The Use of Eosinophil Count in Predicting the Need of Coronavirus Disease 2019 Patient for Treatment in Intensive Care Unit

BACKGROUND: Identification of coronavirus disease 2019 (COVID-19) patients who have the potential to become critical cases at an early stage and providing aggressive therapy can reduce the mortality rate. AIM: This study aims to determine the diagnostic value and differences of eosinophil counts in patients with COVID-19 who require treatment in intensive care unit (ICU) and non-ICU. METHOD: The prospective study was conducted on 382 patients with confirmed COVID-19 who were hospitalized from May to September 2020. Samples were obtained through consecutive sampling techniques. Mann–Whitney analysis was used to determine the difference of eosinophil counts in COVID-19 patients who require treatment in ICU and non-ICU. Receiver operating curve analysis was used to determine the diagnostic value of eosinophil count to predict the need of COVID-19 patients for treatment in ICU. RESULTS: There is a significant difference in the absolute and percentage eosinophil count in COVID-19 patients who need treatment in ICU and non-ICU. The area under the curve of absolute and percentage eosinophil count to predict the need of COVID-19 patients for treatment in ICU is 0.659 and 0.738, respectively. The best cutoff value, sensitivity and specificity of absolute and percentage eosinophil count is <0.025 × 103 μL and <0.25%; 77.7% and 78.3%; and 50.0% and 57.1%, respectively. CONCLUSIONS: The eosinophil count can be used as a biomarker to predict the need of COVID-19 patients for treatment in ICU.

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Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

BioMed Research International ◽

10.1155/2020/7082597 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Li Wang ◽

Tiejun Zhang ◽

Lili Huang ◽

Wei Peng

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Maxillofacial Surgery ◽

Pain Scale ◽

Oral And Maxillofacial Surgery ◽

Midazolam Group ◽

Significant Difference ◽

Behavioral Pain Scale ◽

Random Number Table ◽

The Difference

The aim of the investigation is to clarify the beneficial sedative effects for patients with postoperative intubation in the intensive care unit (ICU) after oral and maxillofacial surgery. Forty patients with postoperative intubation were divided into two groups in method of random number table: midazolam group and dexmedetomidine group. The Ramsay score, the behavioral pain scale (BPS) score, SpO2, HR, MAP, and RR were recorded before sedation (T0), 30 minutes (T1), 1 hour (T2), 2 hours (T3), 6 hours (T4), and 12 hours (T5) after dexmedetomidine or midazolam initiation in intensive care unit, and 10 minutes after extubation (T6). The rate of incidences of side effects was calculated. Sedation with midazolam was as good as standard sedation with dexmedetomidine in maintaining target sedation level. The BPS score in the midazolam group was higher than that in the dexmedetomidine group. The time of tracheal catheter extraction in the dexmedetomidine group was shorter than that in the midazolam group (p≤0.001). The incidence of bradycardia in the dexmedetomidine group was higher than that in the midazolam group (p=0.028). There was no statistically significant difference in the incidence of hypotension between the two groups (p=0.732). The incidence of respiratory depression of group midazolam was higher than that of group dexmedetomidine (p=0.018). The incidence of delirium in the dexmedetomidine group was significantly lower than that in the midazolam group, and the difference was statistically significant (p=0.003). Dexmedetomidine and midazolam can meet the needs for sedation in ICU patients. And dexmedetomidine can improve patients’ ability to communicate pain compared with midazolam.

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A retrospective examination of the effects of regional anesthesia methods applied for postoperative pain control on analgesic consumption after lower extremity surgery

Medical Science and Discovery ◽

10.36472/msd.v7i10.424 ◽

2020 ◽

Vol 7 (10) ◽

pp. 659-662

Author(s):

