Category Archives: issue

Ramping Position to Aid Non-invasive Ventilation (NIV) in Obese Patients in the ICU

Mohamed Shirazy1, Christopher Gowers2, Padraig Headley2

1 Northern Ireland Medical and Dental Training Agency, Belfast, United Kingdom
2 Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, United Kingdom

DOI: 10.2478/jccm-2023-0002

Introduction: The ramping position is recommended to facilitate pre-oxygenation and mask ventilation of obese patients in anaesthetics via improving the airway alignment.
Presentation of case series: Two cases of obese patients admitted to the intensive care unit (ICU) with type 2 respiratory failure. Both cases showed obstructive breathing patterns on non-invasive ventilation (NIV) and failed resolution of hypercapnia. Ramping position alleviated the obstructive breathing pattern and hypercapnia was subsequently resolved.
Conclusion: There are no available studies on the rule of the ramping position in aiding NIV in obese patients in the ICU. Accordingly, this case series is significantly important in highlighting the possible benefits of the ramping position for obese patients in settings other than anaesthesia.

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Brain Tissue Oxygen Levels as a Perspective Therapeutic Target in Traumatic Brain Injury. Retrospective Cohort Study

Gal Roman1, Ondrej Hrdy1, Kamil Vrbica1, Jan Hudec1, Andrej Mrlian2, Martin Smrcka2

1 Department of Anaesthesiology and Intensive Care Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
2 Department of Neurosurgery, Masaryk University and University Hospital Brno, Brno, Czech Republic

DOI: 10.2478/jccm-2023-0001

Introduction: Management of traumatic brain injury (TBI) requires a multidisciplinary approach and represents a significant challenge for both neurosurgeons and intensivists. The role of brain tissue oxygenation (PbtO2) monitoring and its impact on posttraumatic outcomes remains a controversial topic.
Aim of the study: Our study aimed to evaluate the impact of PbtO2 monitoring on mortality, 30 days and 6 months neurological outcomes in patients with severe TBI compared with those resulting from standard intracranial pressure (ICP) monitoring.
Material and methods: In this retrospective cohort study, we analysed the outcomes of 77 patients with severe TBI who met the inclusion criteria. These patients were divided into two groups, including 37 patients who were managed with ICP and PbtO2 monitoring protocols and 40 patients who were managed using ICP protocols alone.
Results: There were no significant differences in demographic data between the two groups. We found no statistically significant differences in mortality or Glasgow Outcome Scale (GOS) scores one month after TBI. However, our results revealed that GOS scores at 6 months had improved significantly among patients managed with PbtO2; this finding was particularly notable for Glasgow Outcome Scale (GOS) scores of 4–5. Close monitoring and management of reductions in PbtO2, particularly by increasing the fraction of inspired oxygen, was associated with higher partial pressures of oxygen in this group.
Conclusions: Monitoring of PbtO2 may facilitate the appropriate evaluation and treatment of low PbtO2 and represents a promising tool for the management of patients with severe TBI. Additional studies will be needed to confirm these findings.

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Prevalence and Risk Factors of Venous Thromboembolism in Critically Ill Patients with Severe COVID-19 and the Association between the Dose of Anticoagulants and Outcomes

Hasan M. Al-Dorzi, Muhannad Q. Alqirnas, Mohamed M. Hegazy, Abdullah S. Alghamdi, Mohammed T. Alotaibi, Mohammed T. Albogami, Mohammed M. Alhafi, Salem Alwadani, Ashraf Elsharkawi, Yaseen M. Arabi

College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

DOI: 10.2478/jccm-2022-0023

Introduction: COVID-19 is characterized by a procoagulant state that increases the risk of venous and arterial thrombosis. The dose of anticoagulants in patients with severe COVID-19 pneumonia without suspected or confirmed thrombosis has been debated.
Aim of the study: We evaluated the prevalence, predictors, and outcomes of venous thromboembolism (VTE) in critically ill COVID-19 patients and assessed the association between the dose of anticoagulants and outcomes.
Materials and methods: This retrospective cohort included patients with COVID-19 who were admitted to the ICU between March and July 2020. Patients with clinically suspected and confirmed VTE were compared to those not diagnosed to have VTE.
Results: The study enrolled 310 consecutive patients with severe COVID-19 pneumonia: age 60.0±15.1 years, 67.1% required mechanical ventilation and 44.7% vasopressors. Most (97.1%) patients received anticoagulants during ICU stay: prophylactic unfractionated heparin (N=106), standard-dose enoxaparin (N=104) and intermediate-dose enoxaparin (N=57). Limb Doppler ultrasound was performed for 49 (15.8%) patients and chest computed tomographic angiography for 62 (20%). VTE was diagnosed in 41 (13.2%) patients; 20 patients had deep vein thrombosis and 23 had acute pulmonary embolism. Patients with VTE had significantly higher D-dimer on ICU admission. On multivariable Cox regression analysis, intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with lower VTE risk (hazard ratio, 0.06; 95% confidence interval, 0.01-0.74) and lower risk of the composite outcome of VTE or hospital mortality (hazard ratio, 0.42; 95% confidence interval, 0.23-0.78; p=0.006). Major bleeding was not different between the intermediate- and prophylactic-dose heparin groups.
Conclusions: In our study, clinically suspected and confirmed VTE was diagnosed in 13.2% of critically ill patients with COVID-19. Intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with decreased risk of VTE or hospital mortality.

