Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. Methods We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. Results Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well matched in baseline characteristics. The median [IQR] age of the HFNC group was 66 [50–77] vs. 65.5 [54–77] years in the NIV group. The most common causes of intubation at admission were shock-related respiratory failure (57.1% vs. 55.5%) and acute hypoxic respiratory failure (34.8% vs. 40.9%) in the HFNC and NIV groups, respectively. The duration of mechanical ventilation before extubation was 5 [3–8] days in the HFNC group vs. 5 [3–9] days in the NIV group. There was no statistically significant difference in the primary outcome: 20/112 (17.9%) in the HFNC group required reintubation at 72 h compared to 20/110 (18.2%) in the NIV group [relative risk (RR) 0.99: 95% confidence interval (CI) (0.70–1.39); P = 0.95]. The 28-day mortality was not different: 8/112 (7.1%) with HFNC vs. 10/110 (9.1%) with NIV (RR 0.88: 95% CI (0.57–1.37); P = 0.59). Conclusions Among sepsis patients, there was no difference between HFNC and NIV in the prevention of reintubation at 72 h after extubation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03246893; Registered 11 August 2017; https://clinicaltrials.gov/ct2/show/NCT03246893?term=surat+tongyoo&draw=2&rank=3
Introduction: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. However, data regarding ECPR in pregnancy are limited. Case summary: A 24-year-old woman with a 33-week twin pregnancy developed witnessed cardiac arrest in an antenatal clinic. She underwent perimortem cesarean delivery (PMCD) and ECPR, but uterine atony with massive bleeding occurred. Emergency hysterectomy and massive blood transfusion were performed in the emergency department and the patient was transferred to the intensive care unit after hemodynamics was stable. Conclusion: Cardiac arrest in pregnancy is a complex condition. Several aspects of management have not been evaluated. Prospective studies for improving the outcomes are needed.
BackgroundMotorcycle is the most common vehicle use in Thailand because of topography, traffic jam problem and income of the owner. The percentage of motorcyclists lower than 20 years and over 60 years are increase every year. Among traffic accidents, increasing numbers of motorcycle accidents have been observed and it is the common cause of death in Thai population. This study aimed to identify severity of injury and helmet use in motorcycle patients in Khon Kaen hospital among teenage, adult and elderly groups.MethodsThis was the retrospective cohort study . The data was extracted from the Electronic Injury Surveillance System that identified the patients who visited emergency department Khon Kaen hospital to treat injuries resulting from motorcycle accident in 1st January 2013–31th December 2104. Helmet use and severity of injuries sustained among those age lower than 20 years, 20–59 years, 60 years and older were compared.Results3,265 patients were lower than 20 years, 8,510 patients were 20–59 years and 737 patients were 60 years and older. All were treated at emergency department. The helmet used in lower than 20 years group and 60 years and older group were lower than 20–59 years group (RR 0.73; 95% CI: 0.68–0.79) and (RR 0.76; 95% CI: 0.66–0.88). Glasgow coma scale ≤ 7 in lower than 20 years group and 60 years and older group were higher than 20–59 years group (RR 1.64; 95% CI: 1.33–2.08) and (RR 4.16; 95% CI: 3.44–5.00). Admission rate in 60 years and older group was higher when compared to 20–59 years group (RR 1.38; 95% CI: 1.29–1.47 p-value <0.00001) and also in hospital mortality in oldest group was about 1.7 fold when compared to 20–59 years group (RR 1.7; 95% CI: 1.15–2.51 p value = 0.00074).ConclusionsThe helmet used in younger and older patients were low and because of the older with motorcycle accident were prone to more severe injuries than younger adults. In future, the injury and prevention program should focus on this aged group.
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