Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

Background: The aim of this study is to evaluate the prognostic factors at medical ICU admittance predicting intensive care unit (ICU) mortality in cancer patients.Methods: Retrospectively data of adult patients admitted to medical ICU of a 1200-bed university hospital during January 2012-December 2013 interval were analysed. The patients were divided into three groups; patients with solid tumor, patients with hematologic malignancy and patients without cancer. The study end point was ICU mortality.Results: 512 patients were identified; 374 patients without cancer, 89 patients with solid tumor and 49 patients with hematologic malignancy. Overall mortality rate in intensive care unit was 46% (n=236). The ICU mortality rate of patients with hematologic malignancy was significantly higher than patients with solid tumors (68.6% vs 53%; p<0.001) and patients without cancer (68.6% vs 39.8%; p<0.001). Logistic regression analysis showed high APACHE II score and the requirement for invasive mechanical ventilation (odds ratio [OR], 5.52; 95% confidence interval [CI], 2.10-14.53; p<0.001) at the time of intensive care unit admittance as independent risk factors for increased mortality. In addition, the requirement of renal replacement therapy(OR, 2.34; [CI: 1.44-3.80]; p<0.002) and vasopressors(OR, 1.67; [CI: 1.10-2.54]; p<0.02)  at the time of intensive care unit admittance were detected as independent risk factors for increased mortality in cancer free group.Conclusions: In critically ill cancer patients; high APACHE II score and the requirement of invasive mechanical ventilation should be evaluated at the time of intensive care unit admittance, for these are strong predictors of increased mortality

A Randomized Clinical Trial Comparing the Effect of Rapidly Infused Crystalloids on Acid-Base Status in Dehydrated Patients in the Emergency Department

Study objective: To compare the effect of normal saline (NS), lactated Ringer's, and Plasmalyte on the acid-base status of dehydrated patients in the emergency department (ED)

Correction: The effect of activated protein C on experimental acute necrotizing pancreatitis

PubMe

The effect of activated protein C on experimental acute necrotizing pancreatitis

INTRODUCTION: Acute pancreatitis is a local inflammatory process that leads to a systemic inflammatory response in the majority of cases. Bacterial contamination has been estimated to occur in 30–40% of patients with necrotizing pancreatitis. Development of pancreatic necrosis depends mainly on the degree of inflammation and on the microvascular circulation of the pancreatic tissue. Activated protein C (APC) is known to inhibit coagulation and inflammation, and to promote fibrinolysis in patients with severe sepsis. We investigated the effects of APC on histopathology, bacterial translocation, and systemic inflammation in experimental acute necrotizing pancreatitis. MATERIALS AND METHOD: Forty-five male Sprague-Dawley rats were studied. Rats were randomly allocated to three groups. Acute pancreatitis was induced in group II (positive control; n = 15) and group III (treatment; n = 15) rats by retrograde injection of taurocholate into the common biliopancreatic duct. Group I rats (sham; n = 15) received an injection of normal saline into the common biliopancreatic duct to mimic a pressure effect. Group III rats were treated with intravenous APC 6 hours after induction of pancreatitis. Pancreatic tissue and blood samples were obtained from all animals for histopathological examination and assessment of amylase, tumor necrosis factor-α, and IL-6 levels in serum. Bacterial translocation to pancreas and mesenteric lymph nodes was measured. RESULTS: Acute pancreatitis developed in all groups apart from group I (sham), as indicated by microscopic parenchymal necrosis, fat necrosis and abundant turbid peritoneal fluid. Histopathological pancreatitis scores in the APC-treated group were lower than in positive controls (10.31 ± 0.47 versus 14.00 ± 0.52; P < 0.001). Bacterial translocation to mesenteric lymph nodes and to pancreas in the APC-treated group was significantly decreased compared with controls (P < 0.02 and P < 0.007, respectively). Serum amylase, tumor necrosis factor--α, and IL-6 levels were also significantly decreased in comparison with positive controls (P < 0.001, P < 0.04 and P < 0.001, respectively). CONCLUSION: APC improved the severity of pancreatic tissue histology, superinfection rates and serum markers of inflammation during the course of acute necrotizing pancreatitis

