scholarly journals Perioperative metabolic acidosis: The Bradford Anaesthetic Department Acidosis Study

2018 ◽  
Vol 20 (1) ◽  
pp. 11-17 ◽  
Author(s):  
TO Lawton ◽  
A Quinn ◽  
SJ Fletcher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Early Phase ◽  
Time Course ◽  
Late Phase ◽  
Common Finding ◽  
Major Surgery ◽  
Arterial Blood ◽  
Early Fluid

Metabolic acidosis is considered deleterious but is common in post-surgical patients admitted to intensive care unit. We evaluated the prevalence and time course of metabolic acidosis in elective major surgery, and generated hypotheses about causes, by hourly arterial blood sampling in 92 patients. Metabolic acidosis began before incision and most had occurred by the next hour. Seventy-eight per cent of patients had a significant metabolic acidosis post-operatively. Two overlapping phases were observed. The early phase started before incision, characterised by a rising chloride and falling anion gap, unrelated to saline use. The late phase was partly associated with lactate, related to surgery type, and early fluids appeared protective. There was a trend towards longer intensive care unit (+1.3 days) and hospital (+3.2 days) stay with metabolic acidosis. This is the first large study of the evolution of this common finding, demonstrating a pre-incision component. The early phase appears unavoidable or unpredictable, but the late phase might be modified by early fluid administration. It remains unclear whether acidosis of this type should be avoided.

scholarly journals Eucalyptus oil poisoning: two case reports

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Abraham M. Ittyachen ◽  
Georgie Rajan George ◽  
Meera Radhakrishnan ◽  
Yetin Joy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Supportive Care ◽  
Emergency Room ◽  
Case Reports ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Eucalyptus Oil ◽  
Arterial Blood

Abstract Background Eucalyptus oil poisoning is rare in adults but is not that uncommon in children. The common side effects in children include depression in the level of consciousness, ataxia, seizures, and vomiting. Unlike in children, seizures are unusual in adult patients with eucalyptus oil poisoning. We report the cases of two patients with eucalyptus oil poisoning, both adults who unintentionally took eucalyptus oil and presented to the emergency room of our institution with seizures. Case presentation Two adult Indian men who unintentionally consumed eucalyptus oil presented to the emergency room of our institution with seizures. In both patients, arterial blood gas analysis showed the presence of severe metabolic acidosis. Both the patients were managed in the intensive care unit and received standard supportive care. Metabolic acidosis was corrected with intravenous bicarbonate infusion. They were successfully discharged on the fourth day. Conclusions All physicians should be aware of the toxic effects of eucalyptus oil, which is used often in daily life in India. Supportive care in an intensive care unit, including rapid correction of metabolic acidosis and adequate maintenance of hemodynamic parameters, will lead to a rapid recovery. Warning labels should be made mandatory on all products that contain eucalyptus oil.

scholarly journals Thrombocytopenia in the intensive care unit

2018 ◽  
Vol 35 (1) ◽  
Author(s):  
Zohreh Ostadi ◽  
Kamran Shadvar ◽  
Sarvin Sanaie ◽  
Ata Mahmoodpoor ◽  
Seied Hadi Saghaleini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Time Course ◽  
The Body ◽  
Major Surgery ◽  
Icu Patients ◽  
Creative Commons ◽  
Minor Surgery ◽  
Open Access Article

Thrombocytopenia is a frequent finding in intensive care unit especially among adults and medical ICU patients.Thrombocytopenia is defined as a platelet count less than 100×109/l in ICU setting. Platelets are made in the bone marrow from megakaryocytes. Although not fully understood, proplatelets transform into platelets in the lung. The body tries to maintain platelet count relatively constant throughout life. Pathophysiology of thrombocytopenia can be defined by hemodilution, elevated levels of platelet consumption, compromise of platelet production, increased platelet sequestration and increased platelet destruction. Unlike in other situations, absolute platelet count alone does not provide sufficient data in characterizing thrombocytopenia in ICU patients. In such cases, the time course of changes in platelet count is also pivotal. The dynamics of platelet count decrease vary considerably between different ICU patient populations including trauma, major surgery and minor surgery/medical conditions.There are strong evidences available that delay in platelet count restoration in ICU patients is an indicator of a bad outcome. How to cite this:Ostadi Z, Shadvar K, Sanaie S, Mahmoodpoor A, Saghaleini SH. Thrombocytopenia in the intensive care unit. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.19 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Surgical intensive care unit (ICU) delirium: A “psychosomatic” problem?

