A Comparison of Cardiologist and Intensivist Clinical Assessment in Determining Type 1 Versus Type 2 Myocardial Infarction in a Critical Care Setting

Euglycaemic ketoacidosis is a rare endocrine emergency, which can have disastrous consequences if left undiagnosed. We present the case of a 57 year old man with type 2 diabetes who developed ketoacidosis (DKA) following a myocardial infarction, despite being normoglycaemic, following discontinuation of his insulin infusion in an intensive care setting. The case highlights the importance of capillary ketone body testing in this scenario as well as the dangers of an over reliance on blood glucose values in the diagnosis of ketoacidosis. The notion that DKA can occur in both type 1 and type 2 diabetes is reaffirmed and the value of adequate insulin therapy in euglycaemic ketoacidosis is emphasized.

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Clinical assessment and measurement of oxygen transport in the critical care setting

Transfusion Science ◽

10.1016/s0955-3886(97)00042-8 ◽

1997 ◽

Vol 18 (3) ◽

pp. 437-445

Author(s):

Dorothy Breen ◽

David Bihari

Keyword(s):

Critical Care ◽

Oxygen Transport ◽

Clinical Assessment ◽

Care Setting ◽

Critical Care Setting

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Lessons learnt from the use of CPAP for patients with type 1 respiratory failure due to COVID-19 pneumonia in a district general hospital outside a critical care setting

Clinical Medicine ◽

10.7861/clinmed.21-2-s19 ◽

2021 ◽

Vol 21 (Suppl 2) ◽

pp. 19-20

Author(s):

James Talbot ◽

Yogini Raste ◽

Anitha Vijayasingam ◽

Stuart Breck

Keyword(s):

Critical Care ◽

Respiratory Failure ◽

General Hospital ◽

Care Setting ◽

District General Hospital ◽

Critical Care Setting ◽

Lessons Learnt

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Type 2 diabetes and COVID-19 related mortality in the critical care setting: A national cohort study in England, March-July 2020

10.2337/figshare.13034210 ◽

2020 ◽

Author(s):

John M. Dennis ◽

Bilal A Mateen ◽

Raphael Sonabend ◽

Nicholas J Thomas ◽

Kashyap A Patel ◽

...

Keyword(s):

Type 2 Diabetes ◽

Critical Care ◽

Cohort Study ◽

Care Setting ◽

Critical Care Setting ◽

Risk Of Death ◽

Risk Increase ◽

Increased Risk ◽

All Cause Mortality

Objective: To describe the relationship between type 2 diabetes and all-cause mortality amongst adults with COVID-19 in the critical care setting. Research Design and Methods: Nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and July 27, 2020. Cox proportional hazards models were used to estimate 30 day in-hospital all-cause mortality associated with type 2 diabetes, adjusted for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease). Results: 19,256 COVID-19 related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70), and 5,447 ICU admissions (mean age 58). 3,524 (18.3%) had type 2 diabetes. 5,077 people (26.4%) died during the study period. People with type 2 diabetes were at increased risk of death (adjusted hazard ratio (aHR) 1.23 [95%CI 1.14;1.32]), results were consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with increasing age (age 18-49 aHR 1.50 [95%CI 1.05;2.15]; age 50-64 1.29 [1.10;1.51]; age 65 or greater 1.18 [1.09;1.29], p-value for age:type 2 diabetes interaction 0.002). Conclusions: Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people.

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Miscellaneous

Oxford Textbook of Advanced Critical Care Echocardiography ◽

10.1093/med/9780198749288.003.0017 ◽

2020 ◽

pp. 255-262

Author(s):

Anthony McLean

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Critical Care ◽

Care Setting ◽

Transoesophageal Echocardiography ◽

Critical Care Setting ◽

Thoracic Cavity ◽

Transthoracic Echocardiogram ◽

Life Threatening ◽

Bedside Diagnosis

Although not commonly encountered in daily clinical practice, with the exception of atheromatous disease in the older population, disorders of the thoracic aorta often present dramatically and require urgent evaluation. Echocardiography is ideally suited for this purpose, particularly in the critical care setting where both transthoracic echocardiogram (TTE) and transoesophageal echocardiography (TOE) can play important roles in the bedside diagnosis and management of afflicted patients. An understanding of the anatomical relationships of the aorta within the thoracic cavity is important, in addition to specific pertinent findings within each of the different pathologies. The physician should be on the alert for complications following acute myocardial infarction and echocardiography is central to the majority of diagnoses. A baseline echo for all critically ill patients who have suffered an infarction is recommended. Constrictive pericarditis, when encountered is usually unexpected, and can be life-threatening if not diagnosed quickly in the critical care setting. As such, the physician needs to know certain echocardiographic features that assist in the diagnosis.

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High sensitivity troponin measurement in critical care: Flattering to deceive or ‘never means nothing’?

Journal of the Intensive Care Society ◽

10.1177/1751143719870095 ◽

2019 ◽

Vol 21 (3) ◽

pp. 232-240 ◽

Cited By ~ 3

Author(s):

Jonathan Hinton ◽

Mark Mariathas ◽

Michael PW Grocott ◽

Nick Curzen

Keyword(s):

Myocardial Infarction ◽

Critical Care ◽

Intensive Care ◽

High Sensitivity ◽

Acute Type ◽

Ongoing Research ◽

Troponin Elevation

Introduction Troponin elevation is central to the diagnosis of acute type 1 myocardial infarction. It is, however, elevated in a range of other conditions, including type 2 myocardial infarction, and this setting is increasingly associated with adverse clinical outcomes. Patients within intensive care frequently have at least one organ failure together with a range of co-morbidities. Interpretation of troponin assay results in this population is challenging. This clinical uncertainty is compounded by the introduction of ever more sensitive troponin assays. Areas covered The aims of this review are to (a) describe the currently available literature about the use of troponin assays in intensive care, (b) analyse the challenges presented by the introduction of increasingly sensitive troponin assays and (c) assess whether the role of troponin assays in intensive care may change in the future, dependent upon recent and ongoing research suggesting that they are predictive of outcome regardless of the underlying cause: the ‘never means nothing’ hypothesis.

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Type 2 diabetes and COVID-19 related mortality in the critical care setting: A national cohort study in England, March-July 2020

10.2337/figshare.13034210.v1 ◽

2020 ◽

Author(s):

John M. Dennis ◽

Bilal A Mateen ◽

Raphael Sonabend ◽

Nicholas J Thomas ◽

Kashyap A Patel ◽

...

Keyword(s):

Type 2 Diabetes ◽

Critical Care ◽

Cohort Study ◽

Care Setting ◽

Critical Care Setting ◽

Risk Of Death ◽

Risk Increase ◽

Increased Risk ◽

All Cause Mortality

Objective: To describe the relationship between type 2 diabetes and all-cause mortality amongst adults with COVID-19 in the critical care setting. Research Design and Methods: Nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and July 27, 2020. Cox proportional hazards models were used to estimate 30 day in-hospital all-cause mortality associated with type 2 diabetes, adjusted for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease). Results: 19,256 COVID-19 related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70), and 5,447 ICU admissions (mean age 58). 3,524 (18.3%) had type 2 diabetes. 5,077 people (26.4%) died during the study period. People with type 2 diabetes were at increased risk of death (adjusted hazard ratio (aHR) 1.23 [95%CI 1.14;1.32]), results were consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with increasing age (age 18-49 aHR 1.50 [95%CI 1.05;2.15]; age 50-64 1.29 [1.10;1.51]; age 65 or greater 1.18 [1.09;1.29], p-value for age:type 2 diabetes interaction 0.002). Conclusions: Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people.

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