Cardiac Follow-Up in Patients with COVID-19

Although major clinical manifestations of coronavirus disease (COVID-19) is related with respiratory system, major cardiac complications such as myocardial injury, arrhyth 2019 mias are reported in many publications. Another remarkable finding related with COVID-19 is the relation between hypertension and disease severity and mortality

Evaluation of Hyperkalemia Associated with Trimethoprim-Sulfamethoxazole in the Intensive Care Unit

Aim: The objective of this study was to determine the incidence and risk factors of hyperkalemia associated with trimethoprim-sulfamethoxazole (TMP-SMX) in the intensive care unit (ICU)

A fatal case of severe serotonin syndrome accompanied by moclobemide and paroxetine overdose

Aim: To present a fatal case of serotonin syndrome accompanied by moclobemide and paroxetine overdose. Case presentation: A 34-year-old married woman was presented following intentional ingestion of 3.5 g moclobemide and 2.6 g paroxetine. She was drowsy, agitated, and having rigor. In 1 h she developed myoclonus and diffuse muscle rigidity prominent in lower extremities. All laboratory tests were unremarkable except hyperglycemia (160 mg/dl), sinus tachycardia (103/min), and metabolic acidosis (7.051 pH, 52 mmHg pO2, 74.7 mmHg pCO2, 15% HCO3, 77% SaO2). Despite oxygen supplementation, her respiratory acidosis got worse and the SaO2 concentration decreased to 72%. Endotracheal intubation and paralysis were decided to control muscle hyperactivity followed by hyperthermia (max. 42.3°C) unresponsive to benzodiazepine. Even aggressive supportive treatment (mechanical ventilation, buffer replacement, cyproheptadine, and dantrolene) were applied, the patient could not recover and suffered cardiopulmonary arrest 20 h after presentation. Conclusion: Physicians working in the emergency departments and intensive care units, managing patients presenting with acute ingestion of selective serotonin reuptake inhibitors combined with monoamine oxidase inhibitors, should be aware of recognizing and treating serotonin stndrome. This is because many of these patients may require intensive care monitoring as well as tracheal intubation and ventilatory support

IMPACT OF TIME TO ANTIBIOTICS ON MORTALITY IN SEVERE SEPSIS AND SEPTIC SHOCK

Introduction: Severe sepsis and septic shock are associated with high mortality. Antibiotherapy must be started as early as possible since it seems to be the most important factor determining survival. In this study, we aimed to evaluate the time intervals between diagnosis and first dose of antibiotherapy and its impact on mortality in severe sepsis and septic shock patients

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

Background: The aim of this study is to evaluate the prognostic factors at medical ICU admittance predicting intensive care unit (ICU) mortality in cancer patients.Methods: Retrospectively data of adult patients admitted to medical ICU of a 1200-bed university hospital during January 2012-December 2013 interval were analysed. The patients were divided into three groups; patients with solid tumor, patients with hematologic malignancy and patients without cancer. The study end point was ICU mortality.Results: 512 patients were identified; 374 patients without cancer, 89 patients with solid tumor and 49 patients with hematologic malignancy. Overall mortality rate in intensive care unit was 46% (n=236). The ICU mortality rate of patients with hematologic malignancy was significantly higher than patients with solid tumors (68.6% vs 53%; p&lt;0.001) and patients without cancer (68.6% vs 39.8%; p&lt;0.001). Logistic regression analysis showed high APACHE II score and the requirement for invasive mechanical ventilation (odds ratio [OR], 5.52; 95% confidence interval [CI], 2.10-14.53; p&lt;0.001) at the time of intensive care unit admittance as independent risk factors for increased mortality. In addition, the requirement of renal replacement therapy(OR, 2.34; [CI: 1.44-3.80]; p&lt;0.002) and vasopressors(OR, 1.67; [CI: 1.10-2.54]; p&lt;0.02)  at the time of intensive care unit admittance were detected as independent risk factors for increased mortality in cancer free group.Conclusions: In critically ill cancer patients; high APACHE II score and the requirement of invasive mechanical ventilation should be evaluated at the time of intensive care unit admittance, for these are strong predictors of increased mortality