Volume 11 | The Journal of Critical Care Medicine

The Use of Biomarkers Testing in Emergency Department

Sonia Luka^1,2, Adela Golea^2,3, Raluca Mihaela Tat¹, Eugenia Maria Lupan Mureșan^2,3, George Teo Voicescu^2,3,4, Ștefan Cristian Vesa⁵, Maria Adriana Albu⁶, Daniela Ionescu⁷

1 Faculty of Medicine, Iuliu Hagieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Clinical Emergency County Hospital, Cluj-Napoca, Romania
3 Discipline of Emergency Medicine, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
4 CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
5 Discipline of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
6 Department of Emergency Medicine and First Aid, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
7 Discipline of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

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.

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

Hana Locihová¹, Darja Jarošová², Karolína Šrámková³, Jana Slonková⁴, Renáta Zoubková⁵, Klára Maternová⁶, Karel Šonka⁷

1 Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Ostrava, Ostrava -Vítkovice, Czech Republic; Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava – Vítkovice, Czech Republic
2 Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava – Vítkovice, Czech Republic
3 Department of Neurology, University Hospital Ostrava, Ostrava -Vítkovice, Czech Republic
4 Department of Neurology, University Hospital Ostrava; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava -Vítkovice, Czech Republic
5 Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Ostrava; Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava -Vítkovice, Czech Republic
6 2nd Department of Surgery – Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
7 Department of Neurology and Center of Clinical Neurosciences, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic

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.