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Kovacevic P, Milakovic D, Kovacevic T, Barisic V, Dragic S, Zlojutro B, Miljkovic B, Vucicevic K, Rizwan Z. Thrombocytopenia risks in ARDS COVID-19 patients treated with high-dose linezolid during vvECMO therapy: an observational study. Naunyn Schmiedebergs Arch Pharmacol 2024:10.1007/s00210-024-03136-1. [PMID: 38713258 DOI: 10.1007/s00210-024-03136-1] [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] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
Patients treated with ECMO are at great risk of nosocomial infections, and around 10% of isolates are gram-positive pathogens. Linezolid (LZD) is effective in the treatment of these infections but appropriate dosing is challenging. The aim was to evaluate the occurrence of thrombocytopenia during ECMO when treated with LZD. An LZD trough concentration of 8 mg/L was set as the cutoff value for thrombocytopenia occurrence among critically ill patients who received parenteral LZD therapy at a dose of 600 mg every 8 h during ECMO. Eleven patients were included in this prospective observational study. Median LZD trough concentrations were 7.85 (interquartile range (IQR), 1.95-11) mg/L. Thrombocytopenia was found in 81.8% of patients. Based on the median LZD trough concentrations cutoff value, patients were divided into two groups, 1.95 (IQR, 0.91-3.6) and 10.3 (IQR, 9.7-11.7) mg/L, respectively. Median platelet values differed significantly between groups on admission, ECMO day 0, ECMO day 1, and LZD sampling day [194 and 152.5, (p < 0.05)], [113 and 214, (p < 0.05)], [76 and 147.5, (p < 0.01)], and [26 and 96.5, (p < 0.01)], respectively. Duration of LZD therapy was similar between the groups. Significant platelet reduction was observed in both groups, emphasizing the need for closer monitoring to prevent LZD-associated thrombocytopenia.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina.
| | - Dragana Milakovic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Vedrana Barisic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljkovic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
| | - Katarina Vucicevic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
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Kovacevic P, Dragic S, Jandric M, Momcicevic D, Malesevic V, Kovacevic T, Matejic-Spasic M, Knezevic T, Zlojutro B. Does adjunctive hemoadsorption provide benefit in the management of ischemia-reperfusion syndrome following near-drowning? A case report. Front Med (Lausanne) 2024; 11:1341156. [PMID: 38633302 PMCID: PMC11021721 DOI: 10.3389/fmed.2024.1341156] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Drowning remains a significant global health concern, claiming over 300,000 lives annually, with a disproportionate impact on young individuals in low-and middle-income countries. Conventional mechanical ventilation, while common, falls short in addressing the hypoxemia and hypercapnia often observed in severe near-drowning cases. Veno-venous extracorporeal membrane oxygenation (vvECMO) emerges as a critical intervention for cardiopulmonary failure post-drowning. This case report delves into the pivotal role of ischemia-reperfusion injury (IRI) in a near-drowning-related pathology. Following the initial insult, reoxygenation exacerbates the inflammatory cascade, resulting in a surge of pro-inflammatory mediators. In this context, CytoSorb®, a hemoadsorption cartridge, demonstrates promise by effectively removing these mediators from circulation. This report outlines its application in a critically ill adolescent patient who experienced near-drowning, presenting a compelling case for CytoSorb as an adjunctive therapy in managing IRI-induced hyperinflammation.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vedrana Malesevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - Tanja Knezevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Kovacevic P, Malic J, Kovacevic T, Dragic S, Zlojutro B, Jandric M, Momcicevic D, Cancarevic-Djajic B, Skrbic R, Rizwan MZ. Comparative Efficacy of High-Dose Dexamethasone Versus Methylprednisolone in Coronavirus Disease 2019 (COVID-19)-Associated Acute Respiratory Distress Syndrome. Cureus 2024; 16:e55725. [PMID: 38586644 PMCID: PMC10998658 DOI: 10.7759/cureus.55725] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE This retrospective (matched paired) clinical trial aimed to compare the efficacy of dexamethasone vs. methylprednisolone at equipotent (high) doses in patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). METHODS A total of 347 patients with moderate and severe COVID-19-associated ARDS were administered either a high (equipotent) dose of dexamethasone (32 mg) or methylprednisolone (180 mg) for a duration of up to 10 days. All participants received the standard of care for critically ill COVID-19 patients. RESULTS The primary outcomes included length of stay in the ICU, ICU mortality, and discharge from the hospital. Based on the obtained results, a tendency towards more favorable clinical outcomes concerning the length of stay in the ICU (in the group of patients treated with non-invasive mechanical ventilation (NIV), p<0.05), ICU mortality, and discharge from the hospital (in the group of patients who were intubated, p<0.05) in patients receiving the high dose of dexamethasone compared to those receiving methylprednisolone was observed. CONCLUSION It appears that severe cases of COVID-19, especially intubated ones, treated with high doses of dexamethasone have a more favorable clinical outcome than the use of equipotent doses of methylprednisolone. However, larger multicenter studies are needed to validate our observations.