2010 ◽  
Vol 8 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Michel Reich ◽  
Regis Rohn ◽  
Daniele Lefevre
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Psychological Factors ◽  
Death Anxiety ◽  
Defense Mechanism ◽  
Cognitive Disorders ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Delirium

AbstractObjective:Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.Method:To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.Results:With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.Significance of results:ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.

scholarly journals Intensive Care Unit Acquired Hypernatremia after Major Surgery is Associated with Urine Concentrating Defect: An Observational Study

2020 ◽  
Author(s):  
Philipp Deetjen ◽  
Ulrich Jaschinski ◽  
Axel Heller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Water Balance ◽  
Water Conservation ◽  
Sodium Excretion ◽  
Free Water ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Water Excretion

Abstract Background: Although intensive care acquired hypernatremia is a common event, limited knowledge exists about the pathogenesis of this disorder. The present study attempts to show that patients undergoing major surgery develop hypernatremia in the presence of both high salt and volume load and concentration disorder of the kidney with insufficient sodium excretion.Methods: In a retrospective study, all patients who were admitted to a 40-bed tertiary surgical intensive care unit of a university hospital from July 2019 to December 2019 with major surgery were examined. Hypernatremia was defined as a sodium value exceeding 145 mmol/l. In addition to the analysis of all patients, complete water and salt balances were performed in a smaller subgroup with 142 patients.Results: 23.9% of patients undergoing major surgery developed hypernatremia, whereby hypernatremia was associated with increased mortality. Patients with hypernatremia showed a renal concentration defect with decreased urine sodium concentration (65 (IQR: 44.8-90) mmol/l vs 78 (IQR: 46-107) mmol/l, p = 0.007) and decreased urine osmolality (514 (IQR: 465-605) mmol/l vs 602 (IQR: 467-740) mmol/l, p < 0.001). In the subgroup of patients with complete sodium and water balance, a positive salt and water balance was observed. After propensity score matching, we found a significantly increased electrolyte free water clearance (1020 ±1740 ml vs -560 ±1620 ml, p <0.001) in the hypernatremia group, together with an inadequately lower total sodium urine excretion (401 ±303 mmol vs 593 ±400 mmol, p = 0.02). Conclusion: The present study shows that postoperative hypernatremia is associated with an imbalance between perioperative salt and water load and renal sodium and water handling with inadequately low renal sodium excretion and inadequately high renal water excretion. The underlying renal concentration disorder may be explained by a defect in a natriuretic-ureotelic response a recently described renal urea-mediated water conservation mechanism after salt exposure.

scholarly journals Sepsis Criteria and Revision in Toxicological Intensive Care Unit

2020 ◽  
Vol 10 (4) ◽  
pp. 31452.1-31452.10
Author(s):  
Haleh Talaie ◽  
◽  
Maryam Nazari ◽  
Habib Emami ◽  
◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Coagulase Negative Staphylococci ◽  
International Consensus ◽  
Suspected Sepsis ◽  
Cross Sectional ◽  
Arterial Blood ◽  
Study Results

Background: Sepsis is one of the significant causes of mortality in hospitalized patients. This cross-sectional study was performed to determine the frequency of positive blood culture and assess sepsis criteria based on Third International Consensus Definitions (related to Sequential Organ Failure Assessment score) and clinical and paraclinical findings (i.e., on-admission leukocytosis, increased lactate level, and fever) in poisoned patients admitted to the Toxicological Intensive Care Unit (TICU). Methods: Medical records of a total of 2000 poisoned patients admitted to the TICU of Loghman Hakim Hospital from 2016 to 2018 were assessed. Among them, 189 cases (9.45%) with suspected sepsis were considered eligible to be enrolled in the study. Results: Of 189 cases, 146 (77.24%) had possible signs and symptoms of sepsis as well as SOFA score higher than two with positive blood culture in 81 cases (55%). The Mean±SD serum level of lactate was 25.97±16.32 on admission. The most common pathogen detected in blood culture was coagulase-negative Staphylococci in 35 (24.0%) out of 146 cases. Glasgow Coma Scale (GCS) less than 12, age older than 50 years, and bilirubin more than 1.2 mg/dL were found as independent predictors of sepsis on multivariate analysis. Conclusion: Based on our findings, it is proposed that the sepsis definition should not be restricted to the guidelines. The patients’ poisoning background and presence of many confounding factors, including poisoning-induced on-admission increased lactate levels, leukocytosis, and disturbed arterial blood gas provide a critical decision-making situation to confirm sepsis according to guidelines.

