Category Archives: Letter to Editor

Inhaled Nitric Oxide in Patients with Severe COVID-19 Infection at Intensive Care Unit – A Cross-Sectional Study

DOI: 10.2478/jccm-2021-0033

In adults with severe hypoxemia, inhaled nitric oxide (iNO) is known to reduce pulmonary shunt and pulmonary hypertension, improving V/Q matching [1]. Studies in refractory hypoxemia among patients with severe acute respiratory distress syndrome (ARDS) suggest that iNO may be allied to other ventilatory strategies as a bridge to clinical improvement [2, 3].
A trial from the 2004 Beijing Coronavirus Outbreak showed that low dose iNO could shorten the time of ventilatory support [4]. Additionally, preclinical studies suggest an inhibitory effect of iNO on viral replication [5]. To date, the role of iNO in COVID19 infection is still unclear. [More]

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The Strategy Management of a SARS-CoV-2 Outbreak in an Eastern European Hospital

DOI: 10.2478/jccm-2020-0047

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is an ongoing global challenge with unpredictable future evolution. Different epidemiological and clinical strategies currently are being evaluated, and the optimal treatment modalities are still to be determined. Developed healthcare systems have been struggling to cope with the additional medical requirements and the lockdown measures, adopted by many countries, are presenting a substantial economic burden.
Countries with more fragile economies and medical systems are facing difficult choices. Romania possesses a progressive yet fragile healthcare system. The national lockdown was declared on 25th March 2020, in order to gain time for better logistic healthcare preparations.
This brief report aims to describe the challenges of managing an in-hospital SARS-CoV-2 outbreak in an academic hospital of national importance. Our institution is the primary national centre for liver transplantation and liver surgery, a major centre for bone marrow transplantation and one of the two national centres for renal transplantation. It shares common buildings with the major national cardiovascular and emergency cardiac surgery centre. [More]

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To Be or Not to Be… Sepsis? A Daily Challenge in ICU

DOI: 10.2478/jccm-2020-0012

Nowadays, one of the most challenging medical issues is related to high morbidity and mortality in sepsis and septic shock. Despite the medical progress regarding early diagnosis and management, this complex pathology remains a life-threatening condition. During the last decades, many definitions and including criteria were developed both in sepsis and septic shock, principally as many early biomarkers became available. However, many issues still exist regarding this subject.
The clinical definitions of sepsis and systemic inflammatory response syndrome (SIRS) have been refined, but both conditions manifest with similar clinical features [1]. The Third International Consensus Definitions Task Force (Sepsis-3) defined sepsis as “a life-threatening organ dysfunction resulting from a dysregulated host response to infection”. Septic shock is “a subset of sepsis in which circulatory, cellular and metabolic alterations are associated with a higher mortality rate than sepsis alone” [2] morphology, cell biology, biochemistry, immunology, and circulation. These definitions are related to the pathophysiology of sepsis, which are the cornerstones of a better understanding of the underlying mechanisms and disorders that occur [3]. [More]

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Diagnostic pitfalls in identification of Elizabethkingia meningoseptica

DOI: 10.2478/jccm-2018-0021

To the Editor of JCCM,
Regarding the article “Emerging Infection with Elizabethkingia meningoseptica in Neonate. A Case Report” by Arbune et al. (2018) [1], there are specific facts which need clarification regarding the reporting of this organism.
First of all, Arbune reported the isolation of the organism from the cerebrospinal fluid (CSF) and blood culture of one case, and that no source of infection was identified. Elizabethkingia meningoseptica, although linked to meningitis and nosocomial infections, can be an environmental contaminant as well. Repeat cultures of the samples are mandatory for the confirmation of such unusual pathogens.[More]

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Diagnosing “Brain Death” in Intensive Care

DOI: 10.1515/jccm-2017-0016

Death represents a biological state which appears at the end of life and can be defined by the halting of all life-sustaining biological functions.
Medically speaking, death represents the irreversible loss of consciousness associated with the irreversible loss of breathing [1].
Throughout its history, humanity has been interested by the mystery surrounding the end of life, and especially of finding out precise means of diagnosis.
But how can we medically diagnose the phenomenon of death?
Currently there are three means of diagnosis [1]: [More]

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Should Critical Care Professionals Take Hoaxes/Rumours Seriously?

