Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement

Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit

Background

Lung ultrasound (LUS) is a simple bedside tool to assess overhydration. Our study aimed to assess extravascular lung water (EVLW) using B-lines and correlate it with weaning, duration of mechanical ventilation, and mortality in critically ill patients admitted to the intensive care unit (ICU).

Patients and methods

150 mechanically ventilated ICU patients prospectively observed over 18 months, with their demographic and clinical data noted. Extravascular lung water was monitored using LUS in four intercostal spaces (ICS) from day 1 to day 5, day 7, day 10, and weekly thereafter. Pulmonary fluid burden was graded as low (1-10), moderate (11-20), and high (21-32). Weaning outcome, duration of weaning, mechanical ventilation, ICU stay, and mortality were compared in patients with and without EVLW.

Results

Out of 150, 54 patients (36.0%) had EVLW. The mean lung score amongst our patients was 8.57 ± 6.0. The mean time for detection of EVLW was 1.43 ± 2.24 days. Lung score was low in 40 (26.67%) patients, moderate in 9 (6.00%) patients, and high in 5 (3.33%) patients. Incidence of weaning failure (p-value = 0.006), duration of weaning, mechanical ventilation, ICU stay (p-value < 0.0001 each), and overall mortality were significantly higher in patients with EVLW (p-value = 0.006).

Conclusion

We conclude that a good proportion of critically ill patients have EVLW. Extravascular lung water significantly increases the duration of weaning, mechanical ventilation days, ICU stay, and overall mortality in critically ill patients.

How to cite this article

Rajpal M, Talwar V, Krishna B, Mustafi SM. Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2024;28(2):165-169.

Ameliorative effect of diazepam against ethanol-induced mitochondrial disruption in brains of the mice

Brain oxidative damage and neurodegeneration by ethanol (ETH) are considered as important factors that triggered by oxidative stress. Recently, the abuse of diazepam (DZM) has increased by alcoholism-addicted patients. The present study evaluated the effects of combination treatment of ETH with DZM on oxidative damage induced in brain mitochondria of the mice. Only ETH (0.3, 0.6, and 2.5 g / kg) and ETH+ DZM (2.5 mg / kg) were administered intraperitoneally (ip) to the mice. Pathological changes and oxidative stress biomarkers including ROS, lipid peroxidation, carbonyl protein, mitochondrial function, and glutathione content were evaluated in brain mitochondria after 42 days. Results indicated that co-treatment of DZM and ETH significantly reduced mitochondrial toxicity, oxidative damage, pathological changes and increased level of glutathione. Subchronic ETH administration induced brain oxidative damage, mitochondrial disruption, and serious damage to the brain cells. Whereas, combination treatment improved oxidative damage, mitochondrial function, and pathological changes in brain cells after intoxication by ETH. These findings suggest antioxidant effect of DZM in combination with ETH and can be considered in reducing oxidative stress and mitochondrial damage attenuation in the brain. Combination therapy may be a better therapeutic candidate for prevention of brain oxidative damage induced by ETH.

Dynamic lung water MRI during exercise stress

PURPOSE

Exercise-induced dyspnea caused by lung water is an early heart failure symptom. Dynamic lung water quantification during exercise is therefore of interest to detect early stage disease. This study developed a time-resolved 3D MRI method to quantify transient lung water dynamics during rest and exercise stress.

METHODS

The method was evaluated in 15 healthy subjects and 2 patients with heart failure imaged in transitions between rest and exercise, and in a porcine model of dynamic extravascular lung water accumulation through mitral regurgitation (n = 5). Time-resolved images were acquired at 0.55T using a continuous 3D stack-of-spirals proton density weighted sequence with 3.5 mm isotropic resolution, and derived using a motion corrected sliding-window reconstruction with 90-s temporal resolution in 20-s increments. A supine MRI-compatible pedal ergometer was used for exercise. Global and regional lung water density (LWD) and percent change in LWD (ΔLWD) were automatically quantified.

RESULTS

A ΔLWD increase of 3.3 ± 1.5% was achieved in the animals. Healthy subjects developed a ΔLWD of 7.8 ± 5.0% during moderate exercise, peaked at 16 ± 6.8% during vigorous exercise, and remained unchanged over 10 min at rest (-1.4 ± 3.5%, p = 0.18). Regional LWD were higher posteriorly compared the anterior lungs (rest: 33 ± 3.7% vs 20 ± 3.1%, p < 0.0001; peak exercise: 36 ± 5.5% vs 25 ± 4.6%, p < 0.0001). Accumulation rates were slower in patients than healthy subjects (2.0 ± 0.1%/min vs 2.6 ± 0.9%/min, respectively), whereas LWD were similar at rest (28 ± 10% and 28 ± 2.9%) and peak exercise (ΔLWD 17 ± 10% vs 16 ± 6.8%).

CONCLUSION

Lung water dynamics can be quantified during exercise using continuous 3D MRI and a sliding-window image reconstruction.

