The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea.

Objective: An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods: The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished-arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1-quartile 3) 2 (1-4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results: The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01-2.47), by 80% in VBG (95% CI: 1.13-2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22-2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality. Conclusions: In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.

Efficacy of Lidocaine Infusion in High-Risk Vascular Surgery-A Randomized, Double-Blind, Placebo-Controlled Single-Center Clinical Trial.

BACKGROUND: In perioperative pain control, adjuvants such as lidocaine can reduce opioid consumption in a specific type of surgery. The aim of this single-center prospective double-blinded randomized controlled trial was to determine opioid consumption in the perioperative period in patients receiving continuous lidocaine infusion. METHODS: Patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive 1% lidocaine or placebo at the same infusion rate based on ideal body weight (bolus of 0.15 mL/kg during the induction of anesthesia followed by continuous infusion of 0.2 mL/kg/h during surgery; postoperatively 0.1 mL/kg/h for 24 h) additionally to standard opioid analgesia. RESULTS: Total opioid consumption within 24 h after surgery was 89.2 mg (95%CI 80.9-97.4) in the lidocaine and 113.1 mg (95%CI 102.5-123.6) in the placebo group (p = 0.0007). Similar findings were observed in opioid consumption intraoperatively (26.7 mg (95%CI 22.2-31.3) vs. 35.1 mg (95%CI 29.1-41.2), respectively, p = 0.029) and six hours postoperatively (47.5 mg (IQR 37.5-59.5) vs. 60 mg (IQR 44-83), respectively, p = 0.01). CONCLUSIONS: In high-risk vascular surgery, lidocaine infusion as an adjunct to standard perioperative analgesia is effective. It may decrease opioid consumption by more than 20% during the first 24 h after surgery, with no serious adverse effects noted during the study period.

Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19.

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65−5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

Comparing transpulmonary thermodilution monitoring to lung ultrasound during pneumonia: an observational study.

INTRODUCTION: Monitoring lung function during pneumonia is essential for the evaluation of the effectiveness of therapy in ICU patients. Among various bedside techniques, two particularly interesting are the lung ultrasound and the transpulmonary thermodilution technique. In this observational single center study we want to assess the correlation between the lung ultrasound examination (LUS) and transpulmonary thermodilution volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). MATERIAL AND METHODS: We analyzed data obtained from medical history of twelve patients requiring mechanical ventilation and hemodynamics monitoring with PICCO catheter due to newly diagnosed pneumonia. We compared lung ultrasound examination performed on the first and third day of new antimicrobial therapy with results of transpulmonary thermodilution examination made on same day. We also calculate the difference between values obtained on first and third day to compare the trends. RESULTS: We did not find any association between tested variables, except a correlation between PVPI and EVLWI, both measured at the same day (Rho = 0.3; 95%CI -0.02-0.59; p = 0.03), and trends in the period of 3 days (Rho = 0.6; 95%CI 0.2-0.8; p = 0.005). CONCLUSIONS: The results of the study indicate that volumetric values achieved using the PiCCO method as well as lung ultrasound should be interpreted with care and related to the clinical state of a patient, keeping in mind that no correlation between the result achieved and the actual state of inflammatory changes in the lungs may be possible.

Perioperative prognostic factors in patients with ruptured abdominal aortic aneurysms treated in the intensive care unit.

