Anaesthetic guidelines for preparation patients for emergency surgical operation

Pacijente koji zbog svog stanja trebaju biti podvrgnuti hitnoj kirurškoj operaciji potrebno je u što kraćem vremenu pripremiti za zahvat. U slučaju životne ugroženosti liječenje se može provesti bez suglasnosti bolesnika ili najuže rodbine. Razgovor s pacijentom važna je karika prijeoperacijske procjene i planiranja anestezioloških postupaka jer daje važne informacije o sadašnjim i prijašnjim bolestima, terapiji, ranijim kirurškim zahvatima i eventualnim komplikacijama anestezije. Fizikalni pregled i laboratorijske pretrage daju precizan uvid u stanje pojedinog organskog sustava. Budući da su kardiovaskularne i plućne bolesti vodeći uzrok perioperacijskog mortaliteta i morbiditeta, procjena tih dvaju organskih sustava iziskuje posebnu pažnju. Također je važno učiniti procjenu živčanog sustava, funkcija jetre i bubrega, gastrointestinalnog, endokrinološkog i hematološkog sustava te mišićno-koštanog sustava u slučaju pozitivne anamneze. Kako bi se pacijenta što bolje pripremilo za anesteziju te kako bi se postigli optimalni uvjeti za kirurški zahvat, pristupa se premedikaciji. Ciljevi premedikacije su: anksioliza, analgezija, amnezija, smanjenje salivacije, smanjenje želučanog volumena i regulacija pH želučanog sadržaja, sprječavanje postoperativne mučnine i povraćanja i sprječavanje vagalnog refleksa prilikom intubacije. Za nadoknadu tekućina koriste se kristaloidne ili koloidne otopine, s ciljem povećanja cirkulacijskog volumena i krvnog tlaka te poboljšanja perfuzije i oksigenacije tkiva. Uvod u anesteziju može se postići intravenskim anesteticima (tiopental, propofol, ketamin, midazolam, etomidat), što je poželjno u slučaju hemodinamske nestabilnosti i mogućnosti povraćanja ili aspiracije, te inhalacijskim anesteticima (dušikov oksid, halotan, desfluran, izofluran, sevofluran, ksenon). U slučaju politraume uloga anesteziologa nerijetko je ključna za konačan ishod liječenja. Najčešće korištene ljestvice za procjenu ozljeda su Glasgow Coma Score (GCS) i Revised Trauma Score (RTS). Primarno zbrinjavanje politraumatiziranog pacijenta uključuje identifikaciju i zbrinjavanje za život opasnih ozljeda prema ABCDE pristupu.Patients whose condition requires urgent surgery need to be prepared for the procedure as soon as possible. In case of vital threat, the operation can be performed without an informed consent. The preoperative talk is the essential part of the preoperative assessment because it gives important information about patient's illness, medical history and therapy, previous operations and complications of anesthesia. Physical examination and laboratory tests show the condition of organ systems. Since cardiovascular and pulmonary diseases are the main cause of perioperative morbidity and mortality, the evaluation of those two organ systems has to be done with great caution. It is important to evaluate the condition of nervous system, liver and kidney function, gastrointestinal, endocrine and hematology system, as well as muscular system if the patient's history indicates so. Premedication needs to be done in order to prepare the patient for anesthesia and to provide optimal conditions for surgery. This includes anxiolysis, analgesia, amnesia, reduction of salivation, reduction of gastric volume and gastric pH control, reduction of postoperative nausea and vomiting and reduction of vagal reflexes to intubation. Crystalloid and colloid solutions are used for fluid resuscitation, with the purpose to increase circulating volume and blood pressure as well as to improve tissue perfusion and oxygenation. Anesthesia can be induced by intravenous anesthetics (thiopental, propofol, ketamine, midazolam, etomidate), which are preferred in case of hemodynamic instability and the risk of vomiting and aspiration, or by inhalational anesthetics (nitrous oxide, halothane, desflurane, isoflurane, sevoflurane, xenon). In case of polytrauma, an anesthesiologist has the key role on the final outcome of the medical treatment. The most commonly used scales to classify and describe the severity of injuries are Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS). The primary survey of polytrauma patients includes the identification and treatment of life threatening injuries by ABCDE protocol

