Publications by authors named "Łukasz Krzych"

129 Publications

Efficacy and safety of therapeutic plasma exchange in stiff person syndrome.

Open Med (Wars) 2021 30;16(1):526-531. Epub 2021 Mar 30.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland.

The stiff person syndrome (SPS) is an extremely rare neurological disorder with primarily immune-mediated etiology. The cardinal symptoms are progressive, fluctuating axial/proximal limb muscle stiffness and spasms. The diagnosis is based on the clinical picture, electromyography examination and detection of antibodies to glutamic acid decarboxylase (anti-GAD). Adverse effects of medications might preclude its use or increase in dosing, therefore symptomatic and/or immunomodulatory medical therapy might be ineffective in acute exacerbation of the disease. We present a case of a 49-year-old female with exacerbation of SPS, in whom some standard pharmacotherapy could not be introduced (clonazepam, baclofen used in the past) and doses of existing standard medications could not be increased (diazepam, gabapentin, and levetiracetam) due to adverse effects. Moreover, a newly introduced medication (methylprednisolone) also led to a serious adverse effect (severe hyperglycemia). The patient underwent therapeutic plasma exchange (TPE) with good effect and no complications. We review the literature regarding the efficacy and safety profile of TPE in exacerbation of SPS unresponsive to medical therapy. The procedure seems to have a good safety profile as an adjunct therapy for exacerbation of SPS not responding to standard medical therapy in this patient population.
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http://dx.doi.org/10.1515/med-2021-0220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010154PMC
March 2021

Iatrogenic blood loss due to daily laboratory testing and the risk of subsequent anaemia in intensive care unit patients: case series.

Acta Biochim Pol 2021 Mar;68(1):135-138

Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.

Introduction: Anaemia is associated with a wide range of negative outcomes. Diagnostic blood loss (DBL) may contribute to its occurrence. We aimed to evaluate DBL and its impact on haemoglobin (HGB) concentration and developing anaemia in the intensive care unit (ICU) patients.

Methods: A study group comprised of 36 adult ICU patients. DBL during 7 consecutive, post-admission days was calculated. Anaemia occurrence was assessed using the WHO thresholds. Data on HGB and haematocrit (HCT) was subjected to analysis.

Results: Upon admission, 24 (67%) patients were diagnosed with anaemia, on the eighth day 29 (80%) subjects (with 6 new cases). The median volume of blood collected was 143.15 mL (IQR 121.4-161.65) per week. No differences in DBL were found between the subjects with newly developed anaemia and their counterparts (p=0.4). The median drop of HGB (HbΔ) was 18 gL-1 (IQR 5-28) and the median drop of haematocrit (HtΔ) was 4.55% (IQR 1.1-7.95). There was no correlation between neither HbΔ and DBL (p=0.8) nor HtΔ and DBL (p=0.7). There were also no differences in HbΔ/HtΔ when age, gender or the primary critical illness were taken into account for the analysis (p>0.05 for all). The 7-day fluid balance was associated with haemoglobin drop (R=0.45; p=0.006).

Conclusions: Anaemia is frequent in ICU patients. Diagnostic blood loss in our institution is acceptable and seems to protect patients against significant iatrogenic blood loss and subsequent anaemia. Dilutional anaemia may interfere with the results so before-after interventional research is needed to explore this interesting topic.
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http://dx.doi.org/10.18388/abp.2020_5525DOI Listing
March 2021

What Do We Know about Early Management of Sepsis and Septic Shock in Polish Hospitals? A Questionnaire Study.

Healthcare (Basel) 2021 Feb 1;9(2). Epub 2021 Feb 1.

First Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland.

Background: Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. We investigate the correspondence between Surviving Sepsis Campaign (SSC) guidelines and clinical practice in Poland, with special attention given to differences between ICU and non-ICU environments as well as regional variations within the country.

Methods: A web-based questionnaire study was performed on a random sample of 60 hospitals from the three most populated regions in Poland-Masovia, Silesia, and Greater Poland. A 19-item questionnaire was built based on the most recent edition of SSC guidelines.

Results: Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; = 0.02). There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). Modification of empiric antimicrobial treatment was required post-ICU admission in 70% of cases. ICUs differed from non-ICUs with regard to the methods of fluid responsiveness assessment and the types of catecholamines and fluids used to treat septic shock. The mean fluid load applied before the implementation of catecholamines was 25.8 ± 10.6 mL/kg. Norepinephrine was the first-line agent used to treat shock, and balanced crystalloids were preferred in both ICUs and non-ICUs.

Conclusion: Compliance with SCC guidelines in Polish hospitals is insufficient, especially outside ICUs. There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field.
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http://dx.doi.org/10.3390/healthcare9020140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912914PMC
February 2021

Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19-Where Are We Now?