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Affiliation(s)
- Pedja Kovacevic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Jovana Malic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Tijana Kovacevic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Sasa Dragic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Biljana Zlojutro
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Milka Jandric
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Danica Momcicevic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Branka Cancarevic-Djajic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Ranko Skrbic
- Hospital-Based Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, BIH
| | - M Zeeshan Rizwan
- Critical Care Medicine, Mayo Clinic Alix School of Medicine, Rochester, USA
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Milaković D, Kovačević T, Kovačević P, Barišić V, Avram S, Dragić S, Zlojutro B, Momčičević D, Miljković B, Vučićević K. Population Pharmacokinetic Model of Linezolid and Probability of Target Attainment in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation-A Step toward Correct Dosing. Pharmaceutics 2024; 16:253. [PMID: 38399307 PMCID: PMC10892643 DOI: 10.3390/pharmaceutics16020253] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
During veno-venous extracorporeal membrane oxygenation (vv ECMO) therapy, antimicrobial drugs are frequently used, and appropriate dosing is challenging due to there being limited data to support the dosage. Linezolid is effective against multidrug-resistant Gram-positive pathogens frequently isolated in ECMO patients. In total, 53 steady-state linezolid levels were obtained following 600 mg intravenous (IV) injections every 8 h, and these were used to develop a population pharmacokinetic (PopPK) model in patients with COVID-19-associated acute respiratory distress syndrome (CARDS) on vv ECMO. The data were analyzed using a nonlinear mixed-effects modelling approach. Monte Carlo simulation generated 5000 patients' individual PK parameters and corresponding concentration-time profiles using the PopPK model, following the administration of 600 mg/8 h (a higher-than-standard dosing) and 600 mg/12 h (standard). The probabilities of pharmacokinetic/pharmacodynamic (PK/PD) target attainment (PTA) and the cumulative fraction of responses (CFR) for three pathogens were calculated and compared between the two dosing scenarios. Linezolid 600 mg/8 h was predicted to achieve greater than or equal to 85%Tf>MIC in at least 90% of the patients with CARDS on vv ECMO compared to only approximately two thirds of the patients after dosing every 12 h at a minimal inhibitory concentration (MIC) of 2 mg/L. In addition, for the same MIC, fAUC24/MIC ≥ 80 was achieved in almost three times the number of patients following an 8-h versus a 12-h interval. PopPK simulation predicted that a significantly higher proportion of the patients with CARDS on vv ECMO would achieve the PK/PD targets following the 8-h dosing interval compared to standard linezolid dosing. Nevertheless, the safety concern, in particular, for thrombocytopenia, with higher-than-standard linezolid dosage is reasonable, and consequently, monitoring is essential.
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Affiliation(s)
- Dragana Milaković
- Department of Nuclear Medicine and Thyroid Gland Diseases, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovačević
- Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
| | - Pedja Kovačević
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Vedrana Barišić
- Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sanja Avram
- Institute of Laboratory Diagnostic, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Saša Dragić
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Danica Momčičević
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade-Faculty of Pharmacy, 11221 Belgrade, Serbia
| | - Katarina Vučićević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade-Faculty of Pharmacy, 11221 Belgrade, Serbia
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Kovacevic P, Dragic S, Jandric M, Momcicevic D, Topolovac S, Malesevic V, Kovacevic T, Matejic-Spasic M, Knezevic T, Zlojutro B. Post VV-ECMO Weaning Hyperinflammation-Can Prophylactic Hemoadsorption Treatment Prevent Complications? Medicina (Kaunas) 2023; 59:1818. [PMID: 37893535 PMCID: PMC10607931 DOI: 10.3390/medicina59101818] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Acute respiratory distress syndrome (ARDS) is a severe clinical condition characterized by acute respiratory failure and a high mortality risk despite conventional mechanical ventilatory support. Veno-venous extracorporeal membrane oxygenation (vvECMO) has emerged as an effective life-support technology for patients with ARDS. However, complications may arise following the decannulation of vvECMO, with a relatively frequent development of systemic hyperinflammation (SHI). Among the various treatment strategies for SHI, the use of hemoadsorption with CytoSorb® has shown promising results in removing excessive levels of cytokines and attenuating the hyperinflammatory response. In this case series, we present three critically ill patients with ARDS secondary to pneumonia who underwent vvECMO and subsequently received prophylactic hemoadsorption with CytoSorb® following decannulation as a part of our clinical practice. This case series aims to describe the potential positive effects of hemoadsorption in preventing the development of SHI after vvECMO decannulation in ARDS patients.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sandra Topolovac
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
| | - Vedrana Malesevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | | | - Tanja Knezevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (S.D.); (M.J.); (D.M.); (S.T.); (V.M.); (T.K.); (B.Z.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
