Category Archives: JCCM 2025

The use of intraventricular vancomycin in subacute brain abscess in an adolescent male: A case report

DOI: 10.2478/jccm-2024-0046

Introduction: Brain abscess is a serious condition in children, leading to rapid deterioration, and permanent neurological damage associated with significant morbidity and mortality. Current management protocols for brain abscesses focus on intravenous antibiotics and surgical excision and drainage.
Case Presentation: A 12-year-old adolescent male who had headache and photophobia and was diagnosed with multiple brain abscesses and was refractory to conventional medical and neurosurgical intervention. A single dose of 10 mg vancomycin was administered through endo-ventricular drain , resulting in resolution of abscesses and alleviation of symptoms.
Conclusion: We describe the first instance of intraventricular vancomycin use in the pediatric age group for the treatment of multiple brain abscesses. Given the variability in dosing reported in the literature, our case report warrants further studies to standardize dosage for this rare intervention.

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The effect of pre-existing sarcopenia on outcomes of critically ill patients treated for COVID-19

DOI: 10.2478/jccm-2024-0045

Background: Sarcopenia, defined by a loss of skeletal muscle mass and function, has been identified as a prevalent condition associated with poor clinical outcome among critically ill patients. This study aims to evaluate the impact of pre-existing sarcopenia on outcomes in critically ill patients with acute respiratory failure (ARF) due to COVID-19.
Material and Methods: A retrospective study was carried out on COVID-19 patients admitted to intensive care. Pre-existing sarcopenia was assessed using early CT scans. Clinical outcomes, including duration of high-flow oxygenation (HFO), mechanical ventilation (MV), length of hospital stay (LOS) and ICU mortality, were evaluated according to sarcopenia status.
Results: Among the studied population, we found a high prevalence (75 patients, 50%) of pre-existing sarcopenia, predominantly in older male patients. Pre-existing sarcopenia significantly impacted HFO duration (6.8 (+/-4.4) vs. 5 (+/-2.9) days; p=0.005) but did not significantly affect MV requirement (21 (28%) vs. 23 (37.3%); p=185), MV duration (7 vs. 10 days; p=0.233), ICU mortality (12 (16%) vs. 10 (13.3 %); p=0.644) or hospital LOS (27 vs. 25 days; p=0.509). No differences in outcomes were observed between sarcopenic and non-sarcopenic obese patients.
Conclusions: Pre-existing sarcopenia in critically ill COVID-19 patients is associated with longer HFO duration but not with other adverse outcomes. Further research is needed to elucidate the mechanisms and broader impact of sarcopenia on septic critically ill patient outcomes.

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The Use of Biomarkers Testing in Emergency Department

DOI: 10.2478/jccm-2024-0041

Introduction: In the fast-paced environment of Emergency Departments (EDs), biomarkers are essential for the rapid diagnosis and management of critical conditions.
Aim of the study: This study evaluates the current clinical practice on key biomarkers in Romanian EDs, addressing the needs of emergency medicine physicians, and the challenges associated with biomarker testing.
Material and Methods: An online survey was sent to physicians working in ED to explore their perceptions, needs, and barriers regarding biomarkers, including Point-of-care (POC). Data was collected anonymously through an online platform and subsequently analyzed.
Results: This survey analyzed data from 168 completed responses, with 95.2% of respondents being specialists in emergency medicine. Procalcitonin and presepsin were most preferred for PoCT, while troponin and D-dimer were highly rated regardless of the testing method, reflecting their utility in sepsis and cardiovascular emergencies. Neuron-specific enolase, interleukin-6, and procalcitonin were the biomarkers considered needed.
Conclusions: The most frequently used biomarkers in ED were troponin, D-dimer, BNP/NT-proBNP, and procalcitonin. NSE, IL-6, and procalcitonin were the most recommended for future integration. High costs, limited availability, and false-positive concerns remain significant challenges in biomarker use.

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Effect of sleep quality on weaning from
mechanical ventilation: A scoping review

DOI: 10.2478/jccm-2024-0043

Introduction: Mechanically ventilated patients have disturbed sleep.
Aim of the study: To explore whether there is a relationship between successful or unsuccessful weaning of patients and their sleep quality and circadian rhythm.
Materials and Methods: A scoping review. The search process involved four online databases: CINAHL, MEDLINE, ProQuest, and ScienceDirect. Original studies published between January 2020 and October 2022 were included in the review.
Results: Six studies met the inclusion criteria. These studies showed that patients with difficult weaning were more likely to have atypical sleep, shorter REM sleep, and reduced melatonin metabolite excretion. Muscle weakness was an independent factor associated with prolonged weaning from mechanical ventilation and was significantly more frequent in patients with atypical sleep. Heterogeneous patient samples and the methodology of the studies hamper a clear interpretation of the results.
Conclusions: A relationship was found between abnormal sleep patterns, reduced melatonin metabolite (6-sulfatoxymelatonin) excretion, and unsuccessful weaning. However, the causality is not clear from the existing research.

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