Int J Environ Res Public Health 2021 01 28;18(3). Epub 2021 Jan 28.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

The recent development in extracorporeal life support (ECLS) has created new therapeutic opportunities for critically ill patients. An interest in extracorporeal membrane oxygenation (ECMO), the pinnacle of ECLS techniques, has recently increased, as for the last decade, we have observed improvements in the survival of patients suffering from severe acute respiratory distress syndrome (ARDS) while on ECMO. Although there is a paucity of conclusive data from clinical research regarding extracorporeal oxygenation in COVID-19 patients, the pathophysiology of the disease makes veno-venous ECMO a promising option.
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http://dx.doi.org/10.3390/ijerph18031173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908448PMC
January 2021

Postoperative Neurocognitive Disorders in Cardiac Surgery: Investigating the Role of Intraoperative Hypotension. A Systematic Review.

Int J Environ Res Public Health 2021 01 18;18(2). Epub 2021 Jan 18.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland.

Perioperative neurocognitive disorders remain a challenging obstacle in patients after cardiac surgery, as they significantly contribute to postoperative morbidity and mortality. Identifying the modifiable risk factors and mechanisms for postoperative cognitive decline (POCD) and delirium (POD) would be an important step forward in preventing such adverse events and thus improving patients' outcome. Intraoperative hypotension is frequently discussed as a potential risk factor for neurocognitive decline, due to its significant impact on blood flow and tissue perfusion, however the studies exploring its association with POCD and POD are very heterogeneous and present divergent results. This review demonstrates 13 studies found after structured systematic search strategy and discusses the possible relationship between intraoperative hypotension and postoperative neuropsychiatric dysfunction.
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http://dx.doi.org/10.3390/ijerph18020786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831914PMC
January 2021

Basics of mechanical ventilation for non-aneasthetists. Part 2: Clinical aspects.

Adv Respir Med 2020 ;88(6):580-589

Chair and Department of Anaesthesiology and Intensive Care, Medical University of Silesia in Katowice, Poland.

Invasive and non-invasive mechanical ventilation (MV) continues to be the most significant life support method. It is, however, coupled with many risks. Historically, concepts of MV did focus on improving the arterial blood gas results rather than preventing harmful side-effects of positive pressure ventilation. Since then, multiple studies exploring this matter emerged and led to the protective MV concept. The golden mean between assuring the best oxygenation and limiting the ventilator-induced lung injury (VILI) is still a matter of debate. These considerations are especially impactful while treating patients with adult respiratory distress syndrome (ARDS), where the limitation of MV's negative effect is specifically important. This paper explores the protective ventilation concept and clinical implications of the latter.
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http://dx.doi.org/10.5603/ARM.a2020.0159DOI Listing
January 2020

Distant Organ Damage in Acute Brain Injury.

Brain Sci 2020 Dec 21;10(12). Epub 2020 Dec 21.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland.

Acute brain injuries pose a great threat to global health, having significant impact on mortality and disability. Patients with acute brain injury may develop distant organ failure, even if no systemic diseases or infection is present. The severity of non-neurologic organs' dysfunction depends on the extremity of the insult to the brain. In this comprehensive review we sought to describe the organ-related consequences of acute brain injuries. The clinician should always be aware of the interplay between central nervous system and non-neurological organs, that is constantly present. Cerebral injury is not only a brain disease, but also affects the body as whole, and thus requires holistic therapeutical approach.
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http://dx.doi.org/10.3390/brainsci10121019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767338PMC
December 2020

Von Willebrand factor in aortic or mitral valve stenosis and bleeding after heart valve surgery.

Thromb Res 2021 02 16;198:190-195. Epub 2020 Dec 16.

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.

Objectives: Low von Willebrand factor (VWF) increases the risk of bleeding. The objective was to assess the influence of VWF on bleeding after valvular surgery.

Methods: We studied 82 consecutive patients in median age of 65.5 years with severe isolated aortic stenosis (AS, n = 62) or mitral stenosis (MS, n = 20), undergoing heart valve surgery in extracorporeal circulation. Preoperatively, we assessed VWF antigen (VWF:Ag) and activity (VWF:RCo), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), and fibrinolysis inhibitors.

Results: Compared with AS, MS patients were more frequently female (80 vs. 55%, p = 0.045) with atrial fibrillation (AF) (80 vs. 8%, p < 0.0001), with no difference in age or comorbidities. Median postoperative drainage was 420 ml for AS, and 425 ml for MS (p = 0.37). Patients with AS had lower VWF:RCo (125.8 [88.5-160.8] vs. 188.0 [140.3-207.3] IU/dl, p = 0.003) and VWF:Ag (135.8 [112.0-171.2] vs. 191.7 [147.3-236.4] IU/dl, p = 0.01) than MS patients. Mean VWF:RCo/Ag ratio was 0.88 ± 0.17, with no intergroup differences. ADAMTS13 levels and activity were similar in both groups. In AS, both VWF:RCo and VWF:Ag correlated inversely with maximal (r = -0.39, p = 0.0003 and r = -0.39, p = 0.0004, respectively) and mean (r = -0.40, p = 0.0004 and r = -0.39, p = 0.0006, respectively) transvalvular pressure gradients. There was no difference in perioperative bleeding between patients following mitral and aortic valve surgery, and bleeding was not associated with VWF:Ag or VWF:RCo.