DOI: 10.1515/jccm-2016-0030

To the Editor of JCCM,
Thanks to the ever larger penetration of the Internet and especially with the advent of Web 2.0 and social media, hoaxes, rumours and urban legends have become an almost everyday occurrence. While social psychology research contends that rumors can negatively impact on the public by generating distress, intense fear, anxiety, possibly resulting in herd behaviour and violence [1], there is evidence that disease-related rumours may alter health-related behaviors and interfere with medical decision-making [2]. Medical misinformation is most frequently associated with collective emergency situations (e.g., Ebola infected patients refused to be hospitalized because of rumours that international health care workers intentionally brought the virus with them [3]; people from around Kenema, Sierra Leone attacked the hospital after hearing rumours of conspiracy [4]; during the 2011 Fukushima nuclear disaster in Japan, rumours that ingestion of iodized salt could prevent radiation damage lead to a shortage of the product in supermarkets and triggered panic and public unrest [1]) and miracle products or cures that can be commercially exploited [5]. However, there are a number of hoaxes/rumours that probably critical care specialists should neither take lightly as innocuous amusements, nor brush aside with a condescending smile.[More]

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Role of Plasma Neutrophil Gelatinase Associated Lipocalin as a New Biomarker

DOI: 10.1515/jccm-2016-0004

I read with interest the study of Raluca Fodor et al., on the significance of Plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), as an early biomarker for acute kidney injury in critically ill patients, published recently in issue no.4/2015 of JCCM journal [1]. In this well-written and interesting study, the authors successfully demonstrated that in critically ill patients, increased levels of NGAL predict, with a good sensitivity and specificity, the development of acute kidney injury within forty-eight hours of admission to an ICU. However, as no information is presented on the aetiology of the acute kidney injury, we believe that the article raises interesting and still un-elucidated hypotheses on the pathophysiological substrate of the systemic release of NGAL in patients with critical conditions. [More]

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Dual Role of Angiopoietine II in the Complex Management of Critically Ill Patients with Sepsis

DOI: 10.1515/jccm-2015-0029

I read with great interest the article entitled “The role of Angiopoietine-2 in the diagnosis and prognosis of sepsis”, published by Szederjesi et al in the issue no.1/2015 of JCCM journal [1]. As the authors pointed out, the  prognosis of patients with sepsis is highly dependent on the early establishment of a proper diagnosis and on the early initiation of the adequate therapy. Therefore, identification of new biomarkers characterising this critically ill condition can be considered extremely important for a better understanding of this condition, leading to a more rapid and accurate diagnostic. The study identified angiopoietine-2 (ANG-2) as such a new biomarker characterising septic shock, demonstrating a good correlation between ANG-2 levels, duration of stay in the intensive care unit and the most widely used ICU mortality prediction scores. At the same time, the study showed a good sensitivity and specificity of this biomarker for diagnosis of sepsis and the authors should be congratulated for their results. [More]

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Challenges of Critical Cardiac Imaging in Cardiogenic Shock

DOI: 10.1515/jccm-2015-0020

To the editor of JCCM
I am writing in reference to the article published by Theodora Benedek and Dan Dobreanu in the first issue of JCCM, entitled “Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating
Acute Myocardial Infarction”.
Cardiogenic shock (CS) represents a critical and life-threatening condition. Survival of patients with CS depends largely, not only on the appropriateness of the therapeutic measures, but also on the correct identification of the underlying disease [1].
Treatment of this underlying condition represents a key element for the correction of the patho-phyisiological pathways responsible for the development of a CS.
In many cases, CS occurs in association with an acute myocardial infarction, usually large infarcts, located on the anterior ventricular wall [2]. Prompt revascularisation is crucial in these cases, as the re-establishment of coronary flow would immediately improve the haemodynamic status of these critically ill patients. However, in routine clinical practice, the diagnosis of an acute coronary syndrome remains challenging, especially when the physician is faced with a patient who arrives in the emergency room (ER) intubated, after surviving a cardiac arrest of unknown aetiology. [More]

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Is therapeutic hypotermia viable in our region as a new option for sudden cardiac arrest caused by acute myocardial infarction?

DOI: 10.1515/jccm-2015-0011

To the editor of JCCM
Therapeutic hypothermia has become a widely accepted option for management of patients with cardiac arrest occurring in the setting of an Acute Myocardial Infarction [1]. Infarct size is one of the major determinants of future evolution of patients with myocardial infarction and every attempt should be made in order to reduce the amount of infarcted, necrotic myocardium. It has been suggested that induction of hypothermia before performing a percutaneous coronary intervention for urgent revascularisation might play a decisive role in reduction of infarct size [1]. In the same time, applying a mild cooling protocol in patients surviving an out-of-hospital cardiac arrest might significantly improve the rates of neurologically intact survivals on long term [2].
It has been proved that via application of therapeutic hypothermia protocols, a 7% reduction in cerebral metabolism can be achieved per each 1oC of hypothermia, that would further lead to a decrease consumption of glucose and oxygen and prevention of neuronal injury [2]. All these are strongly correlated with the evolution of the neurological status in the post-resuscitation period. [More]

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