ObjectiveTo evaluate the usefulness and prognostic value of reactive hyperemia -
peripheral arterial tonometry in patients with sepsis. Moreover, we
investigated the association of reactive hyperemia - peripheral arterial
tonometry results with serum levels of certain inflammatory molecules.MethodsProspective study, conducted in an 18-bed mixed intensive care unit for
adults. The exclusion criteria included severe immunosuppression or
antibiotic therapy initiated more than 48 hours before assessment. We
measured the reactive hyperemia - peripheral arterial tonometry on inclusion
(day 1) and on day 3. Interleukin-6, interleukin-10, high-mobility group box
1 protein and soluble ST2 levels were measured in the blood obtained upon
inclusion.ResultsSeventeen of the 79 patients (21.6%) enrolled were determined to have
reactive hyperemia - peripheral arterial tonometry signals considered
technically unreliable and were excluded from the study. Thus, 62 patients
were included in the final analysis, and they underwent a total of 95
reactive hyperemia - peripheral arterial tonometry exams within the first 48
hours after inclusion. The mean age was 51.5 (SD: 18.9), and 49 (62%) of the
patients were male. Reactive hyperemia indexes from days 1 and 3 were not
associated with vasopressor need, Sequential Organ Failure Assessment score,
Acute Physiology and Chronic Health Evaluation II score, or 28-day
mortality. Among the patients who died, compared with survivors, there was a
significant increase in the day 3 reactive hyperemia index compared with day
1 (p = 0.045). There was a weak negative correlation between the day 1
reactive hyperemia - peripheral arterial tonometry index and the levels of
high-mobility group box 1 protein (r = -0.287).ConclusionTechnical difficulties and the lack of clear associations between the exam
results and clinical severity or outcomes strongly limits the utility of
reactive hyperemia - peripheral arterial tonometry in septic patients
admitted to the intensive care unit.
Aims: This pilot study aimed to evaluate the usefulness of a sequential lung ultrasound score (LUS) in immunosuppressed patients with oncohematologic diseases and acute respiratory dysfunction hospitalized in an intensive care unit (ICU).Materials and methods: LUS was calculated at ICU admission, after 24 h, 48 h and at discharge. A score ranging from 0 to 26 was attributed according to the number of B lines, presence of lung consolidation and pleural effusion.Results: Twenty-six patients were included. The median age was 50 years [interquartile range (IQR) 21] and 14 (54%) were male. LUS on the day of ICU admission was significantly higher in non-survivors compared to survivors (13 [5] vs 9 [9], respectively; p=0.047). The median delta LUS (LUS_D2 – LUS_D1) did not show difference between survivors and non-survivors (2 [0-7.5] vs 1 [-1.5 – 5], p=0.33). Among patients initially submitted to noninvasive mechanical ventilation (NIMV), no difference in LUS at inclusion or after 24 h was found between those who succeeded or failed on this support.Conclusion: The use of LUS to quantify lung aeration loss in oncohematologic patients hospitalized in an ICU due to acute respiratory dysfunction might be a helpful tool to predict the severity of the illness.
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