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Škunca A, Mesić A, Magdić Turković T, Radočaj T, Potočki S. EPIDEMIOLOGICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH MORTALITY IN SEVERELY BURNED PATIENTS - CROATIAN NATIONAL BURN CENTER REPORT. Acta Clin Croat 2023; 62:115-122. [PMID: 38304358 PMCID: PMC10829945 DOI: 10.20471/acc.2023.62.01.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/17/2023] [Indexed: 02/03/2024] Open
Abstract
The authors conducted a single-center retrospective study during the last 6.5 years. The study aimed to describe demographic data of burn patients in the Croatian Burn Center and investigate factors affecting mortality for the first time after the Center was established. The study included 109 severely burned patients with a total body surface area (TBSA) burned ≥20%, admitted to the burn intensive care unit. The relationship between the fatal outcome and age, sex, comorbidity, mechanism of injury, TBSA burned, and inhalation injury was investigated. The mean patient age was 54.50±20.21 years and the mean TBSA burned was 42.48±18.64%, with the mortality rate of 50%. The results demonstrated that patients with 2 or more comorbidities compared with those with no comorbidities had a higher chance of lethal outcome (p<0.0001). With an increase of TBSA by 1%, the odds of lethal outcome are expected to increase by 7% (p<0.0001). Other variables included in the analysis did not show statistical significance. TBSA percentage is a well-known predictor of mortality and numerous studies indicate an association between comorbidities and mortality but there are conflicting results about other demographic factors and injury characteristics.
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Affiliation(s)
- Agata Škunca
- Department of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana Mesić
- Department of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Tihana Magdić Turković
- Department of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Tomislav Radočaj
- Department of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Slavica Potočki
- Department of Chemistry and Biochemistry, Zagreb University School of Medicine, Zagreb, Croatia
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Kličan-Jaić K, Djaković I, Orešković N, Magdić Turković T, Pešić M, Košec V. DILEMMAS ABOUT THE SELECTION OF ANESTHESIA FOR ELECTIVE CESAREAN SECTION IN PREGNANT WOMEN WITH MYOTONIC DYSTROPHY TYPE 2 AND SUSPECTED von WILLEBRAND DISEASE: A CASE REPORT. Acta Clin Croat 2023; 62:224-229. [PMID: 38304361 PMCID: PMC10829951 DOI: 10.20471/acc.2023.62.01.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2024] Open
Abstract
With advancement of medicine in the field of diagnostics and treatment of women suffering from certain genetic disorders, more and more women have attained reproductive age and desired fertility. Maintaining pregnancy, as well as bringing it to an end poses a real challenge not only for obstetricians, but also for anesthesiologists involved in the procedure. In our case report, we describe anesthetic management of a female patient suffering from myotonic dystrophy type 2 and suspected von Willebrand's disease, and undergoing elective cesarean section. It is acknowledged that both diseases have their own peculiarities and specificities related to anesthesia and require careful consideration when it comes to selecting it. Bearing in mind the advantages and disadvantages of certain types of anesthesia, we believe that in this case, general anesthesia was a better choice compared to the regional techniques of anesthesia.
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Affiliation(s)
- Katarina Kličan-Jaić
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nika Orešković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Tihana Magdić Turković
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Maja Pešić
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Magdić Turković T, Sabo G, Babić S, Šoštarić S. SPINAL ANESTHESIA IN DAY SURGERY - EARLY EXPERIENCES. Acta Clin Croat 2022; 61:160-164. [PMID: 36824644 PMCID: PMC9942477 DOI: 10.20471/acc.2022.61.s2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Day surgery is a term that refers to performing an operation under anesthesia without needing to stay in the hospital for more than 24 hours. Day surgery has many advantages over surgery that involves a multiple-day hospital stay. Anesthesia for day surgery must have a rapid onset of action, a rapid cessation of action, and be free of, or have minimal side effects. For many years, general anesthesia was believed to be the anesthesia of choice for day surgery due to the delayed onset of local anesthetic after spinal anesthesia, a much longer duration of motor function recovery after surgery with spinal anesthesia compared to general anesthesia, and a more frequent incidence of side effects with spinal anesthesia, such as urinary retention or post-puncture headache. However, with the discovery of new, shorter-acting local anesthetics, and the use of smaller-diameter spinal needles, spinal anesthesia is becoming an equivalent anesthetic option for day surgery, if not a better one. Our early expiriences with spinal anesthesia in day surgery are excellent.
