Professor of Intensive Care and Anesthesiology at the “Università Cattolica del Sacro Cuore” Rome Italy since November 1999. Director of the Dept. of Anesthesiology and Intensive Care and Emergency Medicine and of the General ICU, Postoperative ICU and Neurosurgical ICU of the Fondazione Policlinico Universitario A.Gemelli IRCCS. Director of the School of Specialty in Anesthesiology and Intensive Care Medicine.
[Background] High-flow nasal cannula (HFNC) is a recently developed oxygen (O2) supply device. In many hypoxemic conditions, it has been reported to improve clinical outcomes, resulting in increased use in clinical practice. The purpose of this pilot study is to examine the current practice of HFNC in Korea. [Methods] From April 1 to June 30, 2018, we retrospectively reviewed medical records of 354 adult patients who were applied HFNC in 4 university hospitals. [Results] The mean age of the patients was 70.7 years old and 64.4% was male. Most were medical patients (n=308). Among them, 174 (56.5%) were patients admitted to non-pulmonology division. The most common cause of O2 therapy was pulmonary conditions including pneumonia (64.4%). The nasal cannula was most commonly applied device prior to HFNC (37.7%). The applied locations of HFNC were in ward (43.2%), intensive care uni t(ICU, 41.5%) and emergency room (15.3%). Half and one third of cases were decided by resident and pulmonologist, respectively. Successful HFNC weaning rate was 57.6% and 71 patients (20.1%) were escalated to NIV or intubation. In multivariate analysis, PaO2 prior to HFNC was associated with escalation to NIV or intubation (p=0.006), and O2 saturation (p=0.017) and respiration rate (p=0.001) just after HFNC application were associated with death during HFNC. [Conclusion] In current, HFNC is common O2 supply device in ward and ICU, and several factors associated with HFNC failure. More precise survey is needed to examine the status of HFNC use and evaluate the factors associated with outcome of HFNC.
Background: Influencing factors for prolonged mechanical ventilation (PMV) following acute type A aortic dissection repair (AADR) were investigated. Material and methods: 325 patients receiving AAADR were enrolled. They were divided into two groups based on the duration of mechanical ventilation; 72 h or less (Group A; n=250) and more than 72 h (Group B; n=75). Results: Preoperative backgrounds showed % of those with COPD, redo operative cases, mal-perfusion to coronary arteries or lower limbs were significantly higher in Group B. Procedure related data revealed that operation time, cardio-pulmonary bypass time, aortic cross clamp time, and postoperative ICU stay were significantly longer in Group B. There were more intraoperative bleeding amounts identified in Group B. % of those complicated with postoperative acute renal failure were significantly higher in Group B. 30-day mortality was significantly higher in Group B. Multivariate analysis demonstrated that COPD, preoperative mal-perfusion to vital organs or lower limbs, operation time were significantly influencing factors of PMV. Conclusions: COPD, mal-perfusion to vital organs or lower limbs, prolonged operation time were influencing factors for PMV. Identifying them could help to establish optimal perioperative management strategies following AAADR.
Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand.
Background: Empirical antimicrobial treatment for patients presenting with bloodstream infections is considered to affect patients' outcome. Method: We conducted a single-center, retrospective study of critically-ill patients hospitalized in the intensive care unit, to examine whether the appropriateness of antimicrobial therapy is associated with mortality from bloodstream infections. The primary study endpoints were the mortality and survival time up to 60 days after the sampling of the blood cultures. Results: We enrolled 62 patients with bloodstream infection, of whom 46 received appropriate and 16 received inappropriate, empirical, antimicrobial therapy. The 60-day mortality of appropriately treated (35%) was significantly lower than that of inappropriately treated (88%) patients (p = .0003), with an adjusted odds ratio of dying = 0.043 (95% confidence interval 0.0047-0.23; p = .0011). Survival time differed significantly between the two groups (p = .0004), with an adjusted hazard ratio = 0.34 (95% confidence interval 0.16-0.70; p = .0043). Conclusion: Appropriate antimicrobial therapy administered to critically-ill patients presenting with bloodstream infections was associated with a lower 60-day mortality than inappropriate therapy. (c) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Maack C, Eschenhagen T, Hamdani N, Heinzel FR, Lyon AR, Manstein DJ, Metzger J, Papp Z, Tocchetti CG, Yilmaz MB, Anker SD, Balligand JL, Bauersachs J, Brutsaert D, Carrier L, Chlopicki S, Cleland JG, de Boer RA, Dietl A, Fischmeister R, Harjola VP, Heymans S, Hilfiker-Kleiner D, Holzmeister J, de Keulenaer G, Limongelli G, Linke WA, Lund LH, Masip J, Metra M, Mueller C, Pieske B, Ponikowski P, Ristic A, Ruschitzka F, Seferovic PM, Skouri H, Zimmermann WH, Mebazaa A. Treatments targeting inotropy. Eur Heart J. 2018 in press Mebazaa A, Combes A, van Diepen S, Hollinger A, Katz JN, Landoni G, Hajjar LA, Lassus J, Lebreton G, Montalescot G, Park JJ, Price S, Sionis A, Yannopolos D, Harjola VP, Levy B, Thiele H. Management of cardiogenic shock complicating myocardial infarction. Intensive Care Med. 2018 in press Léopold V, Gayat E, Pirracchio R, Spinar J, Parenica J, Tarvasmäki T, Lassus J, Harjola VP, Champion S, Zannad F, Valente S, Urban P, Chua HR, Bellomo R, Popovic B, Ouweneel DM, Henriques JPS, Simonis G, Lé vy B, Kimmoun A, Gaudard P, Basir MB, Markota A, Adler C, Reuter H, Mebazaa A, Chouihed T. Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients. Intensive Care Med. 2018;44:847-856
