Category Archives: JCCM 2016

Influence of Ventilation Parameters on Intraabdominal Pressure

Claudiu Puiac1, Janos Szederjesi1*, Alexandra Lazar1, Emoke Almasy1, Paul Rad1, Lucian Puscasiu2

1 Anesthesiology Department, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Gynecology and Obstetrics Department, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/jccm-2016-0016

Introduction: Intraabdominal pressure monitoring is not routinely performed because the procedure assumes some invasiveness and, like other invasive procedures, it needs to have a clear indication to be performed. The causes of IAH are various. Mechanically ventilated patients have numerous parameters set in order to be optimally ventilated and it is important to identify the ones with the biggest interference in abdominal pressure. Although it was stated that mechanical ventilation is a potential factor of high intraabdominal pressure the set parameters which may lead to this diagnostic are not clearly named.
Objectives: To evaluate the relation between intraabdominal pressure and ventilator parameters in patients with mechanical ventilation and to determine the correlation between intraabdominal pressure and body mass index.
Material and method: This is an observational study which enrolled 16 invasive ventilated patients from which we obtained 61 record sheets. The following parameters were recorded twice daily: ventilator parameters, intraabdominal pressure, SpO2, Partial Oxygen pressure of arterial blood. We calculated the Body Mass Index (BMI) for each patient and the volume tidal/body weight ratio for every recorded data point.
Results: We observed a significant correlation between intraabdominal pressure (IAP) and the value of PEEP (p=0.0006). A significant statistical correlation was noted regarding the tidal volumes used for patient ventilation. The mean tidal volume was 5.18 ml/kg. Another significant correlation was noted between IAP and tidal volume per kilogram (p=0.0022). A positive correlation was found between BMI and IAP (p=0.0049), and another one related to the age of the enrolled patients. (p=0.0045).
Conclusions: The use of positive end-expiratory pressures and high tidal volumes during mechanical ventilation may lead to the elevation of intraabdominal pressure, a possible way of reducing this risk would be using low values of PEEP and also low volumes for the setting of ventilation parameters. There is a close positive correlation between the intraabdominal pressure levels and body mass index.

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Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

Maria Livia Ognean1*, Silvia-Maria Stoicescu2, Oana Boantă1, Leonard Năstase2,
Carmen Gliga3, Manuela Cucerea3,4

1 Clinical County Emergency Hospital Sibiu, Neonatology Department
2 University of Medicine and Pharmacy Carol Davila Bucuresti, Institute of Mother and Child Care – Polizu, Neonatology Department
3 Clinical County Emergency Hospital Târgu Mureș, Regional Neonatal Intensive Care Center
4 University of Medicine and Pharmacy Târgu Mureș

DOI: 10.1515/jccm-2016-0010

Introduction: Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability.
Aim of the study: To identify the factors associated with INSURE strategy failure in preterm infants with gestational age (GA) ≤ 32 weeks.
Materials and Methods: This was a retrospective cohort study, based on data collected in the Romanian National Registry for RDS patients by three regional (level III) centers between 01.01.2010 and 31.12.2011. All preterm infants of ≤ 32 weeks GA were included. Prenatal and neonatal information were compared between (Group 1), the preterm infants successfully treated using INtubation-SURfactant-Extubation on nasal CPAP (INSURE) strategy and (Group 2 ), those who needed mechanical ventilation within seventy-two hours after INSURE.
Results: A total of 637 preterm infants with GA ≤ 32 weeks were included in the study. INSURE strategy was performed in fifty-seven cases (8.9%) [ Group 1] and was successful in thirty-one patients (54.4%). No differences were found as regards the studied prenatal and intranatal characteristics between (Group 1) and Group 2 who needed mechanical ventilation. Group 2 preterm infants who needed mechanical ventilation within 72 hours after INSURE had significantly lower mean Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation (SpO2) during resuscitation at birth (p<0.05). Successful INSURE strategy was associated with greater GA, birth weight (BW), fraction of inspired oxygen (FiO2) during resuscitation, and an increased mean dose of surfactant but these associations were not statistically significant (p>0.5).
Conclusion: In preterm infants ≤ 32 weeks gestation, increased INSURE failure rates are associated with complicated pregnancies, significantly lower Apgar scores at 1 and 5 minutes, and lower peripheral oxygen saturation during resuscitation.

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Much Ado About the New Definitions of Sepsis

Sanda-Maria Copotoiu1*, Ruxandra Copotoiu2

1 University of Medicine and Pharmacy of Tirgu Mures, Romania, Clinic of Anesthesia and Intensive Care Emergency County Hospital of Tîrgu Mures, Gheorghe Marinescu street no 38, Tirgu Mures, Romania
2 Les Hôpitaux Universitaires de Strasbourg, Pôle d’anesthésie – réanimations chirurgicales – SAMU – SMUR, Service d’anesthésiologie, Hôpital Civil

DOI: 10.1515/jccm-2016-0015

Following the publication of the new definition of sepsis (Sepsis-3), a plethora of articles have been published in medical journals. Recognizing the epidemiological importance of the previous definitions, first issued in 1992 (Sepsis-1), and subsequently revised in 2001 (Sepsis-2), the most recent opinion emphasizes the failure “to provide adequate groups of patients with homogenous aetiologies, presentations and outcomes”, and blamed one of the causes “for the failure of several randomized controlled trials (RCTs), that tested the efficacy of adjuvant sepsis therapies”. This review summarizes the recent advances in sepsis definition.

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Knowledge Is Power

Leonard Azamfirei, Editor-in-Chief

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/jccm-2016-0014

When Sir Francis Bacon published in his work, Meditationes Sacrae (1597), the saying: “knowledge itself is power”, he most likely wanted to transmit the idea that having and sharing knowledge is the cornerstone of reputation and influence, and therefore power; all achievements emanate from this. Today, scientific knowledge is shared through publications that not only inform, but have the capacity to influence decision making.
The Journal of Critical Care Medicine, a publication of the University of Medicine and Pharmacy Tîrgu Mureș, Romania launched in 2015, was recently included in the Master Journal List of the Emerging Sources Citation Index (ESCI), which is part of the Thomson Reuters Web of Science Core Collection. This new index ensures the indexing of high-quality medical articles that undergo a specific peer-review process prior to publication. The inclusion of the journal in this international database ensures a larger and more consistent international profile, as well as a probable increase in the citation of published articles. [More]

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