Background: ICU prognostic scores were developed to measure the severity of the disease and the p... more Background: ICU prognostic scores were developed to measure the severity of the disease and the patients' prognosis. The objective of this study was to assess the validity of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores in patients with septic shock. Methods: The APACHE II, SOFA and SAPS II scores were determined prospectively, in the first 24 hours after admission, for all 56 patients with septic shock who were included in this study. Data were statistically evaluated; the discriminating power regarding survivors vs deceased patients was calculated based on the receiver operating characteristic curves (ROC). Results: The overall mortality of the 56 patients with septic shock was 60.71% (34 deaths). The average APACHE II score was 25.36 ± 7.477. The average SOFA score was 7.679 ± 3.197. The average SAPS II score was 44.45 ± 16.97. For the APACHE II and SOFA scores the differences when deceased and survivors were compared were not statistically significant (APACHE II: 26.76 ± 6.742 vs 23.18 ± 8.175 respectively for SOFA: 8.029 ± 3.099 vs 7.136 ± 3.342). For the SAPS II score the values are: 49.12 ± 16.61 in deceased vs 37.23 ± 15.20 in survivors, the difference being statistically significant (p = 0.0092). The areas under ROC for the three scores are 0.622 for APACHE II, 0.575 for SAPS II and 0.705 for SOFA. Conclusions: In our study the SAPS II score was superior to the other scores for predicting survival in patients with septic shock.
Acute pancreatitis can develop in patients with shock due to the underlying diseases, surgical in... more Acute pancreatitis can develop in patients with shock due to the underlying diseases, surgical interventions or because of severe hypoperfusion. The aim of our work was to study the histological alterations of the pancreas in patients dying after cardiogenic, hypovolemic or septic shock, to demonstrate the presence and severity of pancreatic injury. We performed a retrospective study which included patients who died and who were autopsied after different types of shock, hospitalized between 2007-2009 in general and cardiac intensive care units. We excluded the patients with known pancreatic diseases. From 223 patients included in our study 39 presented necrotising hemorrhagic alteration of the pancreatic tissue. There were no differences in histological and immunohistochemical findings between the different etiopathogenetic types of shock. None of the patients had characteristic clinical signs for acute pancreatitis. The digestive symptoms, they presented, could be related to the underlying disease or to postoperative state. The common findings in these patients were prolonged and severe hypotension, associated renal dysfunction, leucocytosis, hyperglycemia and hypocalcemia. Pancreatitis can occur in patients with shock, due to prolonged hypoperfusion of the pancreas. It is difficult to diagnose it because clinical signs are altered due to severity of underlying disease or analgo-sedation commonly used in intensive care. We therefore recommend in patients with shock to consider the possible development of ischemic pancreatitis for prompt and efficient treatment.
Trauma affects the activity of the innate immune system. The objective of this case report is to ... more Trauma affects the activity of the innate immune system. The objective of this case report is to present the case that prompted us to analyse all the peripheral white blood cell lines. A 19 year old male patient was admitted to the Intensive Care Clinic with severe head trauma. The final diagnosis was set to be severe cerebral trauma with subarachnoid hemorrhage, right frontal and temporal cerebral contusions, diffuse cerebral edema, left parietal and temporal fracture, sphenoid hemosinus and right sided lung contusions.: Whole blood was immediatly analyzed by flow cytometry for leukocytes. Apoptosis was detected with Annexin V, necrotic cells were stained with propidium iodide. Samples were drawn three consecutive days.: Lymphocytes, monocytes and granulocytes all showed marked increase in viability and decrease in necrosis during the biological monitoring in correlation with a positive clinical outcome. The most important changes were noted in the monocyte population.: Although we...