Conclusions: In severe AS, VWF levels and activity correlate inversely with transvalvular pressure gradients, and are lower than in severe degenerative MS, but do not affect blood loss after valvular surgery in extracorporeal circulation.
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http://dx.doi.org/10.1016/j.thromres.2020.12.005DOI Listing
February 2021

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study.

BMC Anesthesiol 2020 12 2;20(1):296. Epub 2020 Dec 2.

Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.

Background: There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed.

Results: Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p < 0.05): APACHE II (AUC = 0.78; 95%CI 0.73-0.83), APACHE III (AUC = 0.79; 95%CI 0.74-0.84) and SAPS II (AUC = 0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p < 0.05): APACHE II (AUC = 0.71; 95%CI 0.64-0.78), APACHE III (AUC = 0.72; 95%CI 0.65-0.78) and SAPS II (AUC = 0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p > 0.05). The calibration of the scores was good.

Conclusions: All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.
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http://dx.doi.org/10.1186/s12871-020-01203-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709291PMC
December 2020

Fluid Therapy in Patients Undergoing Abdominal Surgery: A Bumpy Road Towards Individualized Management.

Adv Exp Med Biol 2021 ;1324:63-72

Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.

Prudent intraoperative fluid replacement therapy, inotropes, and vasoactive drugs should be guided by adequate hemodynamic monitoring. The study aimed to evaluate the single-centre practice on intraoperative fluid therapy in abdominal surgery (AS). The evaluation, based on a review of medical files, included 235 patients (103 men), aged 60 ± 15 years who underwent AS between September and November 2017. Fluid therapy was analyzed in terms of quality and quantity. There were 124 high-risk patients according to the American Society of Anaesthesiologists Classification (ASA Class 3+) and 89 high-risk procedures performed. The median duration of procedures was 175 (IQR 106-284) min. Eleven patients died post-operatively. The median fluids volume was 10.4 mL/kg/h of anaesthesia, including 9.1 mL/kg/h of crystalloids and 2.7 mL/kg/h of synthetic colloids. Patients undergoing longer than the median procedures received significantly fewer fluids than those who underwent shorter procedures. The volume of fluids in the longer procedures depended on the procedural risk classification and was significantly greater in high-risk patients undergoing high-risk surgery. Patients who died received significantly more fluids than survivors. In all patients, a non-invasive blood pressure monitoring was used and only six patients had therapy guided by metabolic equilibrium. The fluid therapy used was liberal but complied with the recommendations regarding the type of fluid and risk-adjusted dosing. Hemodynamic monitoring was suboptimal and requires modifications. In conclusion, the optimization of intraoperative fluid therapy requires a balanced and standardized approach consistent with treatment procedures.
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http://dx.doi.org/10.1007/5584_2020_597DOI Listing
March 2021

Basics of mechanical ventilation for non-anaesthetists. Part 1: Theoretical aspects.

Adv Respir Med 2020 ;88(5):424-432

Chair and Department of Anaesthesiology and Intensive Care, Medical University of Silesia in Katowice, Poland.

The expanding number of chronic respiratory diseases and the new Covid-19 outbreak create an increasing demand for mechanical ventilation (MV). As MV is no longer limited to intensive care units (ICU) and operating rooms (OR), more clinicians should acquaint themselves with the principles of mechanical ventilation. To fully acknowledge contemporary concepts of MV, it is crucial to understand the elemental physiology and respiratory machine nuances. This paper addresses the latter issues and provides insight into ventilation modes and essential monitoring of MV.
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http://dx.doi.org/10.5603/ARM.a2020.0143DOI Listing
November 2020

Delirium Superimposed on Dementia in Perioperative Period and Intensive Care.

J Clin Med 2020 Oct 13;9(10). Epub 2020 Oct 13.

Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland.

Delirium is a life-threatening condition, the causes of which are still not fully understood. It may develop in patients with pre-existing dementia. Delirium superimposed on dementia (DSD) can go completely unnoticed with routine examination. It may happen in the perioperative period and in the critical care setting, especially in the ageing population. Difficulties in diagnosing and lack of specific pharmacological and non-pharmacological treatment make DSD a seriously growing problem. Patient-oriented, multidirectional preventive measures should be applied to reduce the risk of DSD. For this reason, anesthesiologists and intensive care specialists should be aware of this interesting condition in their everyday clinical practice.
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http://dx.doi.org/10.3390/jcm9103279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601948PMC
October 2020

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review.

J Clin Med 2020 Sep 30;9(10). Epub 2020 Sep 30.

Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland.

