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SUMMARY David Iglesias Pedemonte. Quality of life upon discharge from the intensive care unit: a systematic review. AIM: Assessment of the latest evidence investigating HRQOL of adults upon their discharge from the ICU by identifying, appraising and synthesizing the information gathered from researches taking care of this topic. OBJECTIVES: 1. To evaluate the changes of HRQOL after ICU stay. 2. To give an overview of determinants of HRQOL. METHODS: The search was conducted through popular electronic databases: PubMed and The Cochrane Library. After the design and application of eligibility criteria, several articles were excluded in a stepwise fashion: by title, by abstract and by full- text. Finally 28 articles were included for evaluation. Included researches were analyzed. RESULTS: HRQOL was found to be lower in patients discharged from ICU when compared with the general population in 17 studies. Gradual improvements were found in at least 3 studies. These tend to occur from the 6 month after discharge and from there onwards, however one article identified a relapse of lower scores from the second to the fifth year after discharge. Despite these fluctuations, the HRQOL scores never reached those of the reference populations during the follow-up periods in any of the evaluated studies. Baseline levels of HRQOL tend to be lower in patients included in the ICU than those of the general population in at least 4 studies. Upon discharge from hospitalization these HRQOL scores tend to be lower than those measured at baseline. Several risk factors were found to be associated with lower scores in HRQOL between ICU populations: age, severity of illness, pre-morbid condition, number of comorbidities, presence of shock, diagnostic category, ICU length of stay, length of mechanical ventilation, duration of bed rest, depression, insomnia, delirium, delusional memories, optimism towards disease, awareness of surroundings, frightening experiences, optimism, social integration and financial status. CONCLUSIONS: HRQOL is lower in patients discharged from the ICU than that one of reference populations. It also tends to be lower than that one of the patients prior to ICU admission; however is not significantly lower than that one of simply hospitalized patients. HRQOL measurements are subjected to significant time fluctuations. Several determinants of HRQOL have been identified.

The aim in this research was to perform a retrospective study of thirty-two cases of patients who admitted with dental abscess to ICU between 2013 and 2016. Moreover our objective here was to: - To observe the course of disease in patients with dental abscess. - Learn the methods for managing this pathology, understand therapy methods for treating dental abscess - Analyzing the outcome and observing prognosis for patients with dental abscess

Aim of the study was to assess risk factors associated with worse short – term outcomes of pulmonary embolism (PE). A retrospective study was done by analyzing medical history of participants. 118 patients of Department of Intensive Care with diagnosed and confirmed PE. Factors that significantly predicted in hospital mortality were: systolic blood pressure (SBP) < 100 mmHg, heart rate (HR) ≥ 100 beats/min, shock index ≥ 1, glomerular filtration rate (GFR) < 45 ml/min, oxygen saturation < 90%, IV-V PESI classes, high – risk sPESI class, heart failure and/or chronic pulmonary diseases.

Aim. To identify and analyze factors associated with thermally burned pacients‘ outcomes. Objectives. 1) To determine whether thermally burned patients‘ demographic information influence their outcomes. 2) To determine whether burns‘ severity influence thermally burned patients‘ outcomes. 3) To determine whether developed infection during hopitalization influences thermally burned patients‘ outcomes. 4) To determine whether comorbidity influence thermally burned patients‘ outcomes. 5) To determine whether base excess values estimate thermally burned patients‘ condition severity. Methods. Retrospective study was performed. Medical documentation was analyzed using Microsoft Excel and IBM SPSS Statistics programs. The articles for the scientific literature analysis were selected from ‘Medline’ National Library of Medicine. Keywords used during the selection process included: burns, outcomes, mortality. Based on the keywords a total of 18 full articles were found. The sample for this study consisted of 46 patients hospitalized in Intensive care clininc during the period of 2012 – 2015 years. Results. There were 46 patients hospitalized in the Intensive care unit (ICU) during the period of 2012 – 2015 years, 32 men and 14 women. Patients‘ age mean was 49,04 ± 17,43 years. Patiens‘ average total burn surface area (TBSA) 43,15 ± 25,14 %. 31 patients were diagnosed with inhalation injury. 33 patients developed infection during the time of hospitalization. There were 20 patients with chronic illness anamnesis hospitalized in the ICU. 23 (50%) patients died, 13 of them were men and 10 were women. Thermally burned patients‘ base excess values during hospitalization were -7,5±5,47, 6 hours after hospitalization -5,7±4,17, after 12 hours -4,54±4,56, after 24 hours -3,14±3,87, after 48 hours -1,8±5,68. There were statistically significant relation between outcomes and patients‘ age (p = 0,004), total burned surface area (p < 0,001), developed bacteriaemia (p = 0,002) and comorbidity (p = 0,017). In addition, there were statistically significant relation between inhalation injury and developed pneumonia (p = 0,046). Base excess values during hospitalization, 24 and 48 hours after hospitalization, statistically significantly indicated severity of thermally burned patients‘ condition. Conclusions. There is statistically significant relation between outcome and patient‘s age, TBSA, inhalation injury, developed bacteriaemia and comorbidity. Base excess values during hospitalization, 24 and 48 hours after hospitalization were higher for worse condintion patients.