Background: Sepsis is the leading cause of morbidity and mortality in intensive care units. This ... more Background: Sepsis is the leading cause of morbidity and mortality in intensive care units. This study explored the possible role of vascular endothelial growth factor-C (VEGF-C) and podoplanin (PDPN) in sepsis. Methods: 22 Wistar rats were divided into three groups: two experimental (Group A and B, n=8/8) and a control (Group C, n=6). Sepsis was induced with intraperitoneal injection of ESBL (extended-spectrum beta-lactamases)-producing E-coli live bacteria for group A and with lipopolysaccharide for group B. Sterile saline solution was injected for group C. Blood samples were collected after 24 hours to determine the serum level of VEGF-C, and PDPN expression was examined in liver, kidney, and lung tissues. Bacteremia was assessed for group A. Results: Higher serum levels of VEGF-C were found in Group A vs C (p=0.05) and group B vs. C (p=0.004), respectively.VEGF-C was also increased in animals with negative- vs. positive blood cultures from group A (p=0.04) and from group B vs. t...
The first and most important step in pain management is to correctly assess it. Short-form McGill... more The first and most important step in pain management is to correctly assess it. Short-form McGill Pain Questionnaire-2(SF-MPQ-2) and Multidimensional Pain Evaluation Scale (MPES) are valid and reliable tools used in clinical practice and research. Our aim was to evaluate the efficacy of pharmacological and non-pharmacological treatments applied for pain relief. 27 patients were included in the study, of which 12 were outpatients and 15 were inpatients. Statistical and clinical significant differences were obtained only for the inpatient group on the MPES (p=0.00, difference between means=3.07) and for 3 out of 4 domains of the SF-MPQ-2 (p=0.01, 0.01 and 0.00 and the difference between means=2.60, 2.00 and 2.20 for continuous pain, neuropathic pain and affective descriptors, respectively). Outcomes of pain management are better for inpatients due to a combination of analgesic drugs with physical medicine and rehabilitation procedures and a strict monitoring during their hospitalization.
Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team ... more Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the pro...
Introduction: No definitive answer has been given to the question ‘who should teach cardiopulmona... more Introduction: No definitive answer has been given to the question ‘who should teach cardiopulmonary resuscitation?’ Healthcare professionals and high school teachers are mostly the trainers, but medical students are increasingly being used for this purpose. Methods: We divided 296 high school students in three groups based on trainer professional level. Medical students, anaesthesia and intensive care residents, and anaesthesia and intensive care specialists provided basic life support training. We tested their theoretical knowledge with the help of a multiple-choice question questionnaire and practical abilities with the help of a medical simulator, recording chest compression frequency as the primary outcome parameter. Results: The study shows comparable results in all groups, with the exception of the chest compression frequency which was higher in the students’ and residents’ groups (students: 134.7/min ± 14.1; residents: 137.9/min ± 15.9; specialists: 126.3/min ± 19.3). Increas...
Objective: Mass casualty incidents and disasters require functional and efficient patient data ma... more Objective: Mass casualty incidents and disasters require functional and efficient patient data management systems, as well as smart interconnections with patient tracking applications. Various initiatives developed and tested patient field charts for large-scale events but there is no one definite general format accepted. The current research proposes an upgraded model of the official patient field chart issued by the Romanian Department for Emergency Situations in 2015 to be used for large-scale events. Measures: An upgraded model is created after a thorough content analysis, physical analysis, design upgrade and optimization process. Differences between the official and the upgraded model are measured and compared, and statistical computations are carried out. Results: The main distinctive features of the patient field chart are dynamic triage, unique code identification, QR visual codes, wireless tags and irreversible clear contamination status highlighting. The upgrade process r...
Objective: The main aim of the study was to explore muscle mass changes and to investigate muscul... more Objective: The main aim of the study was to explore muscle mass changes and to investigate musculoskeletal inflammation in critically ill patients. Methods: A pure observational study that comprised two musculoskeletal analyses was conducted. Ultrasonography was used to determine the inflammatory process and muscle mass modifications. We assessed the presence of musculoskeletal inflammation and muscles area reduction. We recruited 26 patients and we performed both imaging investigations (shoulder and hip joints, biceps brachii and rectus femoris areas) and anthropometric measurements (mid-upper arm circumference). Results: More than 70% of patients were classified with low muscle mass, over one half of sarcopenic patients being over-weight and 17% being obese. The relationship between the length of stay in intensive care unit, mechanical ventilation and presence of low mid-upper arm circumference, highlighted a significant difference when comparing sarcopenic and non-sarcopenic grou...