BACKGROUND: The incidence of abdominal aortic aneurysm has been estimated at 20-40 cases per 100,000 per annum. The disease is often asymptomatic; in many cases, its first symptom is shock caused by a ruptured aneurysm. The aim of the present study was to assess retrospectively the selected perioperative factors in patients hospitalised in the intensive care unit (ICU) after repair of ruptured abdominal aortic aneurysm. METHODS: Analysis involved medical records of patients after repair of ruptured abdominal aortic aneurysm treated in ICU in the years 2009-2010. Patients were divided into two groups: group I - survivors who were discharged from ICU and group II - non-survivors. Demographic factors, intraoperative data, vital parameters, laboratory results and severity of patient's state on admission to ICU were analysed. RESULTS: Analysis of laboratory results on admission to ICU showed lower values of pH and HCO(3)(-) concentrations as well as higher international normalised ratio (INR) and activated partial thromboplastin time (APTT) in group II. Mean intraoperative diuresis differed between the groups; in group I - 303 mL and in group II - 155 mL. Mean diuresis on ICU day 1 was higher in group I compared to group II, i.e. 20.87 and 11.27 mL kg b.w.-1, respectively. APACHE II, SAPS II, MODS and SOFA point values were higher in group I than in group II. CONCLUSIONS: Markers of impaired homeostasis, such as pH, HCO(3)(-) concentration, INR and APTT assessed on admission to ICU can be relevant prognostic factors in patients after repair of ruptured abdominal aortic aneurysm. Monitoring of diuresis during surgery and on day 1 of ICU treatment was a sensitive risk marker for acute kidney injury. Multiple organ failure scales such as APACHE II, MODS, SOFA and SAPS II were reliable prognostic tools to be used in the early period of ICU treatment.

[Continuous veno-venous haemofiltration in adult intensive therapy]. / Ciagla hemofiltracja zylno-zylna u chorych leczonych w oddziale intensywnej terapii.

BACKGROUND: Continuous veno-venous haemofiltration (CVVH) has been recommended for renal replacement therapy in acute renal failure (ARF). The aim of the study was to analyse the usefulness of CVVH in intensive therapy settings. METHODS: Sixteen adult patients, treated with CVVH because of ARF complicating multiple organ failure, were allocated to two groups: those who survived and those who did not. Serum lactate, creatinine, potassium, and C-reactive protein concentrations, together with WBC count and arterial blood gases, were assessed before the start of CVVH, and daily during the therapy. The severity of the patients' clinical state was rated according to the Sepsis-related Organ Failure Assessment scale (SOFA) at both the initiation and the termination of therapy. RESULTS: The demographic data did not differ between the groups. Mean serum creatinine (171.5 vs 282.9 mmol L-1, p<0.05), blood lactate (1.8 vs 3.5 mmol L-1, p<0.05), and potassium concentrations (3.9 mmol L-1 vs 4.5 mmol L-1, p<0.05) were significantly higher in those patients who died. Mean SOFA scores were similar in both groups before the start of treatment, but were increased significantly at the end of therapy in the patients who died (7.0 vs 15.0, p<0.05). The concentrations of CRP, and WBC counts were similar in both groups. CONCLUSIONS: We concluded that CVVH can be instituted in cases of ARF, regardless of age or condition of patients. Early institution of CVVH was effective and resulted in normalization of renal function and biochemical parameters.

[The clinical spectrum of connective tissue diseases - a single intensive care experience]. / Analiza przypadków ukladowych chorób tkanki lacznej leczonych w oddziale anestezjologii i intensywnej terapii.

BACKGROUND: Systemic connective tissue diseases are relatively rare disorders of unknown origin, possibly related to autoimmunity. In the retrospective study, we analysed the records of nine patients suffering from connective tissue disorders who were treated during a two-year period in an intensive therapy unit. METHODS: Hospital medical records, observational charts and all other available medical documents were analysed. RESULTS: The clinical courses of 9 patients were studied. They included 4 with scleroderma, 3 with systemic lupus erythematosus, and 2 with inflammatory myopathy. They were admitted to the ITU because of sepsis and/or pneumonia, pulmonary haemorrhage, or cardiovascular failure. Three patients (2 with systemic sclerosis, 1 with systemic lupus erythematosus) died. CONCLUSIONS: A multidisciplinary approach to treatment is a key factor in the successful management of patients with rare diseases, such as connective tissue pathologies. Frequent infections with respiratory and/or circulatory complications are the most common causes of severe morbidity in these patients.