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Affiliation(s)
- Tihana Magdić Turković
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Goran Sabo
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Slaven Babić
- Clinic for Traumatology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Siniša Šoštarić
- Akromion, Special Hosiptal for Orthopaedic Surgery and Traumatology, Krapinske Toplice, Croatia
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Kovačević I, Kogler VM, Turković TM, Dunkić LF, Ivanec Ž, Petek D. Self-care of chronic musculoskeletal pain - experiences and attitudes of patients and health care providers. BMC Musculoskelet Disord 2018. [PMID: 29514616 PMCID: PMC5842573 DOI: 10.1186/s12891-018-1997-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-care is often the first choice for people with chronic musculoskeletal pain. Self-care includes the use of non-prescription medications with no doctor's supervision, as well as the use of other modern and traditional treatment methods with no consultation of the health care provider. Self-care may have positive effects on the successful outcome of a multidisciplinary approach to treatment. The aim of this study was to investigate the experiences and attitudes of patients and health care providers to the self-care of chronic musculoskeletal pain. METHODS Qualitative Phenomenological study, where the data were collected by the method of an audio-taped interview in 15 patients at the outpatient clinic for pain management and in 20 health care providers involved in the treatment of those patients. The interviews were transcribed verbatim and analyzed by principles of Interpretative Thematic Analysis. RESULTS Topics identified in patients: a) positive aspects of self-care, b) a need for pain self-care, c) social aspects of pain self-care. Topics identified in health care providers: a) aspects of self-care, b) a need for self-care c) risks of self-care. Most of patients have positive attitude to self-care and this is the first step to pain management and to care for itself. The most frequent factors influencing decision about the self-care are heavy pain, unavailability of the doctor, long awaiting time for the therapy, or ineffectiveness of methods of conventional medicine. The health care providers believe that self-care of chronic musculoskeletal pain may be a patient's contribution to clinical treatment. However, good awareness of methods used is important in this context, to avoid adverse effects of self-care. CONCLUSION Patients understand the self-care of musculoskeletal pain as an individually adjusted treatment and believe in its effectiveness. Health care providers support self-care as an adjunction to clinical management only, and think that self-care of musculoskeletal pain acts as a placebo, with a short-lived effect on chronic musculoskeletal pain.
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Affiliation(s)
- Irena Kovačević
- University of Applied Health Sciences, Mlinarska 38, 10 000, Zagreb, Croatia.
| | | | | | - Lidija Fumić Dunkić
- Sisters of Charity University Hospital Centre, Vinogradska cesta 29, Zagreb, Croatia
| | - Željko Ivanec
- Sisters of Charity University Hospital Centre, Vinogradska cesta 29, Zagreb, Croatia
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia
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Magdić Turković T, Obraz M, Zlatić Glogoški M, Juranić I, Bodulica B, Kovačić J. Incidence, Etiology and Outcome of Ventilator-Associated Pneumonia in Patients with Percutaneous Tracheotomy. Acta Clin Croat 2017; 56:99-109. [PMID: 29120150 DOI: 10.20471/acc.2017.56.01.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although the incidence of ventilator-associated pneumonia (VAP) is very high,
there are still many uncertainties about clinical course of VAP among tracheotomized patients. The
goal of the present study was to determine the impact of tracheotomy on VAP incidence and etiology,
as well as outcome of VAP patients with tracheotomy. The study was conducted in a 15-bed Surgical
and Neurosurgical Intensive Care Unit (ICU), Sestre milosrdnice University Hospital Center in
Zagreb, Croatia. The study included all patients undergoing only percutaneous tracheotomy during
the study period. According to our data, the incidence of VAP among percutaneous tracheotomized
patients was 42%, not considering the time between tracheotomy and VAP onset. However, when only
patients developing VAP after tracheotomy were taken into account, the incidence of VAP among
tracheotomized patients dropped to 8% only. The most commonly isolated bacterium was Staphylococcus
aureus, accounting for 17 (37%) isolates, followed by Haemophilus influenzae, accounting for
another 10 (22%) isolates. The development of VAP among percutaneously tracheotomized patients
was associated with longer total ICU stay (regardless of whether VAP developed before or after
tracheotomy), while total duration of mechanical ventilation and mortality rate remained unaffected.
