артеријског притиска и интермитентним неинвазивним праћењем крвног притиска, респективно (p < 0,001, p = 0,027 у групи Е, и p = 0,009, p < 0,001 у групи Ф).Закључак Континуирано неинвазивно праћење артеријског притиска је много ефикасније у откривању хипотензије током царског реза у спиналној анестезији, што омогућава бржи третман и мање нежељених ефеката код мајке и новорођенчета

“Post-Intensive Care” Syndrome in Patients After Abdominal Surgery – Pilot Study

Aim. The retrospective observational study aimed to determine whether there is a defined syndrome after intensive care after less than 14 days of stay in the intensive care unit. Material and methods. Patients who stayed in the intensive care unit of the Clinical Hospital Center “Dr. Dragiša Mišović – Dedinje” in Belgrade during the May 2022 were examined. Data from the health information system and therapeutic lists were used, and the questionnaire on quality of life was filled out during telephone conversations with patients. In the end, the data were statistically processed. Results. Of 16 patients, the average stay in the intensive care unit was 4.7 days (from 2 to 10). In eight of them, a certain level of change in the general state of health was shown in the last year (which includes the period of hospitalization), and in two of them this change was significant. The general health was significantly impaired in four of them, primarily related to male sex, age and ASA status. In these four patients, the length of stay in the intensive care unit was eight days at maximum. Conclusion. The results of this pilot study indicate the occurrence of the syndrome after intensive treatment in our sample of patients. As the sample is small, more extensive studies are needed to confirm or refute the claim that even a stay shorter than 14 days in intensive care units can lead to a significant change in health status and the emergence of post-intensive care syndrome in critically ill patients

Treatment and outcome of pregnant women with COVID-19: a single-center descriptive study

This study aims to describe the clinical characteristics, radiological and laboratory results, therapy and outcome of pregnancies complicated by COVID-19 infection. Methodology. A retrospective descriptive study included all pregnant women with COVID-19 who gave birth in our hospital from April 2020 to January 2022. Exclusion criteria were: incomplete or unclear medical documentation, suspected COVID-19 infection without confirmation by PCR or rapid Ag test, previously diagnosed autoimmune diseases, positive history of malignant diseases, and started oxygen support in another institution before admission to our hospital. Results. Our study included 186 pregnant women who gave birth at KBC “Dr. Dragiša Mišović – Dedinje” in the mentioned period. Of these, 69 had no symptoms of COVID-19 infection, and 67 developed a milder clinical picture. In comparison, 41 pregnant women were diagnosed with bilateral pneumonia. A total of 38 pregnant women were admitted to the intensive care unit, of which 32 pregnant women needed oxygen support, 20 pregnant women were on an oxygen mask, 2 of them on a high-flow nasal canal, four pregnant women on non-invasive mechanical ventilation and six pregnant women on invasive mechanical ventilation. Of the total number of patients, 111 had a natural vaginal delivery, while 75 underwent cesarean section. Of 111 pregnant women who had a vaginal delivery, 92 (83%) received epidural analgesia, while 19 (17%) did not. Among pregnant women undergoing cesarean section, nine pregnant women (12%) received epidural anesthesia, 51 of them (68) received spinal anesthesia, while a cesarean section in 15 pregnant women (20%) was performed under general balanced anesthesia. Of 186 hospitalized and delivered pregnant women, 183 (98.4%) were discharged home in good general condition, while three (1.6%) had a fatal outcome. Conclusion. The clinical manifestations of pregnant women suffering from COVID-19 infection corresponded to the symptoms of the general population to the greatest extent. In contrast, the excessive use of antibiotics, even for asymptomatic patients, is very worrying