Prevalence of Augmented Renal Clearance (ARC), Utility of Augmented Renal Clearance Scoring System (ARC score) and Augmented Renal Clearance in Trauma Intensive Care Scoring System (ARCTIC score) in Predicting ARC in the Intensive Care Unit: Proactive Study

Objectives

We aimed to study the prevalence of augmented renal clearance (ARC) and validate the utility of ARC and ARCTIC scores. We also aimed to assess the correlation and agreement between estimated GFR (eGFR-EPI) and 8-hour measured creatinine clearance (8 hr-mCL_cr).

Study design and methodology

This was a prospective, observational study done in the mixed medical-surgical intensive care unit (ICU) and 90 patients were recruited. 8 hr-mCL_cr, ARC, and ARCTIC scores and eGFR-EPI were calculated for all patients. ARC was said to be present if 8 hr-mCLcr was ≥ 130 mL/min.

Results

Four patients were excluded from the analysis. The prevalence of ARC was 31.4%. The sensitivity, specificity, and positive and negative predictive values of ARC and ARCTIC scores were found to be 55.6, 84.7, 62.5, 80.6, and 85.2, 67.8, 54.8, and 90.9 respectively. AUROC for ARC and ARCTIC scores were 0.802 and 0.765 respectively. A strong positive correlation and poor agreement were observed between eGFR-EPI and 8 hr-mCL_cr.

Conclusion

The prevalence of ARC was significant and the ARCTIC score showed good potential as a screening tool to predict ARC. Lowering the cut-off of ARC score to ≥5 improved its utility in predicting ARC. Despite its poor agreement with 8 hr-mCL_cr, eGFR-EPI with a cut-off ≥114 mL/min showed utility in predicting ARC.

How to cite this article

Kanna G, Patodia S, Annigeri RA, Ramakrishnan N, Venkataraman R. Prevalence of Augmented Renal Clearance (ARC), Utility of Augmented Renal Clearance Scoring System (ARC score) and Augmented Renal Clearance in Trauma Intensive Care Scoring System (ARCTIC score) in Predicting ARC in the Intensive Care Unit: Proactive Study. Indian J Crit Care Med 2023;27(6):433-443.

Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns

Bacterial pneumonia is one of the most serious public health issues owing to its medical and economic costs, which result in increased morbidity and mortality in people of all ages around the world. Furthermore, antimicrobial resistance has risen over time, and the advent of multi-drug resistance in GNB complicates therapy and has a detrimental impact on patient outcomes. The current review aimed to summarize bacterial pneumonia with an emphasis on gram-negative etiology, pathogenesis, risk factors, resistance mechanisms, treatment updates, and vaccine concerns to tackle the problem before it causes a serious consequence. In conclusion, the global prevalence of GNB in CAP was reported 49.7% to 83.1%, whereas in VAP patients ranged between 76.13% to 95.3%. The most commonly reported MDR-GNB causes of pneumonia were A. baumannii, K. pneumoniae, and P. aeruginosa, with A. baumannii isolated particularly in VAP patients and the elderly. In most studies, ampicillin, tetracyclines, amoxicillin-clavulanic acid, cephalosporins, and carbapenems were shown to be highly resistant. Prior MDR-GNB infection, older age, previous use of broad-spectrum antibiotics, high frequency of local antibiotic resistance, prolonged hospital stays, ICU admission, mechanical ventilation, and immunosuppression are associated with the MDR-GNB colonization. S. maltophilia was reported as a severe cause of HAP/VAP in patients with mechanically ventilated and having hematologic malignancy due to its ability of biofilm formation, site adhesion in respiratory devices, and its intrinsic and acquired drug resistance mechanisms. Effective combination therapies targeting PDR strains and drug-resistant genes, antibiofilm agents, gene-based vaccinations, and pathogen-specific lymphocytes should be developed in the future.

Working Hours, Sleep Disturbance and Self-Assessed Health in Men and Women: A Multilevel Analysis of 30 Countries in Europe

Objectives

This study examined the gender and cross-country differences in the relationship between working hours and self-assessed health among working men and women in Europe, and further explored the moderating role of sleep disturbance in the relationship.

Methods

We used cross-sectional data from the 6th European Working Condition Survey on 14,603 men and 15,486 women across 30 countries in Europe. A multivariate logistic regression was applied to evaluate the relationship between working hours, sleep disturbance, and self- assessed health. In addition, we employed a two-stage multilevel logistic regression to assess the cross-country variations in the relationship between working hours and self-assessed health.

Results

The study showed a slightly U-shaped relationship between working hours and less-than-good self-assessed health among working adults in Europe (<31 h: aOR = 1.11; 95% CI: 1.00-1.25, 41-50 h: aOR = 0.98; 95% CI: 0.84-1.15, and 50+ h: aOR = 1.31; 95% CI: 1.07-1.59). However, working men had higher odds of reporting less-than-good self-assessed health as compared to women when they devote longer hours to paid work. The results further showed that there are cross-country variations in the association between working hours and less-than-good self-assessed health for both men and women, and that men had slightly lower variations as compared to women. Contrary to expectation, sleep disturbance did not moderate the relationship between working hours and less-than-good self-assessed health for both men and women in Europe.

Conclusions

Although there are gender differences and cross-country variations in the association between working hours and less-than-good self-assessed health, sleep disturbance did not moderate the associations. These findings underscore the importance for strict work time regulation and generous work-family policies that may promote good working conditions and health.