Anaesthetic guidelines for preparation patients for emergency surgical operation

Pacijente koji zbog svog stanja trebaju biti podvrgnuti hitnoj kirurškoj operaciji potrebno je u što kraćem vremenu pripremiti za zahvat. U slučaju životne ugroženosti liječenje se može provesti bez suglasnosti bolesnika ili najuže rodbine. Razgovor s pacijentom važna je karika prijeoperacijske procjene i planiranja anestezioloških postupaka jer daje važne informacije o sadašnjim i prijašnjim bolestima, terapiji, ranijim kirurškim zahvatima i eventualnim komplikacijama anestezije. Fizikalni pregled i laboratorijske pretrage daju precizan uvid u stanje pojedinog organskog sustava. Budući da su kardiovaskularne i plućne bolesti vodeći uzrok perioperacijskog mortaliteta i morbiditeta, procjena tih dvaju organskih sustava iziskuje posebnu pažnju. Također je važno učiniti procjenu živčanog sustava, funkcija jetre i bubrega, gastrointestinalnog, endokrinološkog i hematološkog sustava te mišićno-koštanog sustava u slučaju pozitivne anamneze. Kako bi se pacijenta što bolje pripremilo za anesteziju te kako bi se postigli optimalni uvjeti za kirurški zahvat, pristupa se premedikaciji. Ciljevi premedikacije su: anksioliza, analgezija, amnezija, smanjenje salivacije, smanjenje želučanog volumena i regulacija pH želučanog sadržaja, sprječavanje postoperativne mučnine i povraćanja i sprječavanje vagalnog refleksa prilikom intubacije. Za nadoknadu tekućina koriste se kristaloidne ili koloidne otopine, s ciljem povećanja cirkulacijskog volumena i krvnog tlaka te poboljšanja perfuzije i oksigenacije tkiva. Uvod u anesteziju može se postići intravenskim anesteticima (tiopental, propofol, ketamin, midazolam, etomidat), što je poželjno u slučaju hemodinamske nestabilnosti i mogućnosti povraćanja ili aspiracije, te inhalacijskim anesteticima (dušikov oksid, halotan, desfluran, izofluran, sevofluran, ksenon). U slučaju politraume uloga anesteziologa nerijetko je ključna za konačan ishod liječenja. Najčešće korištene ljestvice za procjenu ozljeda su Glasgow Coma Score (GCS) i Revised Trauma Score (RTS). Primarno zbrinjavanje politraumatiziranog pacijenta uključuje identifikaciju i zbrinjavanje za život opasnih ozljeda prema ABCDE pristupu.Patients whose condition requires urgent surgery need to be prepared for the procedure as soon as possible. In case of vital threat, the operation can be performed without an informed consent. The preoperative talk is the essential part of the preoperative assessment because it gives important information about patient's illness, medical history and therapy, previous operations and complications of anesthesia. Physical examination and laboratory tests show the condition of organ systems. Since cardiovascular and pulmonary diseases are the main cause of perioperative morbidity and mortality, the evaluation of those two organ systems has to be done with great caution. It is important to evaluate the condition of nervous system, liver and kidney function, gastrointestinal, endocrine and hematology system, as well as muscular system if the patient's history indicates so. Premedication needs to be done in order to prepare the patient for anesthesia and to provide optimal conditions for surgery. This includes anxiolysis, analgesia, amnesia, reduction of salivation, reduction of gastric volume and gastric pH control, reduction of postoperative nausea and vomiting and reduction of vagal reflexes to intubation. Crystalloid and colloid solutions are used for fluid resuscitation, with the purpose to increase circulating volume and blood pressure as well as to improve tissue perfusion and oxygenation. Anesthesia can be induced by intravenous anesthetics (thiopental, propofol, ketamine, midazolam, etomidate), which are preferred in case of hemodynamic instability and the risk of vomiting and aspiration, or by inhalational anesthetics (nitrous oxide, halothane, desflurane, isoflurane, sevoflurane, xenon). In case of polytrauma, an anesthesiologist has the key role on the final outcome of the medical treatment. The most commonly used scales to classify and describe the severity of injuries are Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS). The primary survey of polytrauma patients includes the identification and treatment of life threatening injuries by ABCDE protocol

