In recent decades, there is increasing evidence suggesting that hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with cardiac arrest or traumatic brain injury. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been well studied. In the present study, we evaluated the impact of hyperoxia and hypocapnia on neurological outcomes in patients with aneurysmal SAH (aSAH). Patients with aSAH who were admitted to the intensive care unit (ICU) of a tertiary hospital in Hong Kong between January 2011 and December 2016 were retrospectively recruited. Patients' demographics, comorbidities, radiological findings, clinical grades of SAH, PO2, and PCO2 within 24 hours of ICU admission, and Glasgow Outcome Scale (GOS) at 3 months after admission were recorded. Patients with a GOS score of 3 or less were considered having poor neurological outcomes. Among the 244 patients with aSAH, 122 of them (50%) had poor neurological outcomes at 3 months. Early hyperoxia (PO2 > 200 mmHg) and hypercapnia (PCO2 > 45 mmHg) were more common among patients with poor neurological outcomes. Logistic regression analysis indicated that hyperoxia independently predicted poor neurological outcomes (OR 3.788, 95% CI 1.131–12.690, P=0.031). Classification tree analysis revealed that hypocapnia was associated with poor neurological outcomes in patients who were less critically ill (APACHE < 50) and without concomitant intracranial hemorrhage (ICH) or intraventricular hemorrhage (IVH) (adjusted P=0.006, χ2 = 7.452). These findings suggested that hyperoxia and hypocapnia may be associated with poor neurological outcomes in patients with aSAH.
Introduction: Significant ventilator-associated pneumonia and mortality were found in COVID-19 patients who required mechanical ventilation which calls for non-invasive means in managing respiratory failure. Methods: We retrospectively reviewed patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital in Hong Kong with severe acute respiratory syndrome coronavirus 2 infection from 28 November to 15 December 2020. Patients’ laboratory, respiratory parameters and outcome data were recorded and analysed. Results: Eleven received prone ventilation. The median age was 67 (inter-quartile range: 59–72) years, and median COVID-19 GRAM score was 151 (inter-quartile range: 133–181), representing a high-risk group. There were significant improvements 1 h after awake proning in SpO2 (95% vs 92%, p = 0.008), FiO2 (0.4 vs 0.5, p = 0.003), SpO2/FiO2 (240 vs 184, p = 0.005), respiratory rate (19 vs 26, p = 0.006) and respiratory rate – oxygenation index (13.22 vs 7.67, p = 0.003; Table 1). Although not reaching statistical significance, the median PaO2, PaCO2 and PaO2/FiO2 improved after proning. The overall intubation rate was 22% and intensive care unit mortality was 22%, which is in contrast to 65.5% and 27.6%, respectively, in the first three waves. Although did not reach statistical significance, those received prone ventilation tend to have a lower ICU mortality (9.1% vs 42.9%, p = 0.245) and hospital mortality (18.2% vs 42.9%, p = 0.326). Conclusion: Awake proning potentially minimizes complications from invasive ventilation and provides a low-cost low-risk treatment option in COVID-19 patients with respiratory failure. This is particularly important when healthcare resources are strained at times of a pandemic.
Demographics, microbiology, and outcomes were analysed. The primary outcome was 90-day all-cause mortality; secondary outcomes were intensive care unit (ICU) and hospital mortalities, ICU and hospital lengths of stay, and ICU ventilator duration. Results: In total, 984 patients had K pneumoniae bacteraemia; of them, 686 received appropriate empirical antibiotics. Overall, 205 patients required intensive care. Older age (odds ratio [OR]=1.60; 95% confidence interval [CI]=1.120-2.295; P=0.010), chronic kidney disease (OR=1.81; 95% CI=1.181-2.785; P=0.007), mechanical ventilation (OR=1.79; 95% CI=1.188-2.681; P=0.005), pneumonia (OR=1.50; 95% CI=1.030-2.187; P=0.034), and carbapenem-resistant or extended-spectrum betalactamase (ESBL)-producing isolates (OR=12.51; 95% CI=7.886-19.487; P<0.001) were associated with greater risk of inappropriate empirical treatment. Ninety-day mortality was significantly higher among patients with inappropriate empirical treatment; independent predictors included pneumonia (hazard ratio [HR]=2.
The use of extracorporeal membrane oxygenation (ECMO) for cardio-respiratory support is increasing globally over the past decade, not only by its number of cases registered but also by the expanding list of indications. We herein report a patient with recurrent respiratory papillomatosis complicated with central airway obstruction, who presented with impeding asphyxia, and evaluate the feasibility of emergency veno- venous ECMO as a rescue therapy prior to definitive management of the primary pathology.
Circulatory failure and shock are common in critically ill patients, and the cause of shock is usually multifactorial. Transthoracic echocardiography is a noninvasive method to determine the contribution of various factors toward a patient’s circulatory failure. Such factors include fluid status, cardiac contractility as well as vasomotor tone. Advances in echocardiographic measurements allow for the accurate estimation of a patient’s loading status and cardiac contractility, which help to guide treatment strategy and monitor treatment response. This article offers an overview of echocardiographic and clinical parameters and aims to incorporate these findings into a methodical approach to the clinical management of shock. Key words: Transthoracic echocardiogram; Shock; Hemodynamic monitoring; ICU Citation: Tang KB, Lau CWM, Li KC. Shock interpretation and noninvasive hemodynamic monitoring with transthoracic echocardiography in an intensive care unit: a concise review. Anaesth. pain intensive care 2021;25(6):819–827; DOI: 10.35975/apic.v25i6.1713 Received: October 5, 2021; Reviewed: October 10, 202; Accepted: October 25, 2021
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