Chirurgie de l’endocardite infectieuse : à propos de 203 cas

Introduction: infectious endocarditis is a serious disease with a high morbimortality. Diagnosis relies on modified criteria of Dukes. The main surgical indication in emergency are hemodynamic, infectious and embolic complications. The aim of this work is to present epidemiological, clinical and ultrasonographic characteristics, and report our experience in order to assess the results of surgical treatment of the disease and to improve the management. Methods: This is a monocenter retrospective study of 203 patients operated for infective endocarditis, collected between January 2001and June 2015. This study interested only the operative period. Results: The mean age is 42 years with male predominance (62, 12%). The causal heart disease was predominantly rheumatic in 40 % of cases. 7. %88 had endocarditis on cardiac prosthesis. The causative germ in isolated in only 47% of cases; Staphylococcus and Streptococcus were the most frequent germs. The left ventricular function was altered in 24 % of cases. The patients were operated in emergency in 59 cases and delayed surgery in 144 cases. Valve replacement was done in 84,8 % of cases and valve repair in 15.2 % of cases. Stay in intensive care unit was more than 72 hours in 28 % of cases, intubation procedure < 24 hours in 69%, post-operative stay ≥ 7 days in 70 % and simple post-operative history in 60 % of cases. Conclusion: endocardial infection is a serious disease. Regular studies detailing epidemiology of these infections. The actual trend is in favor of earlier surgery, privileging valve repair.

Download Full-text

Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43015 ◽

2019 ◽

Vol 5 (2) ◽

pp. 118-122

Author(s):

Uzzwal Kumar Mallick ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Enayet Hussain ◽

Mohammad Asaduzzaman ◽

Md Sirajul Islam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intravenous Immunoglobulin ◽

Statistical Significance ◽

Axonal Neuropathy ◽

Male Predominance ◽

Icu Stay ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

Download Full-text

Balloon atrial septostomy in the intensive care unit under echocardiographic control—nine years experience

Cardiology in the Young ◽

10.1017/s1047951100000810 ◽

1992 ◽

Vol 2 (2) ◽

pp. 175-178 ◽

Cited By ~ 3

Author(s):

Ashok P. Kakadekar ◽

Alison Hayes ◽

Eric Rosenthal ◽

Ian C. Huggon ◽

Edward J. Baker ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Femoral Vein ◽

Left Ventricular ◽

Balloon Atrial Septostomy ◽

Associated Lesions ◽

Atrial Septostomy ◽

The Mean

SummaryBetween December 1982 and April 1991, balloon atrial septostomy was performed in the intensive care unit under echocardiographic control in 60 neonates. Of the patients, 58 had complete transposition. Two patients had double outlet right ventricle with a sub-pulmonary ventricular septal defect. Associated lesions included a patent arterial duct in 19 patients, ventricular septal defect in nine, obstruction of the left ventricular outflow tract in six, aortic coarctation in two and tricuspid atresia in one. The mean age at septostomy was four days (range 4 hours - 25 days) and the mean weight 3.19 kg (range 1.17–4.25 kg). In 39 (65%) patients, an infusion of prostaglandin was in progress prior to the septostomy and 22 (37%) were being ventilated. Standard subcostal four-chamber echocardiographic views were used to show the atrial septum and to guide the catheter used for septostomy. Venous access was obtained via the femoral vein in 43 (by percutaneous puncture in 40 and by cutdown in three) and the umbilical vein in 17. Transient atrial arrhythmias were common during the septostomy but no acute hemodynamic disturbances or deaths occurred during the procedure. The size of the atrial septal defect as measured by echocardiography after the septostomy ranged from three to 12 mm in diameter. In only one patient was this inadequate. Three (5%) patients died between two and 10 days after the septostomy, two due to necrotizing enterocolitis and one from persistent hypoxemia. One patient had a cerebral thrombosis and convulsions immediately after the septostomy but made a good neurological recovery. Corrective surgery was performed in 52 (86.6%), two (3.3%) had palliative surgery and two were considered unsuitable for total correction, of whom one has died. One patient died whilst awaiting correction. We conclude that balloon atrial septostomy using echocardiographic guidance can be safely and effectively performed in the intensive care unit.

