Safety of Transesophageal Echocardiography Performed by Intensivists and Emergency Physicians in Critically Ill Patients With Coagulopathy and Thrombocytopenia: A Single-Center Experience

Introduction: The use of transesophageal echocardiography (TEE) by intensivist physicians (IPs) and emergency physicians (EPs) in critically ill patients is increasing in the intensive care unit, emergency department, and prehospital environments. Coagulopathy and thrombocytopenia are common in critically ill patients. The risk of performing TEE in these patients is unknown. The goal of this study was to assess whether TEE is safe when performed by IPs or EPs in critically ill patients with high bleeding risk (HBR). Methods: All TEEs performed by an IP or EP between January 1, 2016, and July 31, 2019, were reviewed as part of a quality assurance database. A TEE performed on a patient was deemed HBR if the patient met at least one of the following criteria: undergoing therapeutic anticoagulation, had an INR > 2, activated partial thromboplastin time >40 seconds, fibrinogen <150 mg/dL, and/or platelet count <50 000/μL. The medical record was reviewed on each patient to determine whether upper esophageal bleeding, oropharyngeal bleeding, esophageal perforation, or dislodgement of an artificial airway occurred during or after the TEE. Results: A total of 228 examinations were reviewed: 80 in the high-risk group and 148 in the low-risk group (LBR). There were complications potentially attributable to TEE in 8 (4%) of the 228 exams. Total complications were not different between groups: 4 (5%) in the HBR group versus 4 (3%) in the LBR group (odds ratio [OR] = 1.89 [0.34-10.44], P =.368). Upper esophageal bleeding occurred in 5 total examinations (2%), which was not different between groups: 3 (4%) in the HBR group and 2 (1%) in the LBR group (OR = 2.84 [0.31-34.55], P = .238). There were no deaths attributable to TEE in either group. Conclusion: Transesophageal echocardiography can be safely performed by IPs and EPs in critically ill patients at high risk of bleeding with minimal complications.

Download Full-text

Transesophageal Echocardiography Performed by Intensivist and Emergency Physicians—A 5-Year, Single-Center Experience

Journal of Intensive Care Medicine ◽

10.1177/08850666211042522 ◽

2021 ◽

pp. 088506662110425

Author(s):

Trenton C. Wray ◽

Molly Johnson ◽

Shelby Cluff ◽

Fiona T. Nguyen ◽

Isaac Tawil ◽

...

Keyword(s):

Critical Care ◽

Transesophageal Echocardiography ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Chart Review ◽

The United States ◽

Left Ventricular ◽

Emergency Physicians ◽

Single Center ◽

Common Diagnosis

Purpose: Data on the use of transesophageal echocardiography (TEE) by intensivist physicians (IP) and emergency physicians (EP) are limited. This study aims to characterize the use of TEE by IPs and EPs in critically ill patients at a single center in the United States. Materials and Methods: Retrospective chart review of all critical care TEEs performed from January 1, 2016 to January 31, 2021. The personnel performing the exams, location of the exams, characteristics of exams, complications, and outcome of the patients were reviewed. Results: A total of 396 examinations was reviewed. TEE was performed by IPs (92%) and EPs (9%). The location of TEE included: intensive care unit (87%), emergency department (11%), and prehospital (2%) settings. The most common indications for TEE were: hemodynamic instability/shock (44%), cardiac arrest (23%), and extracorporeal membrane oxygenation (ECMO) facilitation, adjustment, or weaning (21%). The most common diagnosis based on TEE were: normal TEE (25%), left ventricular dysfunction (19%), and vasodilatory shock (15%). A management change resulted from 89% of exams performed. Complications occurred in 2% of critical care TEEs. Conclusion: TEE can be successfully performed by IPs and EPs on critically ill patients in multiple clinical settings. TEE frequently informed management changes with few complications.

