Nucleated red blood cells are a predictor of mortality in patients under extracorporeal membrane oxygenation.

BACKGROUND: The presence of Nucleated Red Blood Cells (NRBCs) in critically ill patients is associated with higher mortality and poor prognosis. Although patients on extracorporeal support such as veno-venous or veno-arterial extracorporeal membrane oxygenation (VV/VA-ECMO) are severely ill, NRBCs have rarely been investigated regarding their predictive value so far. METHODS: As part of a retrospective study, we examined all cardiothoracic surgery patients from July 2019 to September 2020 who received ECMO treatment during their inpatient stay. The aim of this study was to investigate the occurrence of NRBCs during ECMO support in terms of their predictive value for mortality. RESULTS: In total 30 patients (age at admission: 62.7 ± 14.3 year; 26 male; ECMO duration: 8.5 ± 5.1 days; ICU duration: 18.0 ± 14.5 days) were included. 16 patients (53.3%) died during their inpatient stay. There were no significant differences in demographic characteristics between VA- or VV- ECMO patients. NRBCs occurred in all patients while under ECMO support. NRBC value was significant higher in those who died (2299.6 ± 4356.6 µl) compared to the surviving patients (133.6 ± 218.8 µl, p < 0.001). Univariate analysis found that patients with a cutoff value of ≥ 270 NRBCs/µl during ECMO support were 39 times more likely to die (OR 39.0, 95% CI 1.5-997.5, p < 0.001). 12 out of 13 patients (92.3%) with ≥ 270 NRBCs/µl died. The area under the curve (AUC) of the receiver operating characteristic curve was 0.85 (95% CI 0.69-0.96) with a sensitivity of 75.0% and a specificity of 92.9%. CONCLUSION: NRBCs appear to be an accurate biomarker for mortality in patients with ECMO support. They may be helpful in deciding if therapy becomes futile. Trial registration DRKS00023626 (December 20th 2020).

Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients.

BACKGROUND: The aim of this study was to determine simple risk factors for severe pain intensity (≥7 points on a numeric rating scale [NRS]), to analyse their relation to other patient-reported outcome measures and to develop a simple prediction model. METHODS: We used data from 50,005 patients from the PAIN-OUT project. Within a first data set (n = 33,667), relevant risk factors were identified by logistic binary regression analysis, assessed for additional patient-reported outcome measures beyond pain intensity and summed up for developing a simple risk score. Finally, sum of factors was plotted against postoperative pain outcomes within a validation data set (n = 16,338). RESULTS: Odds ratios (OR) for the following risk factors were identified: younger age (<54 years, OR: 1.277), preoperative chronic pain at the site of surgery (OR: 1.195), female sex (OR: 1.433), duration of surgery (>90 minutes, OR: 1.308), preoperative opioid intake (OR: 1.250), feeling anxious (OR: 1.239) and feeling helpless due to pain (OR: 1.198), and the country of the recruiting centre (OR: 1.919). Patients with ≥3 risk factors had more severe pain intensity scores, spent a longer time in severe pain, and wished to have received more pain treatment (P < 0.001). A simple risk score was created with 4 risk factors showing a moderate prediction level. CONCLUSIONS: Patients with ≥3 risk factors are at higher risk for poor postoperative acute pain outcome after surgery. Future studies using this score might show that preventive strategies might decrease pain intensity, pain-related postoperative dysfunction, and the development of chronic pain.

Outpatient Parenteral Antibiotic Therapy (OPAT) with Peripherally Inserted Central Catheter in Patients with Periprosthetic Joint Infection. / Die ambulante i. v. Antibiotikatherapie mittels PICC Line in der Behandlung von chronischen periprothetischen Infektionen.

BACKGROUND: A key factor in the successful treatment of periprosthetic joint infection is the consistent antimicrobial therapy. Depending on the pathogen antimicrobial susceptibility, intravenous (i. v.) antibiotics may not be switched to oral medication at patient discharge, without risking a treatment failure. The implementation of an outpatient i. v. therapy using peripherally inserted central catheters (PICCs) allows for early discharge with continuation of adequate antimicrobial therapy. METHODS: We prospectively evaluated the systematic use of PICC in 11 patients with periprosthetic joint infection. Inclusion criterion was the detection of a pathogen that cannot be optimally treated with oral antibiotics according to the current treatment concept (Trampuz et al.). RESULTS: A total of 12 PICCs in 11 patients were analysed. An error or mechanical nerve irritation was not observed. The occurrence of a catheter-related bloodstream infection (CRBSI) was not recorded. None of our patients had PICC-associated infections, thrombophlebitis or thrombosis. One patient stopped therapy due to a lack of compliance. Ten patients successfully completed their treatment. At a mean follow-up of 29 months, successful infection eradication as measured by the Delphi criteria was achieved in 100%. CONCLUSION: Although the number of patients included in the study was small, our short-term results suggest a good applicability of PICCs in the outpatient i. v. antimicrobial therapy for treatment of periprosthetic joint infection. Catheter-associated complications could not be observed in our collective. The successful infection control in all cases despite proven difficult-to-treat infection is promising.