Download Full-text

Echocardiographic markers of mortality at 60 days in patients with COVID-19 in the intensive care unit

European Heart Journal ◽

10.1093/eurheartj/ehab724.0134 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J Sprockel ◽

J M Rincon ◽

M Rondon ◽

M Bejarano ◽

N Castellanos ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Right Ventricular ◽

Diastolic Dysfunction ◽

Cor Pulmonale ◽

Left Ventricular ◽

Ventricular Dilatation ◽

Acute Cor Pulmonale ◽

The Mean ◽

Right Ventricular Dilatation

Abstract Introduction Coronavirus disease (COVID)-19 predominantly produces its effects through lung damage, but an important component of multi-organ dysfunction is cardiac involvement. We have few reports that inform about the behavior of echocardiographic images of patients with the most severe forms of the disease. Purpose The present work aims to identify prognostic markers for 60-day mortality in patients hospitalized in intensive care based on echocardiographic findings. Methodology A single-center retrospective cohort was conducted. Hospitalized patients were included in one of the nine intensive care units for COVID-19 confirmed by RT-PCR from May to October 2020. Patients with previous conditions that determined a limitation of the therapeutic effort, those who died before 24 hours and pregnant women were excluded. Portable echocardiograms were performed by two expert cardiologists following the recommendations for isolation and personal protection. The time to death was evaluated as outcome. A Cox proportional hazards model was constructed, HR and 95% confidence intervals with their p values. The study was approved by the institutional ethics committee. Results Of 326 patients included, 153 patients had an echocardiogram. The mean age was 60.7 years, 47 (30.7%) were female and 67 (44.7%) had positive troponin. 91 patients (59.5%) not survive, the mean long of stay was 8.4 (SD: 4.2) days. 111 (72.5%) had shock, 128 (83.7%) severe ARDS (PaO2 / FiO2 <100 mmHg), 142 (92.8%) required invasive ventilatory support, and 86 (56.2%) acute kidney injury. 27 (17.6%) patients had acute pulmonary embolism, 16 (10.4%) acute myocardial infarction and 9 (5.9%) myocarditis. The mean right ventricular ejection fraction was 37%, TAPSE was decreased in 16 cases (10.4%). 41 cases (26.8%) had right diastolic dysfunction. 34/48 (71%) cases had pulmonary hypertension. The average LVEF was 59.3% and 74 (48.4%) had some left ventricular diastolic dysfunction. 12 (7.8%) had left ventricular segmental wall motion abnormality and 16 (10.4%) had pericardial effusion. Univariate analysis identified TAPSE, PSAP, acute cor pulmonale and right ventricular dilatation as variables related to the outcome of mortality. The multivariate Cox model (Table 2) documented that acute cor pulmonale with a HR of 12.8 (95% CI 3.51 - 46.63, p<0.001) and right ventricular dilation with a HR of 4, 87 (95% CI 1.36–17.46, P 0.016) were associated with mortality. Conclusions In patients hospitalized in the intensive care unit for COVID-19, acute cor pulmonale and right ventricular dilatation behaved as independent predictors of in-hospital death. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Baselines characteristics Table 2. Multivariate analisys

Download Full-text

Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU

Clinics and Practice ◽

10.3390/clinpract12010002 ◽

2021 ◽

Vol 12 (1) ◽

pp. 8-16

Author(s):

Talita Leite dos Santos Moraes ◽

Joana Monteiro Fraga de Farias ◽

Brunielly Santana Rezende ◽

Fernanda Oliveira de Carvalho ◽

Michael Silveira Santiago ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Medical Records ◽

High Mobility ◽

University Hospital ◽

Limited Mobility ◽

The Mean ◽

The University

Background: Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. Materials and methods: This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). Results: A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23–636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002–0.30). Conclusion: Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.

