Application of Chinese Medicine in the Management of Critical Conditions: A Review on Sepsis

Critical care medicine is a medical specialty engaging the diagnosis and treatment of critically ill patients who have or are likely to have life-threatening organ failure. Sepsis, a life-threatening condition that arises when the body responds to infection, is currently the major cause of death in intensive care units (ICU). Although progress has been made in understanding the pathophysiology of sepsis, many drawbacks in sepsis treatment remains unresolved. For example, antimicrobial resistance, controversial of glucocorticoids use, prolonged duration of ICU care and the subsequent high cost of the treatment. Recent years have witnessed a growing trend of applying traditional Chinese medicine (TCM) in sepsis management. The TCM application emphasizes use of herbal formulation to balance immune responses to infection, which include clearing heat and toxin, promoting blood circulation and removing its stasis, enhancing gastrointestinal function, and strengthening body resistance. In this paper, we will provide an overview of the current status of Chinese herbal formulations, single herbs, and isolated compounds, as an add-on therapy to the standard Western treatment in the sepsis management. With the current trajectory of worldwide pandemic eruption of newly identified Coronavirus Disease-2019 (COVID-19), the adjuvant TCM therapy can be used in the ICU to treat critically ill patients infected with the novel coronavirus.

Download Full-text

Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01857-4 ◽

2021 ◽

Author(s):

Răzvan Bologheanu ◽

Mathias Maleczek ◽

Daniel Laxar ◽

Oliver Kimberger

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Specialty ◽

Routine Care ◽

Treatment Pathways ◽

Icu Length Of Stay ◽

Matched Study ◽

The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

Download Full-text

Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

Journal of Fungi ◽

10.3390/jof7050376 ◽

2021 ◽

Vol 7 (5) ◽

pp. 376

Author(s):

Tobias Lahmer ◽

Gonzalo Batres Baires ◽

Roland M. Schmid ◽

Johannes R. Wiessner ◽

Jörg Ulrich ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Ascites Fluid ◽

Candida Spp ◽

Fungal Peritonitis ◽

Penetration Ratio ◽

Threatening Condition ◽

Liquid Chromatography Tandem Mass ◽

Life Threatening ◽

Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

Download Full-text

Characteristics and Outcomes of Critically Ill Patients with COVID-19 Disease in Jordan

10.47363/jsar/2020(1)112 ◽

2020 ◽

pp. 1-3

Author(s):

Hasan Ibrahim Al-Balas ◽

Keyword(s):

Health Care ◽

Mortality Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Tertiary Hospital ◽

Published Data ◽

First Case ◽

Global Health Care ◽

Novel Coronavirus ◽

Overall Mortality

Introduction: Coronavirus disease 2019 (COVID-19) is an emerging global health care threat that is caused by a novel coronavirus named 2019-nCoV (SARS-CoV-2). The first case of diagnosed COVID-19 patient was declared in Jordan in early March 2020. As of June 8, Jordan had confirmed 831 cases, with 9 deaths, with an overall mortality rate of 1.08%. As there is no published data about critically ill patients in Jordan, we aimed to describe the characteristics and outcomes of critically ill COVID-19 patients in a tertiary hospital in Jordan.

Download Full-text

Analysis of drug related electrolyte disturbances in emergency medicine department

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183938 ◽

2018 ◽

Vol 7 (10) ◽

pp. 2005

Author(s):

Karan B. Shah ◽

Sapna D. Gupta ◽

Devang A. Rana ◽

Supriya D. Malhotra ◽

Pankaj R. Patel

Keyword(s):

Emergency Medicine ◽

Critically Ill ◽

Critically Ill Patients ◽

The Body ◽

Electrolyte Balance ◽

Medicine Department ◽

Electrolyte Disturbance ◽

Exact Test ◽

Electrolyte Disturbances ◽

Emergency Medicine Department

Background: Electrolytes play an important role in various physiological functions of the body. Electrolyte disturbances are one of the most common problems encountered in critically ill patients. Drugs are also known to cause adverse electrolyte consequences. These drugs could be anti-hypertensive agents, hormones, antipsychotics or steroids. There is paucity of published literature on electrolyte disturbances caused by drugs. The purpose of our study was to evaluate the electrolyte disturbances caused by various drugs in critically ill patients.Methods: Following approval of the Institutional Ethics Committee, data collection was started. Adverse Drug Reactions (ADRs) presenting as an electrolyte disturbance in emergency medicine department or occurring in hospitalized patients in the Intensive care unit (ICU) of our hospital was be collected. ADRs resulting into electrolyte disturbances were identified and analysed in detail for demographic details, types of electrolyte disturbances, seriousness, severity, causality and preventability of ADRs. Fisher's exact test was done to find out the statistical difference between the electrolyte disturbances and different drugs.Results: Total 58 ADRs were reported as an electrolyte disturbance. Mean age of the patients affected was 52.48 years. Highest number of ADRs were observed in the age group of 61 to 70 years. Hypokalemia constituted 32 cases (55.2%) followed by hyponatremia (25.9%), hyperkalemia (6.9%), hypernatremia (6.9%), hypocalcemia (1.7%), hypomagnesemia (1.7%) and hypophosphatemia (1.7%). Insulin was associated with maximum cases of ADRs (27.6%).Conclusions: Electrolyte disturbances constitutes a major chunk of ADRs especially in critically ill patients. The physicians must be well-versed with the dynamics of fluid-electrolyte balance.

Download Full-text

Pragmatic Disease-Focused Checklist for Use During Rounding on Critically Ill Patients With COVID-19

American Journal of Critical Care ◽

10.4037/ajcc2021697 ◽

2021 ◽

pp. e1-e5

Author(s):

Somnath Bose ◽

Akiva Leibowitz

Keyword(s):

Critically Ill ◽

Family Communication ◽

Critically Ill Patients ◽

Inflammatory Markers ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Ventilation Strategies ◽

Novel Coronavirus ◽

Existing Structure

The sudden surge in cases of novel coronavirus disease 2019 (COVID-19) has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Among the respondents, 82% were in favor of a disease-focused checklist. Mechanical ventilation parameters, rescue ventilation strategies, sedation regimens, inflammatory markers specific to COVID-19, and family communication were the elements most commonly identified as being important for inclusion in such a checklist.

Download Full-text

Spirituality and Surgery

Surgical Palliative Care ◽

10.1093/med/9780190858360.003.0005 ◽

2019 ◽

pp. 43-54

Author(s):

Daniel B. Hinshaw

Keyword(s):

Nineteenth Century ◽

Critically Ill ◽

Spiritual Care ◽

Critically Ill Patients ◽

Basic Skills ◽

Close Connection ◽

Spiritual Needs ◽

Human Suffering ◽

Scientific Medicine ◽

Life Threatening

Increasing evidence has demonstrated the importance of spirituality and spiritual care for patients with life-threatening illnesses. With the growth of scientific medicine from the nineteenth century, a medical dualism has developed with an intense focus on identifying and treating disease almost to the exclusion of caring for the suffering of the person with the disease. This chapter provides surgeons with an understanding of human suffering and its close connection to spirituality, reviews studies highlighting the importance of spirituality and spiritual care to critically ill patients, and outlines some basic skills surgeons can develop to address the spiritual needs of their patients.

Download Full-text