Sociodemographic Determinants and Common Reasons for Visiting the Emergency Dental Service in the City of Zagreb

Svrha: Svrha rada bila je odrediti socijalno-demografske i kliničke parametre pacijenata koji posjećuju hitnu stomatološku službu te njihove najčešće dijagnoze. Materijali i metode: Podatci su prikupljeni na temelju ankete koju su pacijenti ispunjavali za posjeta službi. Ukupno je sudjelovalo 1730 pacijenata (26 %) od njih 6732, s pritom se ispunjavala anketa u kojoj su postavljena pitanja o socijalno- demografskom statusu i posjećivanju stomatologa te je tražen opis i dinamika simptoma. Nakon prikupljanja podataka provedene su metode deskriptivnog prikaza podataka te metode inferencijalne statistike u SPSS-u. Rezultati: Rezultati nakon analize ankete pokazali su da većina ispitanika (60,4 %) dolazi u hitnu službu vikendima i blagdanima. Istaknimo da je 73,1 % ispitanika naveo je da se već koristio uslugama hitne stomatološke službe, a 65,8 % njih zbog trenutačnog stanja nije posjetilo vojega stomatologa. Najveći broj ispitanika (62,2 %) u hitnu je službu došao unutar tjedan dana od početka tegoba. Najčešće dijagnoze bile su apscesi lica i čeljusti (27,3 %). Postoji statistički značajna razlika između broja pacijenata koji su došli u hitnu stomatološku službu i ispunili upitnik tijekom različitih mjeseci, u smislu da je više njih tražilo pomoć tijekom svibnja i lipnja (59,7 %) u odnosu prema srpnju i kolovozu (40,3 %). Zaključak: Kod većine ispitanika postojale su jasne indikacije za prijam u hitnu stomatološku službu. Većina hitnih stanja nastala je uglavnom zbog neredovitih posjeta izabranom liječniku. Boljom edukacijom pacijenata i provedbom preventivnih programa broj posjeta ovoj službi vjerojatno bi se smanjio.Objective: The objective of the study was to determine the sociodemographic and clinical parameters of patients who visit the emergency dental service and their most common diagnoses. Materials and Methods: The data were collected on the basis of a survey filled out by patients. A total of 1730 out of 6732 patients (26%) were surveyed using a questionnaire to analyze sociodemographic status, dental visits, the description and dynamics of the symptoms. After the data collection, methods of descriptive data presentation and of inferential statistics were made in SPSS. Results: Survey results show that most subjects (60.4%) came during the weekends and holidays. The subjects, 73.1 % of them, stated that they had already used this type of service, and 65.8% did not visit their dentist beforehand. The largest number of subjects (62.2%) reported that they needed emergency service within a week after their problems had begun. The most common diagnoses included face and jaw abscesses (27.3%). There is a statistically significant difference between the number of patients who went to the emergency dental service and completed the questionnaire over the course of several months contrary to patients who were there in May and June (59.7%) compared to July and August (40.3 %). Conclusions: Most subjects had clear indications for being referred to an emergency dental service. Most of the emergency conditions were mainly due to irregular visits to the dentist. Patient education and preventive programs would probably have reduced the number of visits

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim To describe epidemiological characteristics and base - line clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coro - navirus disease 2019 (COVID-19) patients treated at a ter - tiary institution specialized for COVID-19 patients. Methods This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbid - ities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. Results The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m 2 . The most relevant comor - bidities were diabetes mellitus (32.6%), arterial hyperten - sion (71.2%), congestive heart failure (19.1%), chronic kid - ney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dim - er, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, Pa O 2 /FiO 2 ratio, and glomerular filtration rate at ad - mission. Length of ICU stay was 9 days. The median surviv - al was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. Conclusion The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify in - dividual mortality risk factor