Postoperative delirium (POD) and postoperative cognitive decline (deficit) (POCD) are related to a higher risk of postoperative complications and long-term disability. Pathophysiology of POD and POCD is complex, elusive and multifactorial. Intraoperative hypotension (IOH) constitutes a frequent and vital health hazard in the perioperative period. Unfortunately, there are no international recommendations in terms of diagnostics and treatment of neurocognitive complications which may arise from hypotension-related hypoperfusion. Therefore, we performed a comprehensive review of the literature evaluating the association between IOH and POD/POCD in the non-cardiac setting. We have concluded that available data are quite inconsistent and there is a paucity of high-quality evidence convincing that IOH is a risk factor for POD/POCD development. Considerable heterogeneity between studies is the major limitation to set up reliable recommendations regarding intraoperative blood pressure management to protect the brain against hypotension-related hypoperfusion. Further well-designed and effectively-performed research is needed to elucidate true impact of intraoperative blood pressure variations on postoperative cognitive functioning.
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http://dx.doi.org/10.3390/jcm9103183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601108PMC
September 2020

Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit.

Acta Biochim Pol 2020 Sep;67(3):353-358

Students' Scientific Society, Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.

Introduction: Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT).

Materials And Methods: A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL.

Results: The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR -0.0070-0.0195), ΔBEef=-0.9 (IQR -2.0-0.4) and HCO3-act=-1.05 (IQR -2.25-0.35). For ventilatory parameters they were: ΔpO2=-8.3 mmHg (IQR -20.9-0.8) and ΔpCO2=-2.2 mmHg (IQR -4.2--0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10-2.85), ΔK+=-0.120 mM/L (IQR -0.295-0.135) and ΔCl-=1.0 mM/L (IQR -1.0-3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: -10.1 mmHg, ±1.96SD -58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes.

Conclusions: Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.
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http://dx.doi.org/10.18388/abp.2020_5178DOI Listing
September 2020

Haemogram-Derived Indices for Screening and Prognostication in Critically Ill Septic Shock Patients: A Case-Control Study.

Diagnostics (Basel) 2020 Aug 27;10(9). Epub 2020 Aug 27.

Department of Anaesthesiology and Intensive Care, Faculty of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland.

This study aimed (1) to assess the diagnostic accuracy of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR) and platelet count-to-mean platelet volume (PLT/MPV) ratios in predicting septic shock in patients on admission to the intensive care unit (ICU) and (2) to compare it with the role of C-reactive protein (CRP), procalcitonin (PCT) and lactate level. We also sought (3) to verify whether the indices could be useful in ICU mortality prediction and (4) to compare them with Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores. This retrospective study covered 138 patients, including 61 subjects with multi-organ failure due to septic shock (study group) and 77 sex- and age-matched controls. Septic patients had significantly higher NLR ( < 0.01) and NLR predicted septic shock occurrence (area under the ROC curve, AUROC = 0.66; 95% CI 0.58-0.74). PLR, MLR and PLT/MPV were impractical in sepsis prediction. Combination of CRP with NLR improved septic shock prediction (AUROC = 0.88; 95% CI 0.81-0.93). All indices failed to predict ICU mortality. APACHE II and SAPS II predicted mortality with AUROC = 0.68; 95% CI 0.54-0.78 and AUROC = 0.7; 95% CI 0.57-0.81, respectively. High NLR may be useful to identify patients with multi-organ failure due to septic shock but should be interpreted along with CRP or PCT. The investigated indices are not related with mortality in this specific clinical setting.
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http://dx.doi.org/10.3390/diagnostics10090638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555761PMC
August 2020

Antipsychotic Drugs in Prevention of Postoperative Delirium-What Is Known in 2020?

Int J Environ Res Public Health 2020 08 20;17(17). Epub 2020 Aug 20.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used.
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http://dx.doi.org/10.3390/ijerph17176069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503241PMC
August 2020

Sepsis-Associated Brain Dysfunction: A Review of Current Literature.

Int J Environ Res Public Health 2020 08 12;17(16). Epub 2020 Aug 12.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Medyków 14, 40-752 Katowice, Poland.

Sepsis-associated brain dysfunction (SABD) may be the most common type of encephalopathy in critically ill patients. SABD develops in up to 70% of septic patients and represents the most frequent organ insufficiency associated with sepsis. It presents with a plethora of acute neurological features and may have several serious long-term psychiatric consequences. SABD might cause various pathological changes in the brain through numerous mechanisms. Clinical neurological examination is the basic screening method for SABD, although it may be challenging in subjects receiving with opioids and sedative agents. As electrographic seizures and periodic discharges might be present in 20% of septic patients, screening with electroencephalography (EEG) might be useful. Several imaging techniques have been suggested for non-invasive assessment of structure and function of the brain in SABD patients; however, their usefulness is rather limited. Although several experimental therapies have been postulated, at the moment, no specific treatment exists. Clinicians should focus on preventive measures and optimal management of sepsis. This review discusses epidemiology, clinical presentation, pathology, pathophysiology, diagnosis, management, and prevention of SABD.
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http://dx.doi.org/10.3390/ijerph17165852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460246PMC
August 2020

Clinical usefulness of the international renal research institute of vicenza (irriv) score in the intensive care subjects with renal failure: single-centre experience.

Wiad Lek 2020 ;73(7):1384-1390

Department Of Anaesthesiology And Intensive Care, School Of Medicine In Katowice, Medical University Of Silesia, Katowice, Poland.