Mehmet Kenan Erol

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Postoperative Pain ◽

Lower Extremity ◽

Peripheral Nerve ◽

Regional Anesthesia ◽

Intensive Care Stay ◽

Significant Difference ◽

The Difference ◽

Group 1

Objective: If preferable, the regional anesthesia is a more preferred method than general anesthesia. The preference for regional anesthesia increases as postoperative recovery is quicker, hospitalization is less and hospital costs are low. Material and methods: We retrospectively evaluated the hemodynamic findings, postoperative pain, hospital, and intensive care stay in patients aged 18-80 who underwent lower extremity surgery with regional anesthesia in the last 1 year. We divided the cases into 3 groups; Group 1 (n =114) patients with a peripheral nerve block, Group 2 (n =104) spinal anesthesia, and Group 3 (n =81) epidural anesthesia. Results: The difference between group 1 and 2, age hospitalization, and time of stay in intensive care was statistically significant. (P=0.021) (P=0.000). The difference between group 1 and 3 Intensive care unit stay was statistically significant (P = 0.003). The difference between the length of stay in the intensive care unit between groups 2 and 3 was found as statistically significant (P = 0.000). There was no significant difference in terms of hospital stay. Group 1 was found to have the shortest duration of intensive care stay. Conclusion: In lower extremity surgeries, peripheral nerve blocks may have provided more hemodynamic stability and longer analgesic effect compared to central blocks.

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PROGNOSTIC VALUE OF PRO-ADM BIOMARKER IN PATIENTS WITH COVID-19.

Working Paper of Public Health ◽

10.4081/wpph.2021.9312 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Nashua Daidone ◽

Tiziana Callegari ◽

Elia Ranzato

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Value ◽

Early Stage ◽

Plasma Concentrations ◽

Risk Of Mortality ◽

Single Center Study ◽

Significant Difference ◽

Short Term Mortality ◽

Automated Instrument

This study was performed at the analytical laboratory of the Hospital SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (AL) in the period March-June 2020. This is an observational, prospective, single-center study carried out on a cohort of patients diagnosed with ARDS secondary to SARS-CoV2 infection admitted in the first wave of the pandemic at the Sub-Intensive Care Unit of the Hospital of Alessandria. OBJECTIVE The aim of this study was to assess plasma concentrations of the regional mean proadrenomedullin biomarker (MR-proADM) at the time of patient access to the Emergency Department and subsequently 1, 3 and 5 days after admission, to verify its prognostic value in terms of short-term mortality. The second objective of the study was to compare this biomarker with other commonly used biomarkers such as PCR and Procalcitonin, to evaluate the effectiveness of MR-proADM in risk stratification in these patients. METHODOLOGY Samples used in this study were collected in a tube containing the anticoagulant EDTA, and measurements were performed using a fully automated instrument: the Kryptor Compact Plus. RESULTS Among the various Biomarkers assayed only MR-proADM and LDH concentrations were significantly higher in deceased patients than in surviving patients while no statistically significant difference was observed for PCR PCT concentrations. Increasing levels of MRproADM between the second and fifth day of admission to the intensive care unit represent the key to determining mortality risk. CONCLUSIONS Mr-proADM was found to be a more effective biomarker than other commonly used biomarkers (PCR, WBC, Procalcitonin) in identifying Covid-19 patients with poor prognosis at an early stage. This study allowed clinicians to routinely include the assay of this biomarker, useful in the stratification of these patients and in predicting a higher or lower risk of mortality, in the second wave of the epidemic.

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Clinical utility of procalcitonin in severe odontogenic maxillofacial infection

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-020-00288-x ◽

2021 ◽

Vol 43 (1) ◽

Author(s):

Ji-Kwan Kim ◽

Jae-Hoon Lee

Keyword(s):

