Results Following Stent-Graft Coverage of the Hypogastric Artery in the Management of Aortoiliac Aneurysms in Endovascular Aneurysm Repair.

<b><br>Aim:</b> The aim of our study was to assess the outcomes of stent-graft coverage of the hypogastric artery in the management of aortoiliac aneurysms with endovascular aneurysm repair (EVAR).</br> <b><br>Material and methods:</b> From January 2013 to March 2017, a total of 93 patients with aortoiliac aneurysms were treated with EVAR, which required occlusion of one or both of the hypogastric arteries. The patients of the Department of General, Vascular, Endocrine and Transplant Surgery were included in the study continuously and all procedures were elective.</br> <b><br>Results:</b> A total of 93 patients with aortoiliac aneurysms required a unilateral or bilateral procedure. Six patients were excluded from our study because they did not appear at their follow-up appointments. The study included 87 patients (80 men; mean age 71.9 (7.9) years, range 54-88), of which 30 had a unilateral procedure and 57 had a bilateral procedure. In 8 procedures (5.55%, n = 7) there was a type II endoleak that resolved during follow-up and required no surgical intervention. In 10 procedures (6.94%, n = 10) there was a type IB endoleak, with 8 procedures requiring surgical re-intervention in the form of an extension. In 12 procedures (8.33%, n = 9), the hypogastric artery thrombosed.</br> <b><br>Conclusion:</b> Coverage of the hypogastric artery by stent-graft has been proven to be a safe procedure, but there is still a risk of type II endoleak. Although 5.55% (n = 7) of the procedures in our study had a type II endoleak, none required surgical intervention.</br>.

Value, time and outcomes of elevated lactate levels in adult patients on extracorporeal membrane oxygenation.

INTRODUCTION: Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support. METHODS: Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated. RESULTS: The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO (p < .001), while lactate clearance was similar (p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO (p = .007) and VA ECMO (p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality. CONCLUSION: This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.

Post-tracheostomy complications: respiratory failure caused by authologic foreign body-case report.

Tracheostomy is performed frequently as a palliative treatment in patients with end-stage respiratory failure (RF). However, in patients requiring prolonged mechanical ventilation it may be difficult to recognize and can often lead to life-threatening RF. We present two cases of acute-on-chronic respiratory failure (ACRF) occurring in patients who had undergone tracheostomy [one with percutaneous dilatational tracheostomy (PDT) and the second with surgical tracheostomy (ST)]. The first case was admitted due to ACRF several months after previous successful decannulation and the second case after failure of several attempts of weaning from tracheal cannula. In both cases, noninvasive mechanical ventilation assisted flexible bronchoscopy (NIV-FB) was able to identify and solve the tracheal stenosis secondary to stiff banana-shaped whitish foreign bodies. Histology sampling and genetic testing confirmed autologous foreign body formation-tracheal cartilage calcification. NIV-FB was found to be safe and effective in both diagnosis and treatment of the tracheal stenosis. Life-threatening RF connected with tracheal stenosis may be caused by rupture of tracheal cartilage ossification in patients with a history of ST and PDT. Bronchofiberoscopy performed with NIV will be a useful procedure to evaluate and treat the respiratory tract in patients with RF with suspected tracheal stenosis.

Extracorporeal membrane oxygenation (ECMO) - in the treatment of severe, life-threatening respiratory failure.

Extracorporeal membrane oxygenation (ECMO) is a technique involving oxygenation of blood and elimination of carbon dioxide in patients with life-threatening, but potentially reversible conditions. Thanks to the modification of extracorporeal circulation used during cardiac surgeries, this technique can be used in intensive care units. Venovenous ECMO is used as a respiratory support, while venoarterial ECMO as a cardiac and/or respiratory support. ECMO does not cure the heart and/or lungs, but it gives the patient a chance to survive a period when these organs are inefficient. In addition, extracorporeal membrane oxygenation reduces or eliminates the risk of lung damage associated with invasive mechanical ventilation in patients with severe ARDS (acute respiratory distress syndrome). ECMO is a very invasive therapy, therefore it should only be used in patients with extremely severe respiratory failure, who failed to respond to conventional therapies. According to the Extracorporeal Life Support Organization (ELSO) Guidelines, inclusion criteria are: PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours. Proper ECMO management requires advanced medical care. This article discusses the history of ECMO development, clinical indications, contraindications, clinical complications and treatment outcomes.

The importance of fluid balance in critically ill patients: a retrospective observational study

BACKGROUND: Fluid therapy in critically ill patients remains one of the most demanding and difficult aspects of care. This is particularly important in patients admitted to the intensive care unit (ICU) due to cardiovascular disorders. AIMS: The aim of this study was to investigate whether a cumulative fluid balance (FB) affects mortality in critically ill patients hospitalized at the ICU. METHODS: Data were obtained from the medical records of the ICU at the Silesian Centre for Heart Diseases. All patients admitted to the ICU between 2012 and 2016 were evaluated. Patients who died or were discharged from the ICU within 48 hours from admission were excluded. Fluid balance and the type of fluids infused during the first 7 days were assessed. The primary outcome was ICU mortality. RESULTS: Overall, 495 patients were included in the study and 303 (61.2%) survived the ICU stay. Daily FB in the first 24, 48, and 72 hours after admission and the cumulative FB after 7 days were significantly lower in survivors. Fluid balance exceeding 1000 ml and the use of colloid solutions in the first 72 hours were independently associated with mortality, along with the diagnosis of stroke and shock on admission. CONCLUSIONS: A positive FB exceeding 1000 ml in the first 72 hours from admission to the ICU is independently associated with an increased risk of mortality in critically ill patients with cardiovascular disorders. The use of colloid solutions is associated with a higher positive FB.

Surveillance of Antibiotic Prescribing in Intensive Care Units in Poland.

Antibiotic use and microbial resistance in health care-associated infections are increasing globally and causing health care problems. Intensive Care Units (ICUs) represent the heaviest antibiotic burden within hospitals, and sepsis is the second noncardiac cause of mortality in ICUs. Optimizing appropriate antibiotic treatment in the management of the critically ill in ICUs became a major challenge for intensivists. We performed a surveillance study on the antibiotic consumption in 108 Polish ICUs. We determined which classes of antibiotics were most commonly consumed and whether they affected the length of ICU stay and the size and category of the hospital. A total of 292.389 defined daily doses (DDD) and 192.167 patient-days (pd) were identified. Antibiotic consumption ranged from 620 to 3960 DDD/1000 pd. The main antibiotic classes accounted for 59.6% of the total antibiotic consumption and included carbapenems (17.8%), quinolones (14%), cephalosporins (13.7%), penicillins (11.9%), and macrolides (2.2%), respectively, whereas the other antibiotic classes accounted for the remainder (40.4%) and included antifungals (34%), imidazoles (20%), aminoglycosides (18%), glycopeptides (15%), and polymyxins (6%). The most consumed antibiotic classes in Polish ICUs were carbapenems, quinolones, and cephalosporins, respectively. There was no correlation between antibiotic consumption in DDD/1000 patient-days, mean length of ICU stay, size of the hospital, size of the ICU, or the total amount of patient-days. It is crucial that surveillance systems are in place to guide empiric antibiotic treatment and to estimate the burden of resistance. Appropriate use of antibiotics in the ICU should be an important public health care issue.