Objective: The aim: Acute kidney injury (AKI) is a common and clinically important condition that affects both kidney structure and function. International Renal Research Institute of Vicenza (IRRIV) score has been designed to enable early identification of patients who may require renal replacement therapy (RRT). We aimed to assess the usefulness of the IRRIV score in predicting the outcome in the intensive care unit (ICU) patients who may require renal replacement therapy (RRT).

Patients And Methods: Material and Methods: This retrospective study screened 955 consecutive patients hospitalized in a mixed tertiary ICU between Jan 2015 and Jul 2018. Patients with sCr>3.5 mg/dl on the first 24 hours post-admission constituted the study group 1 (G1, n=54). Subjects who underwent RRT based on indications other than elevated sCr level were a study group 2 (G2, n=31). ICU mortality, a need for RRT and ICU length of stay (LoS) were the outcomes.

Results: Results: Median IRRIV score was 5.5 points (IQR 4.5-6.5) in G1 and 3.5 points (IQR 3-5.5) in G2. IRRIV score poorly predicted the need for RRT implementation (AUC=0.652, 95%CI 0.510-0.776, P=0.048). The IRRIV score failed to predict mortality in both groups (G1: AUC=0.610, 95%CI 0.468-0.740, P=0.16; G2: AUC=0.530, 95%CI 0.343-0.710, P=0.79). No correlation was found between the score and ICU LoS (G1: R= -0.13, P=0.36; G2: R= -0.27, P=0.15).

Conclusion: Conclusions: The retrospective analysis of our regional data did not confirm the expected usefulness of the IRRIV score in predicting the need for RRT nor in the prognostication of the patients admitted to the ICU due to renal failure.
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August 2020

Isolated prolongation of activated partial thromboplastin time in intensive care unit patients: a practical diagnostic algorithm and management options.

Anaesthesiol Intensive Ther 2020 ;52(2):165-170

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

Abnormal values for standard laboratory tests of coagulation are frequently reported in critically ill patients. Sepsis-associated coagulopathy with prolonged prothrombin time and thrombocytopenia is common among patients hospitalized in the intensive care unit (ICU). Isolated prolongation of activated partial thromboplastin time (aPTT) occurs less frequently in the ICU setting and has numerous causes. Moreover, there are several preanalytical factors that may impact on results obtained. Isolated prolongation of aPTT in the absence of clinically relevant bleeding is a common finding in patients in the ICU. The first step in the diagnostic process is exclusion of preanalytical error. Next, based on the clinical picture (normal haemostasis vs. bleeding tendency), the appropriate tests should be ordered, taking into account acquired and congenital causes. To establish a diagnosis in a timely fashion, the proposed practical diagnostic algorithm can be followed.
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http://dx.doi.org/10.5114/ait.2020.96484DOI Listing
January 2020

Hyperosmolar Treatment for Patients at Risk for Increased Intracranial Pressure: A Single-Center Cohort Study.

Int J Environ Res Public Health 2020 06 25;17(12). Epub 2020 Jun 25.

Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland.

Treatment with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in central nervous system (CNS) disorders. We sought to evaluate the variability and mean plasma concentrations of the water and electrolyte balance parameters in critically ill patients treated with osmotic therapy and their influence on mortality. This cohort study covered patients hospitalized in an intensive care unit (ICU) from January 2017 to June 2019 with presumed increased ICP or considered to be at risk of it, treated with 15% mannitol (G1, n = 27), a combination of 15% mannitol and 10% hypertonic saline (HTS) (G2, n = 33) or 10% HTS only (G3, n = 13). Coefficients of variation (Cv) and arithmetic means (mean) were calculated for the parameters reflecting the water and electrolyte balance, i.e., sodium (NaCv/NaMean), chloride (ClCv/ClMean) and osmolality (mOsmCv/mOsmMean). In-hospital mortality was also analyzed. The study group comprised 73 individuals (36 men, 49%). Mortality was 67% (n = 49). Median NaCv (G1: = 0.002, G3: = 0.03), ClCv (G1: = 0.02, G3: = 0.04) and mOsmCv (G1: = 0.001, G3: = 0.02) were higher in deceased patients. NaMean ( = 0.004), ClMean ( = 0.04), mOsmMean ( = 0.003) were higher in deceased patients in G3. In G1: NaCv (AUC = 0.929, < 0.0001), ClCv (AUC = 0.817, = 0.0005), mOsmCv (AUC = 0.937, < 0.0001) and in G3: NaMean (AUC = 0.976, < 0.001), mOsmCv (AUC = 0.881, = 0.002), mOsmMean (AUC = 1.00, < 0.001) were the best predictors of mortality. The overall mortality prediction for combined G1+G2+G3 was very good, with AUC = 0.886 ( = 0.0002). The mortality of critically ill patients treated with osmotic agents is high. Electrolyte disequilibrium is the independent predictor of mortality regardless of the treatment method used. Variations of plasma sodium, chloride and osmolality are the most deleterious factors regardless of the absolute values of these parameters.
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http://dx.doi.org/10.3390/ijerph17124573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345768PMC
June 2020

Biomarkers Facilitate the Assessment of Prognosis in Critically Ill Patients with Primary Brain Injury: A Cohort Study.