scholarly journals Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

2020 ◽  
Author(s):  
Lukasz Krzych ◽  
Olga Wojnarowicz ◽  
Paweł Ignacy ◽  
Julia Dorniak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

Feasıbılıty of Transcutaneous Method for Carbon Dıoxıde Monıtorıng in an Intensive Care Unıt

2022 ◽  
Vol 18 ◽  
Author(s):  
Nazlıhan Boyacı ◽  
Sariyya Mammadova ◽  
Nurgül Naurizbay ◽  
Merve Güleryüz ◽  
Kamil İnci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Partial Pressure ◽  
Blood Gas ◽  
Peripheral Oxygen Saturation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Randomized Controlled Studies ◽  
Significant Difference

Background: Transcutaneous partial pressure of carbon dioxide (PtCO2) monitorization provides a continuous and non-invasive measurement of partial pressure of carbon dioxide (pCO2). In addition, peripheral oxygen saturation (SpO2) can also be measured and followed by this method. However, data regarding the correlation between PtCO2 and arterial pCO2 (PaCO2) measurements acquired from peripheric arterial blood gas is controversial. Objective: We aimed to determine the reliability of PtCO2 with PaCO2 based on its advantages, like non-invasiveness and continuous applicability. Methods: Thirty-five adult patients with hypercapnic respiratory failure admitted to our tertiary medical intensive care unit (ICU) were included. Then we compared PtCO2 and PaCO2 and both SpO2 measurements simultaneously. Thirty measurements from the deltoid zone and 26 measurements from the cheek zone were applied. Results: PtCO2 could not be measured from the deltoid region in 5 (14%) patients. SpO2 and pulse rate could not be detected at 8 (26.7%) of the deltoid zone measurements. Correlation coefficients between PtCO2 and PaCO2 from deltoid and the cheek region were r: 0,915 and r: 0,946 (p = 0,0001). In comparison with the Bland-Altman test, difference in deltoid measurements was -1,38 ± 1,18 mmHg (p = 0.252) and in cheek measurements it was -5,12 ± 0,92 mmHg (p = 0,0001). There was no statistically significant difference between SpO2 measurements in each region. Conclusion: Our results suggest that PtCO2 and SpO2 measurements from the deltoid region are reliable compared to the arterial blood gas analysis in hypercapnic ICU patients. More randomized controlled studies investigating the effects of different measurement areas, hemodynamic parameters, and hemoglobin levels are needed.

Chronic Obstructive Pulmonary Disease and Respiratory Acidosis in the Intensive Care Unit

2019 ◽  
Vol 15 (2) ◽  
pp. 79-89 ◽  
Author(s):  
Yamely Mendez ◽  
Francisco E. Ochoa-Martinez ◽  
Tatiana Ambrosii
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Skills ◽  
Laboratory Data ◽  
Chronic Obstructive Lung Disease ◽  
Respiratory Acidosis ◽  
Blood Gases ◽  
Hospital Length ◽  
Chronic Obstructive ◽  
Arterial Blood

Chronic obstructive lung disease is a common and preventable disease. One of its pathophysiological consequences is the presence of carbon dioxide retention due to hypoventilation and ventilation/perfusion mismatch, which in consequence will cause a decrease in the acid/base status of the patient. Whenever a patient develops an acute exacerbation, acute respiratory hypercapnic failure will appear and the necessity of a hospital ward is a must. However, current guidelines exist to better identify these patients and make an accurate diagnosis by using clinical skills and laboratory data such as arterial blood gases. Once the patient is identified, rapid treatment will help to diminish the hospital length and the avoidance of intensive care unit. On the other hand, if there is the existence of comorbidities such as cardiac failure, gastroesophageal reflux disease, pulmonary embolism or depression, it is likely that the patient will be admitted to the intensive care unit with the requirement of intubation and mechanical ventilation.

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