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In between Opioid Crisis and the Need to Treat Pain, Where Do We Stand?

Daniela Ionescu1, Simona Margarit2

1 Department of Anesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Department of Anesthesia and Intensive Care, O Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania

DOI: 10.2478/jccm-2022-0029

Acute and chronic pain are very disturbing conditions for the patient, with numerous implications on the short- and long-term outcome of patients [1]. While acute pain is experienced mostly after surgery, and in some other medical conditions as well, chronic pain may be the symptom or the result of numerous medical conditions among which cancer, muscle-skeletal or neurodegenerative diseases and surgery or persistent inflammation are, probably, the main causes [2].
This is why guidelines, drugs and medical interventions have been proposed to treat acute and chronic pain [3, 4]. While acute pain, both mild or severe is well manageable with treatment, chronic pain may be very disturbing and debilitating for the patients, especially in patients with cancer, neurodegenerative or muscle-skeletal disorders and is generally much more difficult to treat [5]. [More]

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Successful Extracorporeal Blood Purification Therapy Using Double Haemoadsorption Device in Severe Endotoxin Septic Shock: A Case Report

Stefano Ferraro1, Stefania Bianzina2, Sonila Mocka3, Francesca Cappadona4, Giovanni Battista Traverso4, Fabio Massarino4, Pasquale Esposito4,5

1 Unità di Nefrologia, San Paolo Hospital, Savona, Italy
2 Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
3 Unità di Nefrologia, Sant’Andrea Hospital, La Spezia, Italy
4 Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, Genova, Italy
5 Department of Internal Medicine, University of Genova, Italy

DOI: 10.2478/jccm-2022-0028

Introduction: In patients admitted to the Intensive Care Unit (ICU), sepsis can lead to acute kidney injury (AKI), which may require the initiation of continuous renal replacement therapy (CRRT) in 15-20% of cases. There is no consensus about the best extracorporeal treatment to choose in septic patients with AKI.
Case presentation: We describe the case of a 70-year-old woman admitted to the ICU with a severe endotoxin septic shock due to Neisseria meningitidis serogroup C. Despite prompt medical intervention, including fluid resuscitation, high dose vasopressor, inotrope support, and broad-spectrum antimicrobial treatment, in a few hours patient’s haemodynamic worsened and she developed multi-organ failure, including severe AKI, requiring CRRT. So, continuous veno-venous haemodiafiltration was started, using an oXiris® haemodiafilter set, in series with an adsorber device (CytoSorb®). After 48 hours of this combined extracorporeal treatment, haemodynamic parameters improved, allowing a significant reduction of the vasoactive therapy, with a concomitant decrease in endotoxin and inflammatory markers serum levels. In the following days patient’s conditions still improved and renal function recovered.
Conclusions: Timely extracorporeal blood purification therapy, using a double haemoadsorption device, may be effective in the management of severe septic shock.

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Family Burden of ICU Survivors and Correlations with Patient Quality of Life and Psychometric Scores – A Pilot Study

Vassiliki Mantziou, Charikleia S. Vrettou, Alice G. Vassiliou, Stylianos E. Orfanos, Anastasia Kotanidou, Ioanna Dimopoulou

1st Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens (NKUA), “Evangelismos” Hospital, Athens, Greece

DOI: 10.2478/jccm-2022-0027

Introduction: Post intensive care syndrome (PICS) affects an increasing number of critical illness survivors and their families, with serious physical and psychological sequelae. Since little is known about the burden of critical illness on ICU survivor families, we conducted a prospective observational study aiming to assess this, and investigate correlations of the patients’ psychometric and health-related quality of life (HRQOL) scores with family burden.
Materials and Methods: Twenty-nine patients were evaluated in the presence of a family member. Participants were assessed with the use of validated scales for anxiety, depression, post-traumatic stress disorder, cognitive decline, and the family burden scale (FBS).
Results: High burden was present in 27.6% of family members. Statistically significant correlations were observed between the FBS score and trait anxiety, depression, and the physical and psychological components of HRQOL.
Conclusions: Our results suggest that family burden following critical illness is common, suggesting that its assessment should be incorporated in the evaluation of PICS-family in large observational studies.