Int J Environ Res Public Health 2020 06 21;17(12). Epub 2020 Jun 21.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland.

Primary injuries to the brain are common causes of hospitalization of patients in intensive care units (ICU). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is widely used for prognostication among critically ill subjects. Biomarkers help to monitor the severity of neurological status. This study aimed to identify the best biomarker, along with APACHE II score, in mortality prediction among patients admitted to the ICU with the primary brain injury. This cohort study covered 58 patients. APACHE II scores were assessed 24 h post ICU admission. The concentrations of six biomarkers were determined, including the C-reactive protein (CRP), the S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase 9 (MMP-9), and tissue inhibitor of metalloproteinase 1 (TIMP-1), using commercially available ELISA kits. The biomarkers were specifically chosen for this study due to their established connection to the pathophysiology of brain injury. In-hospital mortality was the outcome. Median APACHE II was 18 (IQR 13-22). Mortality reached 40%. Median concentrations of the CRP, NGAL, S100B, and NSE were significantly higher in deceased patients. S100B (AUC = 0.854), NGAL (AUC = 0.833), NSE (AUC = 0.777), and APACHE II (AUC = 0.766) were the best independent predictors of mortality. Combination of APACHE II with S100B, NSE, NGAL, and CRP increased the diagnostic accuracy of mortality prediction. MMP and TIMP-1 were impractical in prognostication, even after adjustment for APACHE II score. S100B protein and NSE seem to be the best predictors of compromised outcome among critically ill patients with primary brain injuries and should be assessed along with the APACHE II calculation after ICU admission.
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http://dx.doi.org/10.3390/ijerph17124458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345834PMC
June 2020

A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland.

Int J Environ Res Public Health 2020 06 11;17(11). Epub 2020 Jun 11.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-007 Katowice, Poland.

Background: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland.

Methods: A web-based questionnaire was performed between 03.2019 and 06.2019. Centres performing neuro-interventional radiology procedures and neuro-critical care were included ( = 29). One response from each hospital was recorded.

Results: In three (10.4%) centres, there was no clear protocol for an interventional treatment plan. Endovascular embolisation was predominantly used in 11 (37.9%) hospitals, and microsurgical clipping, in 10 (34.5%). A written protocol for standard anaesthetic management was established only in six (20.7%) centres for coiling and in five (17.2%) for microsurgical clipping. The diagnosis of cerebral vasospasm was based on transcranial Doppler as the first-choice method in seven (24.1%) units. "3-H therapy" was applied by 15 (51.8%) respondents, and "2-H therapy", by four (13.8%) respondents. In only eight (27.6%) centres were all patients with aSAH being admitted to the ICU.

Conclusion: Many discrepancies exist between the available guidelines and clinical practice in aSAH treatment in Poland. Peri-procedural management is poorly standardised. Means must be undertaken to improve patient-oriented treatment and care.
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http://dx.doi.org/10.3390/ijerph17114161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313024PMC
June 2020

Mortality Prediction Using SOFA Score in Critically Ill Surgical and Non-Surgical Patients: Which Parameter Is the Most Valuable?

Medicina (Kaunas) 2020 Jun 4;56(6). Epub 2020 Jun 4.

Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, 14 Medyków Street, 40752 Katowice, Poland.

assessment systems, such as the Sequential Organ Failure Assessment (SOFA) scale, are routinely used in intensive care units (ICUs) worldwide in order to predict patients' outcome. We aimed to investigate SOFA's usefulness in the prognostication of ICU mortality, including an analysis of the importance of its variables. this single-centre observational study covered 905 patients that were admitted from 01.01.2015 to 31.12.2017 to a tertiary mixed ICU. The SOFA score was calculated on ICU admission. The worst results recorded within 24 h post admission were included into the calculation. The assessment was performed within subgroups of surgical (SP) and non-surgical patients (NSP). The subjects were followed-up until ICU discharge or death. ICU mortality was considered to be the outcome. ICU mortality reached 35.4% (i.e., 320 deceased out of 905 ICU stays) and it was significantly lower in SP ( = 158, 25.3%) as compared with NSP ( = 162, 57.9%) ( < 0.001). A one-point increase in the SOFA score resulted in 1.35 times higher risk of death in the ICU in the whole studied population. Among the individual variables of SOFA, creatinine concentration was the most powerful in prognostication (OR = 1.92) in univariate analysis, while the Glasgow Coma Scale (GCS) score appeared to be the most important variable in multivariate analysis (OR = 1.8). Mortality prediction using consecutive SOFA variables differed between SP and NSP, as well as between men and women. The overall SOFA score predicts mortality to a similar extent in both surgical and non-surgical subjects. However, there are significant differences in prognostication using its particular components.
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http://dx.doi.org/10.3390/medicina56060273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353889PMC
June 2020

Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report.

Int J Environ Res Public Health 2020 05 22;17(10). Epub 2020 May 22.