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Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Lipman J, Ferrer R, Qiu H, Paiva JA, Povoa P, De Bus L, De Waele J, Zand F, Gurjar M, Alsisi A, Abidi K, Bracht H, Hayashi Y, Jeon K, Elhadi M, Barbier F, Timsit JF, Pollock H, Margetts B, Young M, Bhadange N, Tyler S, Ledtischke A, Finnis M, Ledtischke A, Finnis M, Dwivedi J, Saxena M, Biradar V, Soar N, Sarode V, Brewster D, Regli A, Weeda E, Ahmed S, Fourie C, Laupland K, Ramanan M, Walsham J, Meyer J, Litton E, Palermo AM, Yap T, Eroglu E, Attokaran AG, Jaramillo C, Nafees KMK, Rashid NAHA, Walid HAMI, Mon T, Moorthi PD, Sudhirchandra S, Sridharan DD, Haibo Q, Jianfeng X, Wei-Hua L, Zhen W, Qian C, Luo J, Chen X, Wang H, Zhao P, Zhao J, Wusi Q, Mingmin C, Xu L, Yin C, Wang R, Wang J, Yin Y, Zhang M, Ye J, Hu C, Zhou S, Huang M, Yan J, Wang Y, Qin B, Ye L, Weifeng X, Peije L, Geng N, Hayashi Y, Karumai T, Yamasaki M, Hashimoto S, Hosokawa K, Makino J, Matsuyoshi T, Kuriyama A, Shigemitsu H, Mishima Y, Nagashima M, Yoshida H, Fujitani S, Omori K, Rinka H, Saito H, Atobe K, Kato H, Takaki S, Hasan MS, Jamaluddin MFH, Pheng LS, Visvalingam S, Liew MT, Wong SLD, Fong KK, Rahman HBA, Noor ZM, Tong LK, Azman AH, Mazlan MZ, Ali S, Jeon K, Lee SM, Park S, Park SY, Lim SY, Goh QY, Ng SY, Lie SA, Kwa ALH, Goh KJ, Li AY, Ong CYM, Lim JY, Quah JL, Ng K, Ng LXL, Yeh YC, Chou NK, Cia CT, Hu TY, Kuo LK, Ku SC, Wongsurakiat P, Apichatbutr Y, Chiewroongroj S, Nadeem R, Houfi AE, Alsisi A, Elhadidy A, Barsoum M, Osman N, Mostafa T, Elbahnasawy M, Saber A, Aldhalia A, Elmandouh O, Elsayed A, Elbadawy MA, Awad AK, Hemead HM, Zand F, Ouhadian M, Borsi SH, Mehraban Z, Kashipazha D, Ahmadi F, Savaie M, Soltani F, Rashidi M, Baghbanian R, Javaherforoosh F, Amiri F, Kiani A, Zargar MA, Mahmoodpoor A, Aalinezhad F, Dabiri G, Sabetian G, Sarshad H, Masjedi M, Tajvidi R, Tabatabaei SMN, Ahmed AK, Singer P, Kagan I, Rigler M, Belman D, Levin P, Harara B, Diab A, Abilama F, Ibrahim R, Fares A, Buimsaedah A, Gamra M, Aqeelah A, AliAli AM, Homaidan AGS, Almiqlash B, Bilkhayr H, Bouhuwaish A, Taher AS, Abdulwahed E, Abousnina FA, Hdada AK, Jobran R, Hasan HB, Hasan RSB, Serghini I, Seddiki R, Boukatta B, Kanjaa N, Mouhssine D, Wajdi MA, Dendane T, Zeggwagh AA, Housni B, Younes O, Hachimi A, Ghannam A, Belkhadir Z, Amro S, Jayyab MA, Hssain AA, Elbuzidi A, Karic E, Lance M, Nissar S, Sallam H, Elrabi O, Almekhlafi GA, Awad M, Aljabbary A, Chaaban MK, Abu-Sayf N, Al-Jadaan M, Bakr L, Bouaziz M, Turki O, Sellami W, Centeno P, Morvillo LN, Acevedo JO, Lopez PM, Fernández R, Segura M, Aparicio DM, Alonzo MI, Nuccetelli Y, Montefiore P, Reyes LF, Reyes LF, Ñamendys-Silva SA, Romero-Gonzalez JP, Hermosillo M, Castillo RA, Leal JNP, Aguilar CG, Herrera MOG, Villafuerte MVE, Lomeli-Teran M, Dominguez-Cherit JG, Davalos-Alvarez A, Ñamendys-Silva SA, Sánchez-Hurtado L, Tejeda-Huezo B, Perez-Nieto OR, Tomas ED, De Bus L, De Waele J, Hollevoet I, Denys W, Bourgeois M, Vanderhaeghen SFM, Mesland JB, Henin P, Haentjens L, Biston P, Noel C, Layos N, Misset B, De Schryver N, Serck N, Wittebole X, De Waele E, Opdenacker G, Kovacevic P, Zlojutro B, Custovic A, Filipovic-Grcic I, Radonic R, Brajkovic AV, Persec J, Sakan S, Nikolic M, Lasic H, Leone M, Arbelot C, Timsit JF, Patrier J, Zappela N, Montravers P, Dulac T, Castanera J, Auchabie J, Le Meur A, Marchalot A, Beuzelin M, Massri A, Guesdon C, Escudier E, Mateu P, Rosman J, Leroy O, Alfandari S, Nica A, Souweine B, Coupez E, Duburcq T, Kipnis E, Bortolotti P, Le Souhaitier M, Mira JP, Garcon P, Duprey M, Thyrault M, Paulet R, Philippart F, Tran M, Bruel C, Weiss E, Janny S, Foucrier A, Perrigault PF, Djanikian F, Barbier F, Gainnier M, Bourenne J, Louis G, Smonig R, Argaud L, Baudry T, Dessap AM, Razazi K, Kalfon P, Badre G, Larcher R, Lefrant JY, Roger C, Sarton B, Silva S, Demeret S, Le Guennec L, Siami S, Aparicio C, Voiriot G, Fartoukh M, Dahyot-Fizelier C, Imzi N, Klouche K, Bracht H, Hoheisen S, Bloos F, Thomas-Rueddel D, Petros S, Pasieka B, Dubler S, Schmidt K, Gottschalk A, Wempe C, Lepper P, Metz C, Viderman D, Ymbetzhanov Y, Mugazov M, Bazhykayeva Y, Kaligozhin Z, Babashev B, Merenkov Y, Temirov T, Arvaniti K, Smyrniotis D, Psallida V, Fildisis G, Soulountsi V, Kaimakamis E, Iasonidou C, Papoti S, Renta F, Vasileiou M, Romanou V, Koutsoukou V, Matei MK, Moldovan L, Karaiskos I, Paskalis H, Marmanidou K, Papanikolaou M, Kampolis C, Oikonomou M, Kogkopoulos E, Nikolaou C, Sakkalis A, Chatzis M, Georgopoulou M, Efthymiou A, Chantziara V, Sakagianni A, Athanasa Z, Papageorgiou E, Ali F, Dimopoulos G, Almiroudi MP, Malliotakis P, Marouli D, Theodorou V, Retselas I, Kouroulas V, Papathanakos G, Montrucchio G, Sales G, De Pascale G, Montini LM, Carelli S, Vargas J, Di Gravio V, Giacobbe DR, Gratarola A, Porcile E, Mirabella M, Daroui I, Lodi G, Zuccaro F, Schlevenin MG, Pelosi P, Battaglini D, Cortegiani A, Ippolito M, Bellina D, Di Guardo A, Pelagalli L, Covotta M, Rocco M, Fiorelli S, Cotoia A, Rizzo AC, Mikstacki A, Tamowicz B, Komorowska IK, Szczesniak A, Bojko J, Kotkowska A, Walczak-Wieteska P, Wasowska D, Nowakowski T, Broda H, Peichota M, Pietraszek-Grzywaczewska I, Martin-Loeches I, Bisanti A, Cartoze N, Pereira T, Guimarães N, Alves M, Marques AJP, Pinto AR, Krystopchuk A, Teresa A, de Figueiredo AMP, Botelho I, Duarte T, Costa V, Cunha RP, Molinos E, da Costa T, Ledo S, Queiró J, Pascoalinho D, Nunes C, Moura JP, Pereira É, Mendes AC, Valeanu L, Bubenek-Turconi S, Grintescu IM, Cobilinschi C, Filipescu DC, Predoi CE, Tomescu D, Popescu M, Marcu A, Grigoras I, Lungu O, Gritsan A, Anderzhanova A, Meleshkina Y, Magomedov M, Zubareva N, Tribulev M, Gaigolnik D, Eremenko A, Vistovskaya N, Chukina M, Belskiy V, Furman M, Rocca RF, Martinez M, Casares V, Vera P, Flores M, Amerigo JA, Arnillas MPG, Bermudez RM, Armestar F, Catalan B, Roig R, Raguer