Background: ICU prognostic scores were developed to measure the severity of the disease and the p... more Background: ICU prognostic scores were developed to measure the severity of the disease and the patients' prognosis. The objective of this study was to assess the validity of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores in patients with septic shock. Methods: The APACHE II, SOFA and SAPS II scores were determined prospectively, in the first 24 hours after admission, for all 56 patients with septic shock who were included in this study. Data were statistically evaluated; the discriminating power regarding survivors vs deceased patients was calculated based on the receiver operating characteristic curves (ROC). Results: The overall mortality of the 56 patients with septic shock was 60.71% (34 deaths). The average APACHE II score was 25.36 ± 7.477. The average SOFA score was 7.679 ± 3.197. The average SAPS II score was 44.45 ± 16.97. For the APACHE II and SOFA scores the differences when deceased and survivors were compared were not statistically significant (APACHE II: 26.76 ± 6.742 vs 23.18 ± 8.175 respectively for SOFA: 8.029 ± 3.099 vs 7.136 ± 3.342). For the SAPS II score the values are: 49.12 ± 16.61 in deceased vs 37.23 ± 15.20 in survivors, the difference being statistically significant (p = 0.0092). The areas under ROC for the three scores are 0.622 for APACHE II, 0.575 for SAPS II and 0.705 for SOFA. Conclusions: In our study the SAPS II score was superior to the other scores for predicting survival in patients with septic shock.
Acute pancreatitis can develop in patients with shock due to the underlying diseases, surgical in... more Acute pancreatitis can develop in patients with shock due to the underlying diseases, surgical interventions or because of severe hypoperfusion. The aim of our work was to study the histological alterations of the pancreas in patients dying after cardiogenic, hypovolemic or septic shock, to demonstrate the presence and severity of pancreatic injury. We performed a retrospective study which included patients who died and who were autopsied after different types of shock, hospitalized between 2007-2009 in general and cardiac intensive care units. We excluded the patients with known pancreatic diseases. From 223 patients included in our study 39 presented necrotising hemorrhagic alteration of the pancreatic tissue. There were no differences in histological and immunohistochemical findings between the different etiopathogenetic types of shock. None of the patients had characteristic clinical signs for acute pancreatitis. The digestive symptoms, they presented, could be related to the underlying disease or to postoperative state. The common findings in these patients were prolonged and severe hypotension, associated renal dysfunction, leucocytosis, hyperglycemia and hypocalcemia. Pancreatitis can occur in patients with shock, due to prolonged hypoperfusion of the pancreas. It is difficult to diagnose it because clinical signs are altered due to severity of underlying disease or analgo-sedation commonly used in intensive care. We therefore recommend in patients with shock to consider the possible development of ischemic pancreatitis for prompt and efficient treatment.
Trauma affects the activity of the innate immune system. The objective of this case report is to ... more Trauma affects the activity of the innate immune system. The objective of this case report is to present the case that prompted us to analyse all the peripheral white blood cell lines. A 19 year old male patient was admitted to the Intensive Care Clinic with severe head trauma. The final diagnosis was set to be severe cerebral trauma with subarachnoid hemorrhage, right frontal and temporal cerebral contusions, diffuse cerebral edema, left parietal and temporal fracture, sphenoid hemosinus and right sided lung contusions.: Whole blood was immediatly analyzed by flow cytometry for leukocytes. Apoptosis was detected with Annexin V, necrotic cells were stained with propidium iodide. Samples were drawn three consecutive days.: Lymphocytes, monocytes and granulocytes all showed marked increase in viability and decrease in necrosis during the biological monitoring in correlation with a positive clinical outcome. The most important changes were noted in the monocyte population.: Although we...