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective preliminary study covered 10 septic shock patients (5 men; aged 65, IQR 50-78 years). ONSD was measured bilaterally from day 1 to 10 ( = 1), until discharge ( = 3) or death ( = 6). The upper limit for ONSD was set at 5.7 mm. Sequential organ failure assessment score was calculated on a daily basis as a surrogate formulti-organ failure due to sepsis in the study population. On day 1, the medians of right and left ONSD were 5.56 (IQR 5.35-6.30) mm and 5.68 (IQR 5.50-6.10) mm, respectively, and four subjects had bilaterally elevated ONSD. Forty-nine out of 80 total measurements performed (61%) exceeded 5.7 mm during the study period. We found no correlations between ONSD and sequential organ failure assessment (SOFA) during the study period (right: R = -0.13-0.63; left R = -0.24-0.63). ONSD measurement should be applied for screening of SABD cautiously. Further research is needed to investigate the exact role of this non-invasive method in the assessment of brain dysfunction in these patients.
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http://dx.doi.org/10.3390/ijerph17103656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277340PMC
May 2020

Clinical practice in intraoperative haemodynamic monitoring in Poland: a point prevalence study in 31 Polish hospitals.

Anaesthesiol Intensive Ther 2020 ;52(2):97-104

Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia in Katowice, Poland.

Background: Appropriate use of haemodynamic monitoring tools facilitates the adjustment of management to the patient's individual needs. The aim of the study was to evaluate clinical practice in intraoperative monitoring of patients undergoing non-cardiac surgical procedures in selected hospitals in Poland.

Methods: A point prevalence cross-sectional study was carried out among 587 adult patients of 31 Polish hospitals on April 5th, 2018. The method of monitoring in relation to the estimated individual risk as well as to the type and mode of surgery was analysed. In addition, intraoperative fluid therapy and use of catecholamines were evaluated.

Results: Basic monitoring based on non-invasive arterial blood pressure measurements was implemented in 562 (96%) patients. More advanced methods of monitoring were used in 25 (4%) patients during moderate- (n = 16) and high-risk (n = 9) procedures, predominantly in high-risk patients (n = 16) and in university hospital settings (n = 21). Patients monitored basically received significantly higher amounts of fluids, i.e. 8.7 (IQR 6.1-12.6) vs. 6.1 (IQR 4.1-8.6) mL kg-1 h-1, respectively (P < 0.001). The most common vasoactive and inotropic drug was ephedrine, administered to 143 (24%) study patients in a dose of 15 mg (IQR 10-25) - without inter-group differences in categories of individual and procedure-related risk.

Conclusions: The basic method of haemodynamic monitoring used in the study population was based on non-invasive arterial blood pressure measurements. The advanced tools of intraoperative haemodynamic monitoring were seldom used. Monitoring was not tailored to the perioperative risk.
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http://dx.doi.org/10.5114/ait.2020.95168DOI Listing
January 2020

Is Antimicrobial Treatment Effective During Therapeutic Plasma Exchange? Investigating the Role of Possible Interactions.

Pharmaceutics 2020 Apr 25;12(5). Epub 2020 Apr 25.

Students' Scientific Society, Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland.

Antimicrobial treatment during therapeutic plasma exchange (TPE) remains a complex issue. Recommendations based on a limited number of experimental studies should be implemented in clinical practice with caution. Effective management of infections due to plasma or albumin-related interactions, as well as impaired pharmacokinetics, in critical illness is difficult. Knowing the pharmacokinetics of the drugs concerned and the procedural aspects of plasmapheresis should be helpful in planning personalized treatment. In general, possessing a low distribution volume, a high protein-binding affinity, a low endogenous clearance rate, and long distribution and elimination half-lives make a drug more prone to elimination during TPE. A high frequency and longer duration of the procedure may also contribute to altering a drug's concentration. The safest choice would be to start and finish TPE before antimicrobial agent infusion. If this not feasible, a reasonable alternative is to avoid administering the drug just before TPE and to delay the procedure for the time of the administered drug's distributive phase. Ultimately, if plasma exchange must be performed urgently or the drug has a very narrow therapeutic index, monitoring its plasma concentration is advised.
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http://dx.doi.org/10.3390/pharmaceutics12050395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284838PMC
April 2020

Clinical practice on intra-operative fluid therapy in Poland: A point prevalence study.

Medicine (Baltimore) 2020 Apr;99(17):e19953

Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.

