ABSTRACT
BACKGROUND: ICU-acquired diaphragm paresis occurs in about 25% of patients after prolonged mechanical ventilation. Diaphragm function can be evaluated via several approaches including monitoring of electrical activity of diaphragm (electromyography [EMG]) or ultrasound (US) measurements. We aimed to assess the usefulness of diaphragm EMG indices in predicting liberation outcome in comparison with diaphragm US measurements. METHODS: We included consecutive subjects invasively ventilated for > 48 h for acute respiratory failure and who were considered ready to undergo a spontaneous breathing trial (SBT). Exclusion criteria were age < 18 y, pregnancy, tracheostomy, or patients with confirmed neuromuscular diseases. To start the SBT, we set pressure support to 0 cm H2O and PEEP to 5 cm H2O. During the initial 5 min of SBT, mean values of Δ electrical activity of the diaphragm (ΔEAdi) (EAdi peak - EAdi minimal), tidal volume (VT), and breathing frequency were measured. Neuroventilatory efficiency was calculated as VT divided by ΔEAdi. Rapid shallow breathing index was calculated as breathing frequency divided by VT. US examination of the diaphragm and assessment of diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were recorded 30 min after initiation of SBT. RESULTS: Twenty-four subjects were included; DTF predicted weaning failure with area under the curve 0.96 and P value < .001 with sensitivity 100% and specificity 94% for the cutoff value ≤ 15%. DE for the cutoff ≤ 1.56 cm showed sensitivity 75% and specificity 69%, whereas ΔEAdi with cutoff value ≤ 4 µV showed sensitivity 25% and specificity 100%. Neuroventilatory efficiency with cutoff value ≤ 29 mL/µV showed sensitivity 50% and specificity 81%. All 3 parameters showed nonsignificant results with area under the curve 0.73, 0.56, and 0.62 and P values .08, .65, and .34, respectively. CONCLUSIONS: Diaphragm EMG indices were inferior to diaphragm ultrasonography in prediction of mechanical ventilation liberation outcome.
ABSTRACT
BACKGROUND: This study aimed at evaluating the role of presepsin in early identification of sepsis and prediction of mortality in intensive care unit (ICU) patients in comparison to systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) score. MATERIALS AND METHODS: Forty patients were selected randomly after admission to adult ICU. Data from emergency room (ER) triaging, and initial laboratory results were gathered to calculate qSOFA score, SIRS criteria, and SOFA score. Presepsin measurement was performed within 6 hours from ER triaging.The patients were categorized into sepsis and nonsepsis groups depending on the clinical and microbiological criteria and SOFA score changes. RESULTS: Twenty-six patients were diagnosed as septic with an average age of 68.04 ± 18.60 years, while 14 patients were nonseptic with an average age of 51.71 ± 24.88 years.Presepsin with a cutoff value >640 pg/mL (area under the curve [AUC] of 0.848 (p < 0.001}) had a significant diagnostic accuracy of identifying septic cases with sensitivity of 73.08% and specificity of 92.86% as compared to the nonsignificant SIRS (AUC, 0.670; sensitivity, 69.23%; and specificity, 57.14%) or qSOFA (AUC, 0.652; sensitivity, 38.46%; and specificity, 78.57%) criteria.Prespsin with a cutoff value >640 pg/mL also significantly (AUC of 0.920 [p < 0.001]) predicted mortality with sensitivity of 100.0% and specificity of 66.67% compared to the nonsignificant SIRS (AUC, 0.540; sensitivity, 70.0%; and specificity, 43.33%) or qSOFA (AUC, 0.670; sensitivity, 60%; and specificity, 76.67%) criteria. CONCLUSION: Early presepsin measurement in ICU patients is more accurate in the diagnosis of sepsis and prediction of mortality as compared to SIRS or qSOFA score. HOW TO CITE THIS ARTICLE: Abdelshafey EE, Nasa P, Elgohary AE, Khalil MF, Rashwan MA, Ghezala HB, et al. Role of Presepsin for the Diagnosis of Sepsis and ICU Mortality: A Prospective Controlled Study. Indian J Crit Care Med 2021;25(2):153-157.
ABSTRACT
OBJECTIVES: This study aimed to determine the role of ONSD measurement by US for diagnosis of high ICP in TBI patients. METHODS: ONSD measurement by US was performed in adult TBI patients within 1 h of planned CT brain, while CT signs of high ICP were determined. Invasive ICP measurement was performed simultaneously in patients who had intraventricular device in situ. High ICP was determined as ICP > 22 mmHg. RESULTS: A total of 48 patients were enrolled. Twenty-eight patients had positive CT criteria for high ICP, while 20 patients were negative. The mean value of ONSD was 0.63 ± 0.06 cm in positive group compared with 0.55 ± 0.07 cm in negative one with significant difference (p < 0.001). A total of 22 patients had intraventricular device. Thirteen patients had high ICP, while 9 patients had normal ICP. The mean value of ONSD was 0.66 ± 0.05 cm in high ICP group compared with 0.58 ± 0.08 cm in normal one with significant difference (p = 0.004). ONSD with cut-off value > 0.61 cm predicted high ICP with sensitivity of 84.62% and specificity of 66.67% with significant AUC of 0.85 (p = 0.006). CONCLUSION: ONSD measurement by ultrasound is a good screening tool for high ICP in traumatic brain injury patients.