L, Quesada MD, Santos ED, Gomà G, Ubeda A, Salgado DM, Espina LF, Prieto EG, Asensio DM, Rodriguez DM, Maseda E, De La Rica AS, Ayestaran JI, Novo M, Blasco-Navalpotro MA, Gallego AO, Sjövall F, Spahic D, Svensson CJ, Haney M, Edin A, Åkerlund J, De Geer L, Prazak J, Jakob S, Pagani J, Abed-Maillard S, Akova M, Aslan AT, Timuroglu A, Kocagoz S, Kusoglu H, Mehtap S, Ceyhun S, Altintas ND, Talan L, Kayaaslan B, Kalem AK, Kurt I, Telli M, Ozturk B, Erol Ç, Demiray EKD, Çolak S, Akbas T, Gundogan K, Sari A, Agalar C, Çolak O, Baykam NN, Akdogan OO, Yilmaz M, Tunay B, Cakmak R, Saltoglu N, Karaali R, Koksal I, Aksoy F, Eroglu A, Saracoglu KT, Bilir Y, Guzeldag S, Ersoz G, Evik G, Sungurtekin H, Ozgen C, Erdoğan C, Gürbüz Y, Altin N, Bayindir Y, Ersoy Y, Goksu S, Akyol A, Batirel A, Aktas SC, Morris AC, Routledge M, Morris AC, Ercole A, Antcliffe D, Rojo R, Tizard K, Faulkner M, Cowton A, Kent M, Raj A, Zormpa A, Tinaslanidis G, Khade R, Torlinski T, Mulhi R, Goyal S, Bajaj M, Soltan M, Yonan A, Dolan R, Johnson A, Macfie C, Lennard J, Templeton M, Arias SS, Franke U, Hugill K, Angell H, Parcell BJ, Cobb K, Cole S, Smith T, Graham C, Cerman J, Keegan A, Ritzema J, Sanderson A, Roshdy A, Szakmany T, Baumer T, Longbottom R, Hall D, Tatham K, Loftus S, Husain A, Black E, Jhanji S, Baikady RR, Mcguigan P, Mckee R, Kannan S, Antrolikar S, Marsden N, Torre VD, Banach D, Zaki A, Jackson M, Chikungwa M, Attwood B, Patel J, Tilley RE, Humphreys MSK, Renaud PJ, Sokhan A, Burma Y, Sligl W, Baig N, McCoshen L, Kutsogiannis DJ, Sligl W, Thompson P, Hewer T, Rabbani R, Huq SMR, Hasan R, Islam MM, Gurjar M, Baronia A, Kothari N, Sharma A, Karmakar S, Sharma P, Nimbolkar J, Samdani P, Vaidyanathan R, Rubina NA, Jain N, Pahuja M, Singh R, Shekhar S, Muzaffar SN, Ozair A, Siddiqui SS, Bose P, Datta A, Rathod D, Patel M, Renuka MK, Baby SK, Dsilva C, Chandran J, Ghosh P, Mukherjee S, Sheshala K, Misra KC, Yakubu SY, Ugwu EM, Olatosi JO, Desalu I, Asiyanbi G, Oladimeji M, Idowu O, Adeola F, Mc Cree M, Karar AAA, Saidahmed E, Hamid HKS. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med 2023; 49:178-190. [PMID: 36764959 PMCID: PMC9916499 DOI: 10.1007/s00134-022-06944-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. METHODS We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. RESULTS 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. CONCLUSIONS HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia. .,Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France
| | | | - Stéphane Ruckly
- Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France.,ICUREsearch, Biometry, 38600, Fontaine, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK.,JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Jeffrey Lipman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Nimes University Hospital, University of Montpellier, Nimes, France.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal.,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Infection and Sepsis ID Group, Porto, Portugal
| | - Pedro Povoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.,Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Liesbet De Bus
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Adel Alsisi
- ICU Department, Prime Hospital, Dubai, United Arab Emirates.,Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalid Abidi
- Medical ICU, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hendrik Bracht
- Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda General Hospital, Kamogawa, Japan
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de L'Hôpital, 45100, Orléans, France
| | - Jean-François Timsit
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Omdurman maternity hospitalrue Henri Huchard, 75877, Paris Cedex, France
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Kovacevic P, Djajic V, Momcicevic D, Zlojutro B, Jandric M, Kovacevic T, Latinovic M, Seranic A, Bokonjic D, Skrbic R, Dragic S. Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience. J Public Health Res 2023; 12:22799036231151762. [PMID: 36718459 PMCID: PMC9880146 DOI: 10.1177/22799036231151762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
Background Response to the outbreak of poliomyelitis in mid-1950 led to recognition and consequent development of critical care. Seventy years later the humankind was struck by COVID-19, another major challenge for critical care medicine which was especially big in Low-Resources-Settings where more than two thirds of the world population live, including the population of the Republic of Srpska (RS). Design and methods The main aim was to show an overview of all interventions in order to boost hospitals' capacities to the level which is sufficient to manage high amount of critically ill COVID-19 patients in the RS. A before-after cohort study design was conducted to evaluate the effects of interventions for increase in preparedness and capacity of ICUs for admission and treatment of COVID-19 critically ill patients in nine hospitals in the RS. Results: Following interventions, the biggest and university affiliated hospital in the RS has increased ICU capacities: total number of ICU beds increased by 38% and number of ventilators by 114%. Availability of machines for veno-venous extracorporeal membrane oxygenation (vvECMO) increased by 100%. Number of doctors who were involved in treatment of critically ill patients increased by 47% and nurse/patient's ratio reached 1:2.5. Similarly, all other hospitals experienced boosting of ICU beds by 189% and ventilators by 373% while number of doctors increased by 108% and nurse/patient's ratio reached 1:4. Conclusion All interventions implemented during COVID-19 pandemic outbreak in the RS resulted in increasing capacity for treatment of critically ill patients, but the education of health care professionals was identified as the most important conducted intervention.