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Knowledge, Practice and Attitudes to the Management of Sepsis in Jamaica

Karen Roye-Green1, Rohan Willis2, Sharon R. Priestley3, Ivan Vickers1

1 The University of the West Indies Mona Campus, Department of Microbiology, Kingston, Jamaica
2 The University of Texas Medical Branch at Galveston Department of Internal Medicine, TX, USA
3 The University of the West Indies Mona Campus, Department of Sociology, Psychology and Social Work, Kingston, Jamaica

DOI: 10.2478/jccm-2022-0024

Introduction: Sepsis is a life-threatening dysfunction resulting from the dysregulated host response to infection. The mortality of sepsis in Jamaica remains high amid the proven efficacy of the Surviving Sepsis Guidelines implementation in some countries.
Aim of study: To evaluate the inter-relationship of healthcare workers’ attitude towards, knowledge of and practice of sepsis management in Jamaica.
Material and methods: A survey was done using an anonymous self-administered validated questionnaire to healthcare workers across Jamaica. Questions on knowledge, attitude, and practice of sepsis within private and public hospitals were answered.
Results: A total of 616 healthcare workers were eligible for analysis. Most respondents agree that healthcare workers need more training on sepsis (93.7%) and that formal sepsis training modules should be implemented at their hospitals or practice (93.2%). Several signs of sepsis as outlined by qSOFA were correctly identified as such by most respondents (60.6% to 76.4%), with the exception of a low PaCO2 (34.9%), which was correctly identified by a minority of respondents. While a majority (69.3%) were able to correctly define sepsis, only 8.8% of respondents knew the annual sepsis mortality rate. Postgraduate training (p<0.01) and formal sepsis training (p<0.05) were both predictive of high correct knowledge and practice scores. Specialization in Anaesthesia/ Critical Care Medicine (p<0.05) or Emergency Medicine (p<0.05) was predictive of high knowledge scores and Internal Medicine predictive of high practice scores (p<0.01).
Conclusions: This study revealed that education for healthcare workers on sepsis and the implementation of SSC is needed in Jamaica.

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Burnout Syndrome During COVID-19 Second Wave on ICU Caregivers

Anaëlle Caillet¹, Marina Fillon¹, Margaux Plou¹, Emmanuel Tisson¹, Charles-Hervé Vacheron1,2,3, Bernard Allaouchiche1,4,5

1 Hospices Civils de Lyon, Hospital center Lyon-Sud, ICU, F-69310, Pierre-Bénite, France
2 Biostatistics-Bioinformatics Department, Public Health Unit, Hospices Civils de Lyon, Lyon, France
3 CIRI, International Center for Research in Infectiology (Emerging Pathogens Laboratory Team), Inserm, U1111, Claude Bernard Lyon 1 University, CNRS, UMR5308, Lyon, France
4 University Claude Bernard, Lyon1, Lyon, France
5 Lyon university, VetAgro Sup, Lyon veterinary campus, UPSP 2016.A101, Pulmonary and Cardiovascular Agression in Sepsis, F-69280, Marcy l’Étoile, France

DOI: 10.2478/jccm-2022-0026

Objective: The main objective of this article is to evaluate the prevalence of burnout syndrome (BOS) among the Intensive Care Unit (ICU) healthcare workers.
Methods: The COVID-impact study is a study conducted in 6 French intensive care units. Five units admitting COVID patient and one that doesn’t admit COVID patients. The survey was conducted between October 20th and November 20th, 2020, during the second wave in France. A total of 208 professionals responded (90% response rate). The Maslach Burnout Inventory scale, the Hospital Anxiety and Depression Scale and the Impact of Event Revisited Scale were used to study the psychological impact of the COVID-19 Every intensive care unit worker.
Results: The cohort includes 208 professionals, 52.4% are caregivers. Almost 20% of the respondents suffered from severe BOS. The professionals who are particularly affected by BOS are women, engaged people, nurses or reinforcement, not coming willingly to the intensive care unit and professionals with psychological disorders since COVID-19, those who are afraid of being infected, and people with anxiety, depression or post-traumatic stress disorder. Independent risk factors isolated were being engaged and being a reinforcement. Being a volunteer to come to work in ICU is protective. 19.7% of the team suffered from severe BOS during the COVID-19 pandemic in our ICU. The independent risk factors for BOS are: being engaged (OR = 3.61 (95% CI, 1.44; 9.09), don’t working in ICU when it’s not COVID-19 pandemic (reinforcement) (OR = 37.71 (95% CI, 3.13; 454.35), being a volunteer (OR = 0.10 (95% CI, 0.02; 0.46).
Conclusion: Our study demonstrates the value of assessing burnout in health care teams. Prevention could be achieved by training personnel to form a health reserve in the event of a pandemic.

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