Povezanost upalnih parametara i infekcija krvi uzrokovanih multirezistentnim Gram negativnim bakterijama kod COVID-19 pozitivnih bolesnika liječenih u jedinici intenzivnog liječenja – retrospektivna studija jednog centra

Objectives: During the COVID-19 pandemics we have seen in critically ill COVID-19 patients treated in the intensive care unit the parallel outbreak of multidrug resistant Gram-negative bacteria bloodstream infections, mainly Acinetobacter baumannii and Klebsiella pneumoniae. Methods: We conducted a retrospective cohort single-center study. The aim was to investigate the incidence, etiology and impact of intensive care unit bloodstream infections in COVID-19 patients admitted to the COVID-19 intensive care unit with a known burden of multidrug resistance and to evaluate the possibility that inflammatory parameters levels measured at two different time points of treatment can early predict multidrug resistant Gram-negative bacteria bloodstream infections and enable timely beginning of bacterial targeted antimicrobial therapy. Results: Our study confirmed that procalcitonin values of 2,46 mcg/L and neutrophil/lymphocyte ratio of 28,9 could be a reliable indicators for high risk stratification of multidrug resistant Gram-negative bacterial infection origin in critically ill COVID-19 patients (Mann Whitney U test, P=0,02). Conclusion: Monitoring dynamic shift of inflammatory parameters in critically ill COVID-19 patients could reliably help clinician to recognize the multidrug resistant Gram-negative bacteria bloodstream infections and start with the antimicrobial therapy in a timely manner.Cilj istraživanja: Tijekom COVID-19 pandemije uočili smo kod kritično bolesnih COVID-19 pozitivnih bolesnika liječenih na odjelu intenzivne njege paralelno izbijanje infekcija krvi uzrokovanih multirezistentnim Gram negativnim bakterijama, uglavnom Acinetobacter baumannii i Klebsiella pneumoniae. U praksi rezultati mikrobiološke potvrde infekcija krvi završeni su s određenom vremenskom odgodom. Stoga primarni cilj istraživanja bio je odrediti povezanost upalnih parametara (leukociti, limfociti, neutrofili, omjer neutrofila i limfocita, C-reaktivni protein, prokalcitonin) mjerenih u dvije različite vremenske točke (dan prijema u jedinicu intenzivnog liječenja i dan nastanka infekcija krvi potvrđenih pozitivnim hemokulturama) i nastanka infekcija krvi uzrokovanih multirezistentnim Gram negativnim. Sekundarni ciljevi istraživanja bili su istražiti učestalost, etiologiju i utjecaj infekcija krvi uzrokovanih multirezistentnim Gram negativnim bakterijama na ishod liječenja COVID-19 pozitivnih bolesnika. Materijali i metode: Proveli smo retrospektivno kohortno istraživanje u Kliničkoj bolnici Dubrava na intenzivističkom odjelu COVID-19 pozitivnih bolesnika u vremenskom period od 31. listopada 2020. godine do 31. ožujka 2021. godine. U istraživanju je sudjelovalo 166 COVID-19 pozitivnih bolesnika koji su zadovoljili kriterije uključenja u istraživanje. 122 COVID-19 bolesnika imali su mikrobiološki potvrđenu infekciju krvi uzrokovanu multirezistentnim Gram negativnim bakterijama. Kontrolna gupa imala je 44 COVID-19 bolesnika koji nisu razvili infekciju krvi. Svi podaci bolesnika skupljali su se iz povijesti bolesti i elektroničke baze podataka. Rezultati: Naša studija potvrdila je cut-off vrijednosti upalnih parametara prokalcitonina od 2,46 mcg/L i omjer neutrofila/limfocita od 28,9 kao pouzdane pokazatelje stratifikacije visoko rizičnih COVID-19 bolesnika za nastanak infekcije krvi uzrokovane multirezistentnim Gram negativnim bakterijama, Acinetobacter baumannii i Klebsiella pneumoniae (Mann Whitney U test, P=0,02). Zaključak: Dinamički monitoring upalnih parametara sa cut-off vrijednostima proklacitonina i omjera neutrofila i limfocita u različitim vremenskim intervalima u kritično bolesnih COVID-19 pozitivnih bolesnika pouzdani je pokazatelj visokog rizika nastanka infekcija krvi uzrokovanih multirezistentnim Gram negativnim bakterijama koji u kliničkoj praksi omogućuje pravovremeno uvođenje ciljane antimikrobne terapije prije dospijeća mikrobiološke potvrde