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Affiliation(s)
- Pedja Kovacevic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Pedja Kovacevic, Univeristy Clinical Centre
of the Republic of Srpska, Filipa Kljajica Fice 49, Banja Luka 78000, The
Republic of Srpska, Bosnia and Herzegovina.
| | - Vlado Djajic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Milka Jandric
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Milan Latinovic
- Ministry of Health and Social Welfare
of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and
Herzegovina
| | - Alen Seranic
- Ministry of Health and Social Welfare
of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and
Herzegovina
| | - Dejan Bokonjic
- Medical Faculty Foča, University of
East Sarajevo, Foča, The Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Skrbic
- Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Sasa Dragic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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8
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Zlojutro B, Jandric M, Momcicevic D, Dragic S, Kovacevic T, Djajic V, Stojiljkovic MP, Skrbic R, Djuric DM, Kovacevic P. Dynamic changes in coagulation, hematological and biochemical parameters as predictors of mortality in critically ill COVID-19 patients: A prospective observational study. Clin Hemorheol Microcirc 2023; 83:137-148. [PMID: 36373312 DOI: 10.3233/ch-221583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/09/2022]
Abstract
INTRODUCTION This study was created to analyze dynamic alterations in coagulation, hematological and biochemical parameters and their association with mortality of COVID-19 patients. To identify the most sensitive biomarkers as predictors of mortality more research is required. METHODS The present study was a prospective, one-year-long observational study conducted on all critically ill, COVID-19 patients with respiratory failure. The following data were collected: demographic and clinical characteristics of the study population, comorbidities, coagulation, biochemical and hematological parameters. The primary outcome was the proportion of patients who died. RESULTS 91 patients with median age 60 (50-67), 76.9% male, met the acute respiratory distress syndrome criteria. It was tested whether dynamic change (delta-Δ) of parameters that were found to be predictors of mortality is independently associated with poor outcome. Adjusted (multivariate) analysis was used, where tested parameters were corrected for basic and clinical patients characteristics. The only inflammatory parameter which dynamic change had statistically significant odds ratio was ΔCRP (p < 0.005), while among coagulation parameters statistically significant OR was found for Δ fibrinogen (p < 0.005) in predicting mortality. CONCLUSION Monitoring of coagulation, hematological and biochemical parameters abnormalities and their dynamical changes can potentially improve management and predict mortality in critically ill COVID -19 patients.
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Affiliation(s)
- Biljana Zlojutro
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Milka Jandric
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Sasa Dragic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Milos P Stojiljkovic
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Skrbic
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pedja Kovacevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
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9
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Kovacevic P, Topolovac S, Dragic S, Jandric M, Momcicevic D, Zlojutro B, Kovacevic T, Loncar-Stojiljkovic D, Djajic V, Skrbic R, Ećim-Zlojutro V. Characteristics and Outcomes of Critically Ill Pregnant/Postpartum Women with COVID-19 Pneumonia in Western Balkans, The Republic of Srpska Report. Medicina (B Aires) 2022; 58:medicina58121730. [PMID: 36556932 PMCID: PMC9781202 DOI: 10.3390/medicina58121730] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. As of 5 March 2020, the COVID-19 pandemic has resulted in approximately 111,767 cases and 6338 deaths in the Republic of Srpska and 375,554 cases and 15,718 deaths in Bosnia and Herzegovina. Our objective in the present study was to determine the characteristics and outcomes of critically ill pregnant/postpartum women with COVID-19 in the Republic of Srpska. Materials and Methods: The retrospective observational study of prospectively collected data included all critically ill pregnant/postpartum women with COVID-19 in a university-affiliated hospital between 1 April 2020 and 1 April 2022. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Patients' demographics, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analysed. Results: Out of the 153 registered pregnant women with COVID-19 treated at the gynaecology department of the University Clinical Centre of the Republic of Srpska, 19 (12.41%) critically ill pregnant/postpartum women (median age of 36 (IQR, 29-38) years) were admitted to the medical intensive care unit (MICU). The mortality rate was 21.05% (four patients) during the study period. Of all patients (19), 14 gave birth (73.68%), and 4 (21.05%) were treated with veno-venous extracorporeal membrane oxygenation (vvECMO). Conclusions: Fourteen infants were born prematurely and none of them died during hospitalisation. A high mortality rate was detected among the critically ill pregnant/postpartum patients treated with mechanical ventilation and vvECMO in the MICU. The preterm birth rate was high in patients who required a higher level of life support (vvECMO and ventilatory support).