Background: Sepsis is the leading cause of morbidity and mortality in intensive care units. This ... more Background: Sepsis is the leading cause of morbidity and mortality in intensive care units. This study explored the possible role of vascular endothelial growth factor-C (VEGF-C) and podoplanin (PDPN) in sepsis. Methods: 22 Wistar rats were divided into three groups: two experimental (Group A and B, n=8/8) and a control (Group C, n=6). Sepsis was induced with intraperitoneal injection of ESBL (extended-spectrum beta-lactamases)-producing E-coli live bacteria for group A and with lipopolysaccharide for group B. Sterile saline solution was injected for group C. Blood samples were collected after 24 hours to determine the serum level of VEGF-C, and PDPN expression was examined in liver, kidney, and lung tissues. Bacteremia was assessed for group A. Results: Higher serum levels of VEGF-C were found in Group A vs C (p=0.05) and group B vs. C (p=0.004), respectively.VEGF-C was also increased in animals with negative- vs. positive blood cultures from group A (p=0.04) and from group B vs. t...
The first and most important step in pain management is to correctly assess it. Short-form McGill... more The first and most important step in pain management is to correctly assess it. Short-form McGill Pain Questionnaire-2(SF-MPQ-2) and Multidimensional Pain Evaluation Scale (MPES) are valid and reliable tools used in clinical practice and research. Our aim was to evaluate the efficacy of pharmacological and non-pharmacological treatments applied for pain relief. 27 patients were included in the study, of which 12 were outpatients and 15 were inpatients. Statistical and clinical significant differences were obtained only for the inpatient group on the MPES (p=0.00, difference between means=3.07) and for 3 out of 4 domains of the SF-MPQ-2 (p=0.01, 0.01 and 0.00 and the difference between means=2.60, 2.00 and 2.20 for continuous pain, neuropathic pain and affective descriptors, respectively). Outcomes of pain management are better for inpatients due to a combination of analgesic drugs with physical medicine and rehabilitation procedures and a strict monitoring during their hospitalization.
Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team ... more Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the pro...
Introduction: No definitive answer has been given to the question ‘who should teach cardiopulmona... more Introduction: No definitive answer has been given to the question ‘who should teach cardiopulmonary resuscitation?’ Healthcare professionals and high school teachers are mostly the trainers, but medical students are increasingly being used for this purpose. Methods: We divided 296 high school students in three groups based on trainer professional level. Medical students, anaesthesia and intensive care residents, and anaesthesia and intensive care specialists provided basic life support training. We tested their theoretical knowledge with the help of a multiple-choice question questionnaire and practical abilities with the help of a medical simulator, recording chest compression frequency as the primary outcome parameter. Results: The study shows comparable results in all groups, with the exception of the chest compression frequency which was higher in the students’ and residents’ groups (students: 134.7/min ± 14.1; residents: 137.9/min ± 15.9; specialists: 126.3/min ± 19.3). Increas...
Objective: Mass casualty incidents and disasters require functional and efficient patient data ma... more Objective: Mass casualty incidents and disasters require functional and efficient patient data management systems, as well as smart interconnections with patient tracking applications. Various initiatives developed and tested patient field charts for large-scale events but there is no one definite general format accepted. The current research proposes an upgraded model of the official patient field chart issued by the Romanian Department for Emergency Situations in 2015 to be used for large-scale events. Measures: An upgraded model is created after a thorough content analysis, physical analysis, design upgrade and optimization process. Differences between the official and the upgraded model are measured and compared, and statistical computations are carried out. Results: The main distinctive features of the patient field chart are dynamic triage, unique code identification, QR visual codes, wireless tags and irreversible clear contamination status highlighting. The upgrade process r...
Objective: The main aim of the study was to explore muscle mass changes and to investigate muscul... more Objective: The main aim of the study was to explore muscle mass changes and to investigate musculoskeletal inflammation in critically ill patients. Methods: A pure observational study that comprised two musculoskeletal analyses was conducted. Ultrasonography was used to determine the inflammatory process and muscle mass modifications. We assessed the presence of musculoskeletal inflammation and muscles area reduction. We recruited 26 patients and we performed both imaging investigations (shoulder and hip joints, biceps brachii and rectus femoris areas) and anthropometric measurements (mid-upper arm circumference). Results: More than 70% of patients were classified with low muscle mass, over one half of sarcopenic patients being over-weight and 17% being obese. The relationship between the length of stay in intensive care unit, mechanical ventilation and presence of low mid-upper arm circumference, highlighted a significant difference when comparing sarcopenic and non-sarcopenic grou...
Uploads