Perspectives of Autonomic nervous system perioperative monitoring –focus on selected tools.

Autonomic nervous system’s role as a “life-sustaining†system is well known. However, the anatomically and functionally complexity of ANS, makes difficult its monitoring in perioperative setting. Various methods have been proposed for measuring its activity. The current review focuses on selected tools-  electrodermal activity, pupilometry, heart rate variability, surgical skin index and  salivatory-a amylase- and their application in the field of anesthesia, intensive care and emergency medicine

Management of a young female patient with Fournier’s gangrene and Lemierre’s syndrome

Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery.Key words: Fournier’s gangrene, Lemierre’s syndrom

ICU handover procedure: the Greek perspective

Background: Passing the right information poses a challenge in clinical practice. This is the first study in Greece that tries to describe the handover procedure in an intensive care unit to a tertiary hospital.Methods: A two phase study was conducted during a 155 days period. It included a blind and open observational study which examined the quality and content of clinical handover by night shift doctor to the medical team and a survey about the process. Retrospective cross-checking of the information handed over with one written down in the actual patient record was also conducted.Results: A total of 800 set of patients’ daily records were examined. A structure of system-based approach of the handover was recorded, with system coverage varying from 21% (nutrition) to 86% (respiratory system) and good relation with the actual record in most areas of interest. Other areas, such as comorbidities, and relatives’ issue were poorly covered. Education meeting that was held between the two phases did ameliorate the content and the quality of information passed over, and in some areas, proved to have a positive effect on certain aspect of handover like e.g. frequency of interruptions, infection status, relatives’ issues and proposed management plan coverage.Conclusions:Handoverprocess is vital for maintaining stability and quality of care in intensive care unit. Its continual efficiency reevaluation is at least as important as the handover itself for preserving it as a valuable tool in everyday practice.

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry.

BACKGROUND It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. METHODS Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. RESULTS Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic. CONCLUSION Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic

Highlights on Hemodynamics

In the era of functional hemodynamic monitoring and computational modeling, the present book published by IntechOpen® highlights some interesting aspects in the field. Divided into two sections, it presents hemodynamic topics of special interest. Thus, the authors offer the readers not only a ""vigorous"" review of the current literature but also a research direction for further advancement

Resuscitation Aspects

In an era of transition from &ldquo;classic&rdquo; Cardiopulmonary resuscitation (CPR) to assisted device-CPR or hemodynamic driven CPR, this book, published by InTechOpen, highlights some interesting aspects of resuscitation. Divided in three sections, the research presented emphasizes the details of resuscitation in special circumstances to possible future applications in the field. The authors offer us not only a &ldquo;vigorous&rdquo; review of the current literature but also a research road map for further advancement