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Correspondence:
| | - Sandra Topolovac
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | | | - Vlado Djajic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Ranko Skrbic
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Vesna Ećim-Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
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Kovacevic P, Dragic S, Kovacevic T, Zlojutro B, Jandric M, Momcicevic D. Does the Prolonged Duration of Continuous Ambulatory Peritoneal Dialysis Affect the Serum Levels of Endothelin-1 and Nitric Oxide? Saudi J Kidney Dis Transpl 2022; 33:31-36. [PMID: 36647976 DOI: 10.4103/1319-2442.367823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
End-stage renal disease and its treatment with continuous ambulatory peritoneal dialysis (CAPD) can affect almost all organs and organ systems including vascular endothelium. Consequently, disturbance in the production of vasoactive substances endothelin-1 (ET-1) and nitric oxide (NO) occurs in these patients. There are only a small number of studies that investigated the impact of long-term CAPD on imbalance in production of vasoactive substances ET-1 and NO among these patients. Therefore, our study aimed to investigate the impact of duration of CAPD on potential overproduction of ET-1 and NO in uremic patients. This study included 23 uremic patients [10 males, mean age: 56.3 (±16.2) years] treated with CAPD. All studied patients were further divided into subgroups, groups A and B. Group A included patients on treatment with CAPD <5 years, and group B included those on treatment longer than five years. Our results showed that serum levels of these vasoactive substances are significantly higher among patients treated with CAPD longer than five years (ET-1: 51.24 ± 32.11 vs. 139.53 ± 42.42; NO: 15.50 ± 2.57 vs. 26.57 ± 5.96, respectively). We concluded that imbalance in production of vasoactive substances is present in long-term CAPD treatment and this imbalance can lead to disturbance in the local blood flow control.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska; Intensive Care Medicine Department, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska; Intensive Care Medicine Department, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
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Kovacevic P, Dragic S, Zlojutro B, Jandric M, Kovacevic T, Momcicevic D, Gasic B, Meyer J. Impact of prolonged duration of different types of renal replacement therapies on serum levels of endothelin-1 and pulmonary function tests. Folia Med (Plovdiv) 2021; 63:738-744. [DOI: 10.3897/folmed.63.e56682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/06/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction: This study was carried out to investigate the impact of duration of different renal replacement therapies such as hemodialysis and continuous ambulatory peritoneal dialysis on potential overproduction of endothelin-1 (ET-1) and pulmonary function tests in these patients.
Materials and methods: The study included 26 patients (14 males, mean age 54.9±16.2 years) with end stage renal diseases (ESRD) receiving regular hemodialysis (HD) and 23 patients (10 males, mean age 55.8±15.8 years) with ESRD treated with continuous ambulatory peritoneal dialysis (CAPD). The spirometry values were recorded before the onset of HD and prior to emptying the peritoneal cavity in CAPD patients and ET-1 was measured using the enzyme immunoassay (EIA) methodology. Two groups of patients (groups 1 and 2) were further divided into subgroups (group A and group B). Groups A (1-A and 2-A) included patients treated with any type of renal replacement therapy (RRT) (HD or CAPD) less than 5 years, and groups B (1-B and 2-B) included patients treated with any type of RRT (HD or CAPD) longer than 5 years.
Results: Patients treated with HD or CAPD for more than five years were found to have significantly higher serum levels of ET-1 (HD = 41.49±21.28 vs. 185.13±73.67, p<0.01; PD = 51.24±32.11 vs. 139.53±42.42, p<0.01, respectively). Values of most pulmonary function parameters differed significantly between groups treated longer or shorter than 5 years: FVC (HD = 108.4±13.34 vs. 80.82±11.26, p<0.01; CAPD = 97.20±18.99 vs. 73.25±10.73, p<0.01, respectively), FEV1 (HD = 108.33±15.8 vs. 76.73±4.9, p<0.01; CAPD = 100.67±18.31 vs. 66.75±6.25, p<0.01, respectively).
Conclusions: Prolonged duration of any type of renal replacement therapy is associated with higher serum levels of ET-1 and with lower pulmonary function tests in ESRD patients.
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Dragic S, Momcicevic D, Zlojutro B, Jandric M, Kovacevic T, Djajic V, Gajic O, Kovacevic P. Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series. Clin Med Insights Case Rep 2021; 14:11795476211025138. [PMID: 34248359 PMCID: PMC8239986 DOI: 10.1177/11795476211025138] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hydrogen ion concentration which is expressed as pH value is in human blood maintained in narrow physiological range (7.36-7.44 in arterial blood). This range is crucial for normal functioning of most biochemical reactions. Extreme acidosis with pH < 6.8 is incompatible with life, unless pathophysiologic process is rapidly reversed. Timely, standardized, and structured approach to assessment and management of extreme critical illness is essential to maximize the chances of patient's survival. CASES We present a series of 3 critically ill patients admitted to Medical intensive care unit (MICU) diagnosed with extreme metabolic acidosis (pH ⩽ 6.8). Each patient was treated using Checklist for Early Recognition and Treatment of Acute Illness and INjury (CERTAIN) which is a standard decision support tool in our MICU. Causes of extreme metabolic acidosis included hemorrhagic shock, sepsis, and acute renal failure and diabetic ketoacidosis. Rapid assessment, prompt resuscitation (IV fluids, vasopressors, mechanical ventilation, and renal replacement), and application of specific causal treatment led to positive outcomes in all 3 patients. DISCUSSION Medical physiology textbooks set the lower limit of pH value at which life is possible to 6.8. However, examples from clinical practice show that if adequate resuscitation measures are taken early in the acute phase of the disease, the biochemical cascade of reactions that are considered irreversible (at pH ⩽ 6.8) may be reversed after all. CONCLUSION Critical care approach to extreme metabolic acidosis is a prime example of applied clinical physiology where basic science and clinical practice connect. With these case series we show that timely and structured approach to critical illness shifts the boundaries of reversibility for some of the most severe physiologic derangements.