Bacterial superinfections in critically ill COVID-19 patients – experiences from University Hospital Dubrava tertiary COVID-19 center

Cilj istraživanja: Utvrditi incidenciju najčešćih bakterijskih superinfekcija, distribuciju uzročnika ovisno o sijelu infekcije, demografske podatke, relevantne laboratorijske i kliničke parametre te ishode liječenja kritično oboljelih bolesnika liječenih u tercijarnom regionalnom centru specijaliziranom za liječenje COVID-19 bolesnika PRIC KB Dubrava. Ispitanici i metode: Provedeno je retrospektivno opservacijsko ispitivanje te su podaci skupljeni pregledom povijesti bolesti u bolničkom informacijskom sustavu (BIS, In2, Zagreb) pacijenata liječenih u jedinicama intenzivne medicine PRIC-IC KB Dubrava tijekom razdoblja od 01. ožujka 2020. do 01. veljače 2021. Skupljeni podaci analizirani su u statističkom programskom paketu jamovi. Rezultati: Od ukupno 692 pacijenta, 383 je razvilo bakterijsku ili gljivičnu superinfekciju. Njih 305 je razvilo pneumoniju, 133 bakterijemiju a 120 urinarnu infekciju. 66,3% pacijenata bilo je muškog spola, te su češće primani sa bolničkih odjela i JIM-ova drugih bolnica. Od 305 pacijenata sa pneumonijom 295 je bilo mehanički ventilirano te je razvilo VAP. Kod pacijenata koji nisu razvili bakterijemiju primjećen je porat omjera neutrofili leukociti, te limfopenija i pad vrijednosti CRP-a. Urinarna infekcija češća je kod žena. U sve tri skupine, pacijenti su imali produljen period boravka u JIM-u i u bolnici. Zaključci: Incidencija bakterijskih superinfekcija u kritično oboljelih COVID-19 pacijenata vrlo je visoka i iznosi 55,3%. Najčešće bakterijske superinfekcije su VAP, bakterijemija i urinarna infekcija. Najčešći uzročni patogeni su MDR bakterije. Pacijenti sa sekundarnom infekcijom imaju dulji period boravka u JIM. Povećanje omjera neutrofili / limfociti i progresija limfopenije povezane su sa nepovoljnim kliničkim ishodima.Goal: To determine incidence of bacterial superinfections, causative pathogens demographic data, relevant laboratory parameters and outcomes in critically ill COVID-19 patients treated in primary respiratory intensivist center (PRIC) UH Dubrava. Patients and methods: In this retrospective observational study, clinical and laboratory data of 692 critically ill patients treated in PRIC UH Dubrava between March 1st 2020. and February 1st 2021. was collected using the hospital information system software (BIS) and statistical analysis was performed using the jamovi statistical package. Results: Out of 692 patients admitted to the ICU, 383 acquired bacterial or fungal superinfections. 305 acquired pneumonia, 133 bloodstream infections and 120 urinary infections. 66.3% of patients were males, and bacterial superinfections were more common in patients admitted from hospital wards or external ICUs. Out of 305 patients with pneumonia, 295 were receiving mechanical ventilation and satisfied the criteria for ventilator associated pneumonia. Patients with bloodstream infections maintained elevated neutrophil lymphocyte ratio, lymphopenia and elevated CRP levels on day 7 compared to those without BSI. Urinary infections were more common in females, and did not have an effect on outcomes. All patients that developed superinfections had prolonged ICU and hospital stay. Conclusion: Incidence of bacterial superinfections in critically ill COVID-19 patients is 55.3%. Most common infections are ventilator associated pneumonia, bloodstream infections and urinary infections. Most common pathogens are multi-drug resistant pathogens. Patients with bacterial superinfections have longer ICU and hospital stay, and in these patients, persistent elevation of NLR ratio and worsening of lymphopenia are characteristic for patients with worse outcomes