Download Full-text

Conversion From Continuous Infusion Fentanyl to Continuous Infusion Hydromorphone in the Pediatric Intensive Care Unit

Annals of Pharmacotherapy ◽

10.1177/10600280211003170 ◽

2021 ◽

pp. 106002802110031

Author(s):

Maura Harkin ◽

Jamie L. Miller ◽

Sin Yin Lim ◽

Stephen B. Neely ◽

Christina K. Walsh ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Continuous Infusion ◽

Dose Reduction ◽

Mixed Models ◽

Pediatric Intensive Care ◽

Primary Objective ◽

Critically Ill Children ◽

The Mean

Background: Opioid rotations from fentanyl to hydromorphone may reduce opioid/sedative exposure in critically ill children. Objective: The primary objective was to determine the conversion percentage from fentanyl to hydromorphone infusions using equianalgesic conversions (0.1 mg fentanyl = 1.5 mg hydromorphone). Secondary objectives included identification of the median time and hydromorphone rate at stabilization (defined as the first 24-hour period no hydromorphone rates changed, 80% of State Behavioral Scale [SBS] scores between 0 and −1, and <3 hydromorphone boluses administered). Additional outcomes included a comparison of opioid/sedative requirements on the day of conversion versus the three 24-hour periods prior to conversion. Methods: This retrospective study included children <18 years old converted from fentanyl to hydromorphone infusions over 6.3 years. Linear mixed models were used to determine if the mean cumulative opioid/sedative dosing differed from the day of conversion versus three 24-hour periods prior to conversion. Results: A total of 36 children were converted to hydromorphone. The median conversion percentage of hydromorphone was 86% of their fentanyl dose (interquartile range [IQR] = 67-100). The median hydromorphone rate at stabilization was 0.08 mg/kg/h (IQR = 0.05-0.1). Eight (22%) were stabilized on their initial hydromorphone rate; 8 (22%) never achieved stabilization. Patients had a significant decrease in opioid dosing on the day of conversion versus the 24-hour period prior to conversion but no changes in sedative dosing following conversion. Conclusion and Relevance: A median 14% fentanyl dose reduction was noted when transitioning to hydromorphone. Further exploration is needed to determine if opioid rotations with hydromorphone can reduce opioid/sedative exposure.

Download Full-text

Evaluation of Drug Use Patterns in Intensive Care Unit of Tertiary Care Hospital: A Descriptive Cross-Sectional Study

Journal of Nobel Medical College ◽

10.3126/jonmc.v10i1.37943 ◽

2021 ◽

Vol 10 (1) ◽

pp. 31-35

Author(s):

Rinku Ghimire ◽

Rupesh Kumar Shreewastav

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Prescription Patterns ◽

Male Predominance ◽

The Mean

Background: Prescription of rational drugs is needed to save critically ill patients. This study was conducted to assess the prescription patterns of drugs in the intensive care unit. Materials and Methods: A descriptive cross-sectional study among patients admitted in intensive care unit from March 2020 to February 2021 after approval from the Institutional Review Committee (ref no. 344 /2019). Demographic profile, prescription patterns, the average number of drugs used, route of administration, and duration of hospitalization were recorded based on the pre-structured questionnaires. Convenient sampling was chosen. Data were analyzed by SPSS, version 20. Results: Prescription patterns of 225 were analyzed. The mean age was 55.60 ± 20.16 years with a male predominance of 131(58.2%). Cardiac disorders 57(25.3%) were the most common admitting diagnosis followed by pulmonary, neurological, and kidney disorders. The average length of hospital stay was 4.14 days (range 1-38 days). A total of 887 drugs were prescribed. The mean number of drugs prescribed per patient was 7.71 ± 1.92. Parenteral drugs accounted for 81.39%. Antibiotics were prescribed to all patients. Intravenous fluids were given to 62.2% of patients, blood and blood products to 21.33%. Thromboprophylaxis was used in 15 (6.7%) patients. Seven hundred twenty-two (81.39%) drugs were injectables, 129(14.54%) were used by the oral or nasogastric route and 36 (4.05%) were inhaled drugs. Conclusion: Newer generations antibiotics were the most commonly prescribed drugs. Pantoprazole, Metoclopramide, and Hydrocortisone were the top three most commonly prescribed individual drugs. There was marked underuse of thromboprophylaxis, analgesics, and sedatives.