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Affiliation(s)
- Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Clinical Pharmacy, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajic
- Management, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
| | | | - Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
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Kovacevic P, Jandric M, Kovacevic T, Momcicevic D, Zlojutro B, Baric G, Dragic S. Impact of Checklist for Early Recognition and Treatment of Acute Illness on Treatment of Critically Ill Septic Patients in a Low-Resource Medical Intensive Care Unit. Microb Drug Resist 2021; 27:1203-1206. [PMID: 33739869 DOI: 10.1089/mdr.2020.0454] [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: 11/13/2022] Open
Abstract
Introduction: Treatment of sepsis and septic shock can be a challenge even for intensive care units (ICUs) in high income countries, but it is especially difficult for ICUs with limited resources. Aim: To evaluate the impact of CERTAIN on treatment of critically ill septic patients in low-resource medical ICU. Materials and Methods: In a before-and-after study design, we compared clinical outcomes, processes, and complications (hospital acquired infections) 1 year before and 2 years after (2016 and 2017) introduction of CERTAIN. Results: A total of 125 patients with sepsis were prospectively identified for a 3-year period. Mean patient age, gender distribution, number of patients on mechanical ventilation (33 [76.7%] vs. 42 [84%] vs. 24 [75%]) and vasopressor use (23 [53.5%] vs. 34 [68%] vs. 24 [75%]) were similar before (2015) and 2 years after (2016 and 2017) the implementation of CERTAIN. Severity of illness (Simplified Acute Physiology Score II [SAPS II score]) was higher after the implementation. The checklist was incorporated in the daily practice with 100% adherence to its use. The duration of mechanical ventilation (5.3 ± 5.3 vs. 4.2 ± 3.6 vs. 3.7 ± 5.5), antibiotic treatment (8.2 ± 5.4 vs. 6.9 ± 4.1 vs. 5.8 ± 5.6), central venous catheter use (6.2 ± 5.7 vs. 5.7 ± 4.6 vs. 4.2 ± 6.1), ICU stay (8.4 ± 5.4 vs. 7.1 ± 4.1 vs. 5.8 ± 5.6), and the incidence of nosocomial infection (33.3% vs. 30% vs. 12.5%) decreased in the period after the onset of the intervention, but the results did not reach statistical significance. When adjusted for baseline characteristics, CERTAIN was not associated with hospital mortality (odds ratio 0.88, 0.38-2.04). Conclusion: CERTAIN was readily adopted in the ICU workflow and was associated with improvement in treatment of critically ill patients with sepsis.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Clinical Pharmacy, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Goran Baric
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Dragic S, Momcicevic D, Zlojutro B, Jandric M, Kovacevic T, Djajic V, Gajic A, Talic G, Kovacevic P. Impact of risk factors on serum levels of vasoactive substances in patients with peripheral arterial occlusive disease at different Fontaine’s stages. Acta Angiologica 2021. [DOI: 10.5603/aa.2020.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kovacevic P, Matijasevic J, Dragic S, Zlojutro B, Gavrilovic S, Jandric M, Andrijevic A, Kovacevic T, Carapic V, Travar M, Preradovic L, Momcicevic D. Characteristics and outcomes of critically ill patients with influenza A (H1N1) in the Western Balkans during the 2019 post-pandemic season. Indian J Med Microbiol 2020; 38:415-420. [PMID: 33154256 DOI: 10.4103/ijmm.ijmm_20_169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background This study looked at the characteristics and outcomes of critically ill patients with confirmed influenza A (H1N1) pdm09 infection in the Western Balkans in the post-pandemic period. Materials and Methods This retrospective observational study of medical records and associated data collected during the post-pandemic period included all mechanically ventilated adult patients of two university-affiliated hospitals of the Western Balkans between 1 January and 31 March 2019 who had influenza A (H1N1) pdm09 infection confirmed by real-time reverse transcriptase-polymerase chain reaction from nasopharyngeal swab specimens and respiratory secretions. Results The study included 89 patients, 49 males (55.1%), aged 56.09 ± 12.64 years. The median time from shift from hospital time to intensive care unit was 1 day (range: 1-2). In the post-pandemic period, cases observed in this study were found to have the following comorbidities: cardiovascular diseases in 44 (49.4%) patients and diabetes in 21 (23.6%) patients. Thirty-one patients (34.8%) in this study were obese. All 89 patients (100%) experienced some degree of acute respiratory distress syndrome, and 39 (44%) had multiorgan failure. Eighty-three patients (93%) were intubated and mechanically ventilated, 6 (7%) received non-invasive mechanical ventilation, 12 (13%) were treated with vvECMO and 36 (40%) received renal replacement therapy. Vasoactive support was needed by 56 (63%) patients. The median duration of mechanical ventilation was 9 (6-15.5) days. The hospital mortality rate was 44%. Conclusion Critically ill patients with confirmed influenza A (H1N1) pdm09 infection in the post-pandemic season were older, required vasoactive drugs more often, and there was a trend of higher survival compared to H1N1 infection patients in the previous pandemic seasons.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska; Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina, Novi Sad, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Srdjan Gavrilovic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Ana Andrijevic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Tijana Kovacevic
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina; Department of Pharmacy, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Vladimir Carapic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Maja Travar
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina; Department of Microbiology, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Ljubisa Preradovic
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina, Novi Sad, Serbia
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
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Dragic S, Momcicevic D, Zlojutro B, Jandric M, Kovacevic T, Djajić V, Gajić A, Talić G, Kovacevic P. Serum levels of nitric oxide and endothelin-1 in vasculopathy managed with hyperbaric oxygen therapy. Clin Hemorheol Microcirc 2020; 75:233-241. [PMID: 32116239 DOI: 10.3233/ch-190796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/03/2023]
Abstract
Roles of nitric oxide (NO) and endothelin-1 (ET-1) in the local regulation of blood flow under physiological conditions are important and well known, while data on their effects and interactions in conditions of hyperbaric hyperoxia is still insufficient. This was a prospective observational study which included patients who underwent hyperbaric oxygen therapy (HBOT) in accordance with existing therapeutic protocol for peripherial arterial disease (PAD) during time period of six months, between january and july of 2016. Clinical stage of PAD according to Fontain was taken into account, as well as risk factors, demographic, anthropometric and clinical characteristics of studied patients. The study included 64 patients with a mean age (±Sd) 60.2±12.7 years, of whom 28 were female. Patients' NO serum levels in all observed categories before and after HBOT were not signifficantly different, except for stage II PAD (NObefore HBOT 21.9±9.6 vs. NOafter HBOT 26.2±12.1 (p = 0.04)). On the contrary, in all studied patients ET-1 level increased signifficantly after HBOT (ET-1before HBOT 4.2±11.6 vs. ET-1after 18.3±21.0 (p < 0.001)). Treatment of PAD using HBOT leads to the predominance of vasoconstrictor effects probably caused by elevation of serum ET-1 concentrations, while other factors such as exposure time to hyperbaric conditions, activation of antioxidant molecules, and the influx of other interfering substances must be considered in interpreting the effects of NO molecules.