Anaesthetic guidelines for preparation patients for emergency surgical operation

Pacijente koji zbog svog stanja trebaju biti podvrgnuti hitnoj kirurškoj operaciji potrebno je u što kraćem vremenu pripremiti za zahvat. U slučaju životne ugroženosti liječenje se može provesti bez suglasnosti bolesnika ili najuže rodbine. Razgovor s pacijentom važna je karika prijeoperacijske procjene i planiranja anestezioloških postupaka jer daje važne informacije o sadašnjim i prijašnjim bolestima, terapiji, ranijim kirurškim zahvatima i eventualnim komplikacijama anestezije. Fizikalni pregled i laboratorijske pretrage daju precizan uvid u stanje pojedinog organskog sustava. Budući da su kardiovaskularne i plućne bolesti vodeći uzrok perioperacijskog mortaliteta i morbiditeta, procjena tih dvaju organskih sustava iziskuje posebnu pažnju. Također je važno učiniti procjenu živčanog sustava, funkcija jetre i bubrega, gastrointestinalnog, endokrinološkog i hematološkog sustava te mišićno-koštanog sustava u slučaju pozitivne anamneze. Kako bi se pacijenta što bolje pripremilo za anesteziju te kako bi se postigli optimalni uvjeti za kirurški zahvat, pristupa se premedikaciji. Ciljevi premedikacije su: anksioliza, analgezija, amnezija, smanjenje salivacije, smanjenje želučanog volumena i regulacija pH želučanog sadržaja, sprječavanje postoperativne mučnine i povraćanja i sprječavanje vagalnog refleksa prilikom intubacije. Za nadoknadu tekućina koriste se kristaloidne ili koloidne otopine, s ciljem povećanja cirkulacijskog volumena i krvnog tlaka te poboljšanja perfuzije i oksigenacije tkiva. Uvod u anesteziju može se postići intravenskim anesteticima (tiopental, propofol, ketamin, midazolam, etomidat), što je poželjno u slučaju hemodinamske nestabilnosti i mogućnosti povraćanja ili aspiracije, te inhalacijskim anesteticima (dušikov oksid, halotan, desfluran, izofluran, sevofluran, ksenon). U slučaju politraume uloga anesteziologa nerijetko je ključna za konačan ishod liječenja. Najčešće korištene ljestvice za procjenu ozljeda su Glasgow Coma Score (GCS) i Revised Trauma Score (RTS). Primarno zbrinjavanje politraumatiziranog pacijenta uključuje identifikaciju i zbrinjavanje za život opasnih ozljeda prema ABCDE pristupu.Patients whose condition requires urgent surgery need to be prepared for the procedure as soon as possible. In case of vital threat, the operation can be performed without an informed consent. The preoperative talk is the essential part of the preoperative assessment because it gives important information about patient's illness, medical history and therapy, previous operations and complications of anesthesia. Physical examination and laboratory tests show the condition of organ systems. Since cardiovascular and pulmonary diseases are the main cause of perioperative morbidity and mortality, the evaluation of those two organ systems has to be done with great caution. It is important to evaluate the condition of nervous system, liver and kidney function, gastrointestinal, endocrine and hematology system, as well as muscular system if the patient's history indicates so. Premedication needs to be done in order to prepare the patient for anesthesia and to provide optimal conditions for surgery. This includes anxiolysis, analgesia, amnesia, reduction of salivation, reduction of gastric volume and gastric pH control, reduction of postoperative nausea and vomiting and reduction of vagal reflexes to intubation. Crystalloid and colloid solutions are used for fluid resuscitation, with the purpose to increase circulating volume and blood pressure as well as to improve tissue perfusion and oxygenation. Anesthesia can be induced by intravenous anesthetics (thiopental, propofol, ketamine, midazolam, etomidate), which are preferred in case of hemodynamic instability and the risk of vomiting and aspiration, or by inhalational anesthetics (nitrous oxide, halothane, desflurane, isoflurane, sevoflurane, xenon). In case of polytrauma, an anesthesiologist has the key role on the final outcome of the medical treatment. The most commonly used scales to classify and describe the severity of injuries are Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS). The primary survey of polytrauma patients includes the identification and treatment of life threatening injuries by ABCDE protocol