Intra-operative fluid therapy (IFT) is the cornerstone of peri-operative management as it may significantly influence the treatment outcome. Therefore, we sought to evaluate nationwide clinical practice regarding IFT in Poland.A cross-sectional, multicenter, point-prevalence study was performed on April 5, 2018, in 31 hospitals in Poland. Five hundred eighty-seven adult patients undergoing non-cardiac surgery were investigated. The volume and type of fluids transfused with respect to the patient and procedure risk were assessed.The study group consisted of 587 subjects, aged 58 (interquartile range [IQR] 40-67) years, including 142 (24%) American Society of Anesthesiology Physical Status (ASA-PS) class III+ patients. The median total fluid dose was 8.6 mL kg h (IQR 6-12.5), predominantly including balanced crystalloids (7.0 mL kg h, IQR 4.9-10.6). The dose of 0.9% saline was low (1.6 mL kg h, IQR 0.8-3.7). Synthetic colloids were used in 66 (11%) subjects. The IFT was dependent on the risk involved, while the transfused volumes were lower in ASA-PS III+ patients, as well as in high-risk procedures (P < .05).The practice of IFT is liberal but is adjusted to the preoperative risk. The consumption of synthetic colloids and 0.9% saline is low.
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http://dx.doi.org/10.1097/MD.0000000000019953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440051PMC
April 2020

Plasma Matrix Metalloproteinase-9 and Tissue Inhibitor of Matrix Metalloproteinase-1 as Prognostic Biomarkers in Critically Ill Patients.

Open Med (Wars) 2020 4;15:50-56. Epub 2020 Mar 4.

Department of Physiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice Poland.

Matrix metalloproteinase 9 (MMP-9) plays an important role in inflammatory and pathological processes by enabling the inflow of leukocytes to the site of infection or tissue damage. MMP-9 and tissue inhibitor of metalloproteinase 1 (TIMP-1) have been described as potential prognostic biomarkers in various clinical settings. The aim of the study was to evaluate the usefulness of plasma levels of MMP-9 and TIMP-1 as well as the MMP-9/ TIMP-1 ratio in predicting the outcome in patients admitted to the intensive care unit (ICU). The study included 56 critically ill patients with multiple organ failure. Plasma levels of MMP-9 and TIMP-1 were determined on hospitalization day 1, 2, 3 and 7. Nineteen (35.7%) patients died. The level of TIMP-1 was statistically significantly higher on day 1 and 7 of hospitalization in non-survivors, as compared to survivors (p=0.01). A statistically significant positive correlation was found between MMP-9 and TIMP-1. The MMP-9/TIMP-1 ratio was comparable in both groups during of observation (0.62 on day 1). The MMP-9/TIMP-1 ratio was positively correlated with the level of lactate and negatively correlated with platelet count. Likewise, TIMP-1 was positively correlated with the level of lactate. The level of MMP-9 was higher in the non-survivor group only on day 7 of observation. In conclusion, although TIMP-1 and MMP-9 concentrations were higher in non-survivors and the MMP-9/TIMP-1 ratio was related to some parameters of critical illness, further research is needed to verify whether they can serve as reliable biomarkers for early prognostication of ICU patients.
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http://dx.doi.org/10.1515/med-2020-0008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065420PMC
March 2020

Can the fate be cheated? Septic shock in the course of an abdominal multi-organ trauma - a case report.

Anaesthesiol Intensive Ther 2020 ;52(1):70-71

Katedra i Klinika Anestezjologii i Intensywnej Terapii, Śląski Uniwersytet Medyczny w Katowicach, Polska.

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http://dx.doi.org/10.5114/ait.2020.93180DOI Listing
February 2021

Prognostic Factors for Nonasphyxia-Related Cardiac Arrest Patients Undergoing Extracorporeal Rewarming - HELP Registry Study.

J Cardiothorac Vasc Anesth 2020 Feb 5;34(2):365-371. Epub 2019 Aug 5.

Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.

Objective: Extracorporeal rewarming is the treatment of choice for patients who had hypothermic cardiac arrest, allowing for best neurologic outcome. The authors' goal was to identify factors associated with survival in nonasphyxia-related hypothermic cardiac arrest patients undergoing extracorporeal rewarming.

Design: All 38 cardiac surgery departments in Poland were encouraged to report consecutive hypothermic cardiac arrest patients treated with extracorporeal life support. All variables collected were analyzed in order to compare survivor and nonsurvivor groups. The parameters available at the initiation of extracorporeal rewarming were considered as potential predictors of survival in a logistic regression model. The primary outcome was survival to discharge from the intensive care unit. The secondary outcome was neurologic status.

Setting: Multicenter retrospective study.

Participants: Ninety-eight cases in the final analysis.

Interventions: All patients in nonasphyxia-related hypothermic cardiac arrest rewarmed with extracorporeal life support.

Measurements And Main Results: The survival rate was 53.1%, and 94.2% of survivors had favorable neurologic outcome. The lowest reported core temperature with cerebral performance category scale 1 was 11.8°C. A univariate analysis identified 3 variables associated with survival, namely: age, initial arterial pH, and lactate concentration. In a multivariate analysis, 2 independent predictors of survival were age (0.957; 95% confidence interval [CI] 0.924-0.991) and lactates (0.871; 95% CI 0.789-0.961). The area under the receiver operating characteristics curve for this fitted model was 0.71; 95% CI 0.602-0.817.

Conclusions: Favorable survival with good neurologic outcome in nonasphyxiated hypothermic patients treated with extracorporeal life support was reported. Age and initial lactate level are independently associated with survival.
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http://dx.doi.org/10.1053/j.jvca.2019.07.152DOI Listing
February 2020