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Affiliation(s)
- Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.,Pan- European University "Apeiron", College of Health Sciences, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Pharmacy Department, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajić
- Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Aleksandar Gajić
- Institute for the Physical Medicine and Rehabilitation "dr. Miroslav Zotovic" Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Goran Talić
- Institute for the Physical Medicine and Rehabilitation "dr. Miroslav Zotovic" Banja Luka, Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
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Kovacevic P, Zlojutro B, Kovacevic T, Baric G, Dragic S, Momcicevic D. Microorganisms Profile and Antibiotics Sensitivity Patterns in the Only Medical Intensive Care Unit in Bosnia and Herzegovina. Microb Drug Resist 2019; 25:1176-1181. [PMID: 31120362 DOI: 10.1089/mdr.2018.0458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/29/2022] Open
Abstract
Treatment of critically ill patients entails a great risk for intrahospital infections. Systematic monitoring of intrahospital infection data is a widely used practice in developed countries, while in developing and underdeveloped countries these data are scarce. In Bosnia and Herzegovina, a developing country, precise data cannot be found; hence, this study was created with the aim to monitor the profile and resistance patterns of microorganisms isolated from patients being treated in the only medical intensive care unit (MICU) in the country. This is a retrospective observational study of microorganisms isolated from all patients treated at MICU in the University Clinical Center of Republic of Srpska from January 1 through December 31, 2017. Analysis of all samples was performed using standardized microbiological procedures, while sensitivity to antimicrobials was performed using the disk diffusion method. One thousand six hundred twenty-five samples were taken from 633 critically ill patients and sent off for analysis; 572 were positive for bacteria (35.2%). Gram-negative bacteria were isolated more frequently (65.2%), specifically Acinetobacter baumannii (25.5%), followed by Klebsiella spp. (10.8%). A. baumannii was resistant to all antibiotics except for colistin, to which it was highly sensitive (99.7%). It was moderately sensitive (76%) to rifampicin. Staphylococcus epidermidis, Staphylococcus aureus, and Enterococci were the most prevalent Gram-positive bacteria (15%, 7.3%, and 9.2%, respectively) isolated in this study. It is clear from this study that Gram-negative bacteria are predominant in the newly established MICU. A. baumannii was found to be the most prevalent Gram-negative bacteria, and S. epidermidis was the most prevalent Gram-positive bacteria.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina.,Medical School, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina.,Medical School, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Goran Baric
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina.,Pan-European University "Apeiron," Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina.,Medical School, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Kojicić M, Kovacević P, Bajramović N, Batranović U, Vidović J, Aganović K, Gavrilović S, Zlojutro B, Thiery G. Characteristics and outcome of mechanically ventilated patients with 2009 H1N1 influenza in Bosnia and Herzegovina and Serbia: impact of newly established multidisciplinary intensive care units. Croat Med J 2013; 53:620-6. [PMID: 23275328 PMCID: PMC3541588 DOI: 10.3325/cmj.2012.53.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To describe characteristics and outcome of mechanically ventilated patients admitted to three newly established intensive care units (ICU) in Bosnia-Herzegovina and Serbia for 2009 H1N1 influenza infection. Methods The retrospective observational study included all mechanically ventilated adult patients of three university-affiliated hospitals between November 1, 2009 and March 1 2010 who had 2009 H1N1 influenza infection confirmed by real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Results The study included 50 patients, 31 male (62%), aged 43 ± 13 years. Median time from hospital to ICU admission was 1 day (range 1-2). Sixteen patients (30%) presented with one or more chronic medical condition: 8 (16%) with chronic lung disease, 5 (10%) with chronic heart failure, and 3 (6%) with diabetes mellitus. Thirty-two (64%) were obese. Forty-eight patients (96%) experienced acute respiratory distress syndrome (ARDS), 28 (56%) septic shock, and 27 (54%) multiorgan failure. Forty-five patients (90%) were intubated and mechanically ventilated, 5 received non-invasive mechanical ventilation, 7 (14%) high-frequency oscillatory ventilation, and 7 (14%) renal replacement therapy. The median duration of mechanical ventilation was 7 (4-14) days. Hospital mortality was 52%.
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Affiliation(s)
- Marija Kojicić
- Medical Intensive Care Unit, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
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