Download Full-text

Establishing Cardiac Surgery in Eastern Nepal: Early Results

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i3.1033 ◽

2018 ◽

Vol 16 (3) ◽

pp. 257-263

Author(s):

Lokesh Shekher Jaiswal ◽

Jagat Narayan Prasad ◽

Prashant Shah ◽

Narendra Pandit

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Heart Disease ◽

Congenital Heart ◽

Heart Diseases ◽

Open Heart Surgery ◽

Left Atrial Myxoma ◽

Early Results ◽

The Mean

Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years).The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.Keywords: CABG; cardiac surgery; congenital heart disease; early results; RHD.

Download Full-text

Diuretic strategies in patients with resistance to loop-diuretics in the intensive care unit: A retrospective study from the MIMIC-III database

Journal of Critical Care ◽

10.1016/j.jcrc.2021.06.009 ◽

2021 ◽

Vol 65 ◽

pp. 282-291

Author(s):

Jean-Maxime Côté ◽

Josée Bouchard ◽

Patrick T. Murray ◽

William Beaubien-Souligny

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Loop Diuretics ◽

Mimic Iii

Download Full-text

1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1594 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S713-S713

Author(s):

Carlo Fopiano Palacios ◽

Eric Lemmon ◽

James Campbell

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Linear Regression ◽

Length Of Stay ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

P Value ◽

Fisher Exact Test ◽

The Mean ◽

Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

Download Full-text

The use of score for neonatal acute physiology perinatal extention II (SNAPPE II) in predicting neonatal outcome in neonatal intensive care unit

Paediatrica Indonesiana ◽

10.14238/pi45.6.2005.241-5 ◽

2016 ◽

Vol 45 (6) ◽

pp. 241

Author(s):

Mia R A ◽

Risa Etika ◽

Agus Harianto ◽

Fatimah Indarso ◽

Sylviati M Damanik

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Characteristic Curve ◽

Newborn Care ◽

Scoring Systems ◽

Laboratory Observation ◽

The Mean ◽

Overall Mortality

Background Scoring systems which quantify initial risks have animportant role in aiding execution of optimum health services by pre-dicting morbidity and mortality. One of these is the score for neonatalacute physiology perinatal extention (SNAPPE), developed byRichardson in 1993 and simplified in 2001. It is derived of 6 variablesfrom the physical and laboratory observation within the first 12 hoursof admission, and 3 variables of perinatal risks of mortality.Objectives To assess the validity of SNAPPE II in predicting mor-tality at neonatal intensive care unit (NICU), Soetomo Hospital,Surabaya. The study was also undertaken to evolve the best cut-offscore for predicting mortality.Methods Eighty newborns were admitted during a four-month periodand were evaluated with the investigations as required for the specifi-cations of SNAPPE II. Neonates admitted >48 hours of age or afterhaving been discharged, who were moved to lower newborn care <24hours and those who were discharged on request were excluded. Re-ceiver operating characteristic curve (ROC) were constructed to derivethe best cut-off score with Kappa and McNemar Test.Results Twenty eight (35%) neonates died during the study, 22(82%) of them died within the first six days. The mean SNAPPE IIscore was 26.3+19.84 (range 0-81). SNAPPE II score of thenonsurvivors was significantly higher than the survivors(42.75+18.59 vs 17.4+14.05; P=0.0001). SNAPPE II had a goodperformance in predicting overall mortality and the first-6-daysmortality, with area under the ROC 0.863 and 0.889. The best cut-off score for predicting mortality was 30 with sensitivity 81.8%,specificity 76.9%, positive predictive value 60.0% and negativepredictive value 90.0%.Conclusions SNAPPE II is a measurement of illness severity whichcorrelates well with neonatal mortality at NICU, Soetomo Hospital.The score of more than 30 is associated with higher mortality

Download Full-text