Download Full-text

Clinical Performance Status and Technical Factors Affecting Outcomes from Percutaneous Transhepatic Biliary Interventions; A Multicentre, Prospective, Observational Cohort Study

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02888-0 ◽

2021 ◽

Author(s):

Gregory C. Makris ◽

Andrew C. Macdonald ◽

Kader Allouni ◽

Hannah Corrigall ◽

Charles R. Tapping ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Risk Group ◽

Performance Status ◽

Group Versus ◽

High Risk Group ◽

Low Risk ◽

Karnofsky Score ◽

The Uk ◽

Biliary Interventions

Abstract Purpose The purpose of this study was to evaluate the predictive value of a ‘Modified Karnofsky Scoring System’ on outcomes and provide real-world data regarding the UK practice of biliary interventions. Materials and Methods A prospective multi-centred cohort study was performed. The pre-procedure modified Karnofsky score, the incidence of sepsis, complications, biochemical improvement and mortality were recorded out to 30 days post procedure. Results A total of 292 patients (248 with malignant lesions) were suitable for inclusion in the study. The overall 7 and 30 day mortality was 3.1% and 16.1%, respectively. The 30 day sepsis rate was 10.3%. In the modified Karnofsky ‘high risk’ group the 7 day mortality was 9.7% versus 0% for the ‘low risk’ group (p = 0.002), whereas the 30 day mortality was 28.8% versus 13.3% (p = 0.003). The incidence of sepsis at 30 days was 19% in the high risk group versus 3.3% at the low risk group (p = 0.001) Conclusion Percutaneous biliary interventions in the UK are safe and effective. Scoring systems such as the Karnofsky or the modified Karnofsky score hold promise in allowing us to identify high risk groups that will need more careful consideration and enhanced patient informed consent but further research with larger studies is warranted in order to identify their true impact on patient selection and outcomes post biliary interventions.

Download Full-text

Clinical and histopathological correlation: A study on 334 eyes with retinoblastoma from Vietnam

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i1.342 ◽

2016 ◽

Vol 16 (1) ◽

pp. 23-34

Author(s):

Ha Ngan Nguyen ◽

Van Trong Pham ◽

Tuan Anh Hoang ◽

Van Hong Pham ◽

Chung Ngoc Nguyen ◽

...

Keyword(s):

Optic Nerve ◽

High Risk ◽

Clinical Features ◽

Risk Group ◽

Clinical Signs ◽

Group Versus ◽

High Risk Group ◽

Iris Neovascularization ◽

Nerve Invasion ◽

Vitreous Seeding

Purpose: To elucidate the clinical features which predict high-risk histopathological factors for subsequent metastatic disease as well as to report the incidence of these high-risk histopathological factors in a cohort of Asian patients with retinoblastoma. Design: A retrospective and non-randomized sequential cases series. Methods: A retrospective study was done on 334 eyes with retinoblastoma at Vietnam National Institute of Ophthalmology during a 10 year period (January 2004 – December 2013). All pathology specimens and medical records were reviewed and assessed for invasion and clinical signs. Results: Among 334 eyes, 225 (67.4%) had high-risk retinoblastoma and 109 (22.6%) had non-high-risk features on histopathology. The high-risk histopathological features included anterior chamber seeding (48.2%), iris infiltration (14.7%), ciliary body involvement (14.1%), massive choroidal invasion (29.9 %), post-laminar optic nerve invasion (21.2%), invasion of optic nerve transection (9.6 %), combined choroidal and optic nerve invasion (9.6 %), scleral invasion (3.3%), and extra-scleral infiltration (11.4%). The significant clinical features in high-risk group versus non-high-risk group included hyphema (19.6% vs 3.7%, p < 0.001), pseudohypopyon (19.1% vs 6.4%, p = 0.001), iris neovascularization (25.3% vs 5.5%, p < 0.001), vitreous seeding (72.4% vs 37.6%, p < 0.001), staphyloma (24% vs 4.6%, p < 0.001) and scleritis (20% vs 3.7%, p < 0.001). Conclusions: Clinical signs including hyphema, pseudohypopyon, iris neovascularization, vitreous seeding, staphyloma, and scleritis were significantly associated with high-risk features on histopathology. Globe preserving methods should be used with caution in patients with these signs.

Download Full-text

Apache II scoring in predicting surgical outcome in patients of perforation peritonitis

International Surgery Journal ◽

10.18203/2349-2902.isj20172790 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2321 ◽

Cited By ~ 2

Author(s):

Anand Agarwal ◽

Ganpat Singh Choudhary ◽

Mansingh Bairwa ◽

Amit Choudhary

Keyword(s):