Bacterial Infections ◽

Laboratory Tests ◽

Area Under The Curve ◽

Diagnostic Value ◽

Sepsis Syndrome ◽

Sepsis Group ◽

Cell Counts ◽

Significant Difference ◽

The Difference ◽

Maxillofacial Infections

Abstract Background Most of the maxillofacial infections are bacterial infections, and there is a possibility that systemic infections occur by maxillofacial infections. The aim of this study was to investigate the diagnostic value of procalcitonin in patients with odontogenic bacterial infections of the maxillofacial region. Methods We enrolled sixty patients, who were admitted with odontogenic maxillofacial infection from September 2018 to March 2020. White blood cell counts, C-reactive protein, and procalcitonin concentrations were evaluated. Sixty patients were classified into two groups, sepsis and non-sepsis groups, based on systemic inflammatory response syndrome. A Student t test was performed to statistically analyze the difference in inflammatory markers between sepsis and non-sepsis groups. Results The mean procalcitonin values on admission were 7.24 ng/mL (range, 0.09–37.15 ng/mL) and 0.40 ng/mL (range, 0.02–4.94 ng/mL) in the sepsis group and non-sepsis group, respectively. The procalcitonin values between the two groups showed a significant difference (P < 0.05). The area under the curve of procalcitonin was 0.927 (P < 0.001), and the cutoff value of procalcitonin that maximizes the area under the curve was calculated to be 0.87 ng/mL. Conclusions According to our study, routine laboratory tests have insufficient accuracy in diagnosing sepsis syndrome. Therefore, it is strongly recommended to perform the procalcitonin test in patients with maxillofacial infection in addition to the conventional laboratory tests to diagnose the systemic inflammatory condition of the patients.

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Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

Revista de Chimie ◽

10.37358/rc.19.8.7475 ◽

2019 ◽

Vol 70 (8) ◽

pp. 3008-3013

Author(s):

Silvia Maria Stoicescu ◽

Ramona Mohora ◽

Monica Luminos ◽

Madalina Maria Merisescu ◽

Gheorghita Jugulete ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Sepsis ◽

Predictive Value ◽

Neonatal Intensive Care ◽

Complete Blood Count ◽

Clinical Manifestations ◽

Receiver Operating Curve ◽

Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

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Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

Anaesthesia and Intensive Care ◽

10.1177/0310057x20962113 ◽

2021 ◽

Vol 49 (1) ◽

pp. 23-34

Author(s):

Katherine P Hooper ◽

Matthew H Anstey ◽

Edward Litton

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Meta Analysis ◽

Diagnostic Testing ◽

Intervention Group ◽

Cochrane Central Register ◽

Safety And Efficacy ◽

Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

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0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study

SLEEP ◽

10.1093/sleep/zsaa056.585 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A225-A225

Author(s):

J Xue ◽

R Zhao ◽

J Li ◽

L Zhao ◽

B Zhou ◽

...

Keyword(s):

Pilot Study ◽

Pulse Oximeter ◽

Characteristic Curve ◽

Diagnostic Value ◽

Receiver Operator Characteristic Curve ◽

Oxygen Desaturation ◽

Significant Difference ◽

Acceptance Range ◽

The Difference ◽

Two Parameters

Abstract Introduction To evaluate the utility of the ring pulse oximeter for screening of OSA in adults. Methods 87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15). Results Among the 87 participants, 18 cases were AHI<5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P>0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p<0.05). Although MSpO2 correlated significantly (r=0.448, P<0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p<0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively. Conclusion The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA. Support The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).

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Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽

10.3390/diagnostics10100829 ◽

2020 ◽

Vol 10 (10) ◽

pp. 829

Author(s):

Yana Kogan ◽

Edmond Sabo ◽

Majed Odeh

Keyword(s):

Area Under The Curve ◽

Diagnostic Value ◽

Parapneumonic Effusion ◽

C Reactive Protein ◽

Diagnostic Efficacy ◽

Reactive Protein ◽

Significant Difference ◽

Study Population ◽

Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

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Comparison of three fixation methods for orotracheal intubation in 95 adults

European Journal of Medical Research ◽

10.1186/s40001-020-00446-x ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Ye Sun ◽

Hua Fan ◽

Xiao-Xia Song ◽

Hua Zhang

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tracheal Intubation ◽

Older People ◽

Endotracheal Intubation ◽

Orotracheal Intubation ◽

The Other ◽

Fixation Methods ◽

The Difference

Abstract Background The present study aimed to compare three fixation methods for orotracheal intubation. Methods Through literature retrieval, the effects of the adhesive/twill tape method, fixator method, and adhesive/twill tape–fixator alternation method on patients with tracheal intubation in the intensive care unit (ICU) were compared. Results The fixator and alternation methods were more effective in protecting the tongue mucosa and teeth. The alternation method was superior to the other two methods in maintaining the position of the endotracheal intubation. However, the difference in facial and lip injuries between the three methods was not statistically significant. Conclusion The fixator method can significantly reduce intraoral injury and is more suitable for older people with weak tongue mucosa and loose teeth. These are worth popularizing among a wider group.

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