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Affiliation(s)
- Tihana Magdić Turković
- Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Melanija Obraz
- Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Milana Zlatić Glogoški
- Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ida Juranić
- Opus Medicus Occupational Health and Sports Medicine, Zagreb, Croatia
| | - Bruna Bodulica
- Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Josipa Kovačić
- Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Turković TM, Lukić A, Perić M. EARLY VERSUS LATE PERCUTANEOUS TRACHEOTOMY IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE SINGLE CENTER OBSERVATIONAL STUDY. Acta Clin Croat 2016; 55 Suppl 1:33-40. [PMID: 27276770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Despite decades of experience in tracheotomy, there still exists a controversy over its ideal timing. The aim of our study was to compare the impact of early and late percutaneous tracheotomy in terms of their ability to reduce mechanical ventilation duration and length of stay in Intensive Care Unit, as well as the frequency of ventilator-associated pneumonia and mortality rates in tracheotomized patients. This retrospective observational study indicated that early tracheotomy in surgical and neurosurgical patients was associated with a reduced duration of mechanical ventilation and reduced length of stay in Intensive Care Unit, but was unable to reduce the frequency of ventilator-associated pneumonia and mortality. The reason behind the shorter duration of mechanical ventilation and shorter length of stay in Intensive Care Unit in the early tracheotomy arm was shorter duration of mechanical ventilation carried out prior to tracheotomy, while the duration of mechanical ventilation and the length of stay in Intensive Care Unit after tracheotomy were similar in both groups, suggesting that the procedure itself and not its timing influenced the duration of mechanical ventilation and the length of stay in Intensive Care Unit of tracheotomized patients.
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Turković TM, Lukić A, Pažur I, Ožegić O, Obraz M. THE IMPACT OF TRACHEOTOMY ON THE CLINICAL COURSE OF VENTILATOR-ASSOCIATED PNEUMONIA. Acta Clin Croat 2016; 55:100-109. [PMID: 27333725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is the most common infection among intensive care unit (ICU) patients. The aim of the present study was to evaluate the impact of tracheotomy on VAP clinical course. The study was conducted in a 15-bed Surgical and Neurosurgical ICU, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients developing VAP during ICU stay were eligible for the study. In VAP patients not tracheotomized during ICU stay, the mortality rate was approximately two times higher as compared with patients tracheotomized either before or after VAP onset (crude risk ratio 1.83, 95% confidence interval (95% CI) 1.15-2.91, p = 0.01; crude odds ratio 3.47, 95% CI 1.52-7.94; p = 0.003). In the surviving VAP patients, the duration of mechanical ventilation before VAP onset was higher in the "T before VAP" group as compared with the "no T before VAP" group (8, 6-10 vs. 3, 2-5; p < 0.001), but the number of post-VAP days on mechanical ventilation was shorter in "T before VAP" patients than in "no T before VAP" patients (0, 0-1 vs. 4, 3-9; p < 0.001). The duration of mechanical ventilation after VAP onset in the "T after VAP" group was longer as compared with the "T before VAP" group (4, 3-12 vs. 0, 0-1; p < 0.001). The present study indicated tracheotomy to be associated with a reduced duration of mechanical ventilation after VAP onset, but only if patients were tracheotomized at the moment of VAP onset.
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Turković TM, Grginić AG, Cucujić BĐ, Gašpar B, Širanović M, Perić M. MICROBIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERNS OF PATHOGENS CAUSING VENTILATOR- ASSOCIATED PNEUMONIA AT INTENSIVE CARE UNIT, SESTRE MILOSRDNICE UNIVERSITY HOSPITAL CENTER, ZAGREB, CROATIA. Acta Clin Croat 2015; 54:127-135. [PMID: 26415308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is very common in many intensive care Units, but there are still many uncertainties about VAP, especially about the choice of initial empiric antibiotics. The incidence of specific pathogens with different susceptibility patterns causing VAP varies from hospital to hospital. This is the reason why empiric initial antibiotic treatment for VAP should be based not only on general guidelines (that recommend therapy according to the presence of risk factors for multidrug-resistant bacteria), but also on up-to-date information on local epidemiology. The aim of this study was to determine the microbial profile of pathogens causing VAP and their antibiotic susceptibility patterns. The study was conducted in the 15-bed surgical and neurosurgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia. Retrospective data were collected from September 2009 to March 2013. All patients that developed VAP during the study period were eligible for the study. According to study results, the incidence of VAP was 29.4%. The most commonly isolated bacterium was Staphylococcus aureus (21.1%), followed by Pseudomonas aeruginosa (19.0%) and Acinetobacter species (13.6%). All Staphylococcus aureus isolates were susceptible to vancomycin and linezolid. Pseudomonas aeruginosa showed 100% susceptibility to cefepime and very high susceptibility to pip'eracillin-tazobactam (96%), ceftazidime (93%) and ciprofloxacin (89%). Ampicillin-sulbactam was highly effective for Acinetobacter species, showing resistance in only 8% of isolates. In conclusion, according to study data, appropriate empiric antibiotic therapy for patients with VAP without risk factors for multidrug-resistant bacteria is ceftriaxone and for patients with risk factors for multidrug-resistant bacteria ampicillin-sulbactam plus cefepime plus vancomycin or linezolid.
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