Healthcare-Associated Bloodstream Infections Due to Multidrug-Resistant Acinetobacter baumannii in COVID-19 Intensive Care Unit: A Single-Center Retrospective Study

Healthcare-associated infections are an emerging cause of morbidity and mortality in COVID-19 intensive care units (ICUs) worldwide, especially those caused by multidrug-resistant (MDR) pathogens. The objectives of this study were to assess the incidence of bloodstream infections (BSIs) among critically ill COVID-19 patients and to analyze the characteristics of healthcare-associated BSIs due to MDR Acinetobacter baumannii in an COVID-19 ICU. A single-center retrospective study was conducted at a tertiary hospital during a 5-month period. The detection of carbapenemase genes was performed by PCR and genetic relatedness by pulsed-field gel electrophoresis (PFGE) and multilocus-sequence typing. A total of 193 episodes were registered in 176 COVID-19 ICU patients, with an incidence of 25/1000 patient-days at risk. A. baumannii was the most common etiological agent (40.3%), with a resistance to carbapenems of 100%. The blaOXA-23 gene was detected in ST2 isolates while the blaOXA-24 was ST636-specific. PFGE revealed a homogeneous genetic background of the isolates. The clonal spread of OXA-23-positive A. baumannii is responsible for the high prevalence of MDR A. baumannii BSIs in our COVID-19 ICU. Further surveillance of resistance trends and mechanisms is needed along with changes in behavior to improve the implementation of infection control and the rational use of antibiotics

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim: To describe epidemiological characteristics and baseline clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coronavirus disease 2019 (COVID-19) patients treated at a tertiary institution specialized for COVID-19 patients. ----- Methods: This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbidities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. ----- Results: The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m2. The most relevant comorbidities were diabetes mellitus (32.6%), arterial hypertension (71.2%), congestive heart failure (19.1%), chronic kidney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dimer, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, PaO2/FiO2 ratio, and glomerular filtration rate at admission. Length of ICU stay was 9 days. The median survival was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. ----- Conclusion: The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify individual mortality risk factors

Distribution of Pathogens and Predictive Values of Biomarkers of Inflammatory Response at ICU Admission on Outcomes of Critically Ill COVID-19 Patients with Bacterial Superinfections—Observations from National COVID-19 Hospital in Croatia

Background: Superinfections contribute to mortality and length of stay in critically ill COVID-19 patients. The aim of this study was to determine the incidence and pathogen distribution of bacterial and fungal superinfections of the lower respiratory tract (LRTI), urinary tract (UTI) and bloodstream (BSI) and to determine the predictive value of biomarkers of inflammatory response on their ICU survival rates. Methods: A retrospective observational study that included critically ill COVID-19 patients treated during an 11-month period in a Croatian national COVID-19 hospital was performed. Clinical and diagnostic data were analyzed according to the origin of superinfection, and multivariate regression analysis was performed to determine the predictive values of biomarkers of inflammation on their survival rates. Results: 55.3% critically ill COVID-19 patients developed bacterial or fungal superinfections, and LRTI were most common, followed by BSI and UTI. Multidrug-resistant pathogens were the most common causes of LRTI and BSI, while Enterococcus faecalis was the most common pathogen causing UTI. Serum ferritin and neutrophil count were associated with decreased chances of survival in patients with LRTI, and patients with multidrug-resistant isolates had significantly higher mortality rates, coupled with longer ICU stays. Conclusion: The incidence of superinfections in critically ill COVID-19 patients was 55.3%, and multidrug-resistant pathogens were dominant. Elevated ferritin levels and neutrophilia at ICU admission were associated with increased ICU mortality in patients with positive LRTI