High Risk ◽

Critically Ill ◽

Critically Ill Patients ◽

Surgical Outcome ◽

Risk Group ◽

Low Risk ◽

Apache Ii ◽

Apache Score ◽

Medium Risk ◽

Perforation Peritonitis

Background: Many scoring systems have been found useful in predicting the outcome in critically ill patients, amongst them acute physiology and chronic health evaluation score (APACHE II) appeared to be the most widely used and had a general acceptance in assessing the critically ill patients, for its easy applicability and ability to predict outcome.Methods: To predict the surgical outcome in patients of perforation peritonitis APACHE II scoring done in every diagnosed case of perforation peritonitis in a prospective study from January 2015 to June 2016 was done. 100 patients with perforation peritonitis fulfilling the inclusion and exclusion criterion underwent exploratory laparotomy in Mahatma Gandhi hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.Results: In current study, 69 patients were in the low risk group (apache score 0-5) and 24 patients were in the medium risk group (Apache score 6-10) and 7 patients were in the high-risk group (Apache score 11-16). Of these 100 % patients in low risk group and 95.8% patients in medium risk group were discharged in satisfactory manner and 100% patients expired in high risk group.Conclusions: APACHE II score correlated well with the outcome in current study, it also correlated well with the hospital and ICU stay.

Download Full-text

A Novel Nine-Gene Signature Associated With Immune Infiltration for Predicting Prognosis in Hepatocellular Carcinoma

Frontiers in Genetics ◽

10.3389/fgene.2021.730732 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rongqiang Liu ◽

ZeKun Jiang ◽

Weihao Kong ◽

Shiyang Zheng ◽

Tianxing Dai ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

High Risk ◽

Liver Cancer ◽

Prognostic Value ◽

Risk Group ◽

Prognostic Significance ◽

Group Versus ◽

Gene Signature ◽

High Risk Group ◽

Data Sets

Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide, and its prognosis remains unsatisfactory. The identification of new and effective markers is helpful for better predicting the prognosis of patients with HCC and for conducting individualized management. The oncogene Aurora kinase A (AURKA) is involved in a variety of tumors; however, its role in liver cancer is poorly understood. The aim of this study was to establish AURKA-related gene signatures for predicting the prognosis of patients with HCC.Methods: We first analyzed the expression of AURKA in liver cancer and its prognostic significance in different data sets. Subsequently, we selected genes with prognostic value related to AURKA and constructed a gene signature based on them. The predictive ability of the gene signature was tested using the HCC cohort development and verification data sets. A nomogram was constructed by integrating the risk score and clinicopathological characteristics. Finally, the influence of the gene signature on the immune microenvironment in HCC was comprehensively analyzed.Results: We found that AURKA was highly expressed in HCC, and it exhibited prognostic value. We selected eight AURKA-related genes with prognostic value through the protein-protein interaction network and successfully constructed a gene signature. The nine-gene signature could effectively stratify the risk of patients with HCC and demonstrated a good ability in predicting survival. The nomogram showed good discrimination and consistency of risk scores. In addition, the high-risk group showed a higher percentage of immune cell infiltration (i.e., macrophages, myeloid dendritic cells, neutrophils, and CD4+T cells). Moreover, the immune checkpoints SIGLEC15, TIGIT, CD274, HAVCR2, and PDCD1LG2 were also higher in the high-risk group versus the low-risk group.Conclusions: This gene signature may be useful prognostic markers and therapeutic targets in patients with HCC.

Download Full-text

Acromegaly and Obstructive Sleep Apnea: Identifying the High-Risk Group

10.1055/s-0039-1679596 ◽

2019 ◽

Author(s):

Xiaojun Zhan ◽

Chandala Chitguppi ◽

Ethan Berman ◽

Gurston Nyquist ◽

Tomas Garzon-Muvdi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Obstructive Sleep

Download Full-text

Recommendations from male students help shape mental health support for this high-risk group

10.3310/alert_42077 ◽

2020 ◽

Keyword(s):

Mental Health ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Male Students ◽

Mental Health Support ◽

Health Support

Download Full-text

Anamnestic factors that shape reproductive health of women with repeated unsuccessful popygamy in vitro fertilization

HEALTH OF WOMAN ◽

10.15574/hw.2016.114.140 ◽

2016 ◽

pp. 140-143

Author(s):

N.V. Cotsabin ◽

◽

O.M. Makarchuk ◽

Keyword(s):

High Risk ◽

Risk Group ◽

Polycystic Ovary ◽

High Risk Group ◽

Stress Factors ◽

Control Group ◽

Fertilization In Vitro ◽

Infertile Women ◽

Group I

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p <0.05), secondary infertility - mostly in the second and third experimental groups (p <0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p <0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p<0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

Download Full-text