Background: We used data from a large international database to assess the incidence and impact of extracerebral organ dysfunction on prognosis of patients admitted after cardiac arrest (CA). Methods: This was a sub-analysis of the Intensive Care Over Nations (ICON) database, which contains data from all adult patients admitted to one of 730 participating intensive care units (ICUs) in 84 countries from 8-18 May 2012, except admissions for routine postoperative surveillance. For this analysis, patients admitted after CA (defined as those with "post-anoxic coma" or "cardiac arrest" as the reason for ICU admission) were included. Data were collected daily in the ICU for a maximum of 28 days; patients were followed up for outcome data until death, hospital discharge, or a maximum of 60 days in-hospital. Favorable neurological outcome was defined as alive at hospital discharge with a last available neurological Sequential Organ Failure Assessment (SOFA) subscore of 0-2. Results: Among the 469 patients admitted after CA, 250 (53 %) had had out-of-hospital CA; 210 (45 %) patients died in the ICU and 357 (76 %) had an unfavorable neurological outcome. Non-survivors had a higher incidence of renal (43 vs. 16 %), cardiovascular (56 vs. 45 %), and respiratory (62 vs. 48 %) failure on admission and during the ICU stay than survivors (all p < 0.05). Similar results were found for patients with unfavorable vs. favorable neurological outcomes. In multivariable analysis, independent predictors of ICU mortality were renal failure on admission, high admission Simplified Acute Physiology Score (SAPS) II, high maximum serum lactate levels within the first 24 h after ICU admission, and development of sepsis. Independent predictors of unfavorable neurological outcome were mechanical ventilation on admission, high admission SAPS II score, and neurological dysfunction on admission. Conclusions: In this multicenter cohort, extracerebral organ dysfunction was common in CA patients. Renal failure on admission was the only extracerebral organ dysfunction independently associated with higher ICU mortality., SCOPUS: ar.j, info:eu-repo/semantics/published

Acute kidney injury is known to be one of the common diseases who have increase number of admitting to ICU, having a variety of outcomes associated with comorbidities, risk factors and blood tests that interfere with the severity of the disease. We tried to evaluate and determine whether creatinine does play an impact role by assessing AKI patients outcomes and determine the prognosis of AKI patients who require dialysis .The research instrument we used was based on (creatinine, BUN, GFR, risk factors and comorbidities) of admitted patients during 2 consecutive years 2014 and 2015. Our objectives was to classify AKI patient into 2 stages according their creatinine values ( or equal to 2,7 mg/dl), to asses AKI-associated risk factor and to determine AKI-interferes with comorbidities, as well as to determine the prognosis for patients who required dialysis in their treatment. We detailed the values from inpatient by a retrospective study containing of (n=30) in LSMU Kauno Klinikos between dates 2014 and 2015, given blood tests where analyzed, correlation between all 3 (creatinine, BUN and GFR) was assessed, frequency of comorbidities was determined, staging of AKI was done according to given creatinine values, comorbidities in AKI and CKI was calculated and explained, patients comorbidities was shown and staged according creatinine levels (< 2,7 mg/dl and >or equal from 2,7 mg/dl) and last but not least, the frequency of risk factors for patients with kidney diseases and classifying them into AKI and CKD furthermore according there creatinine levels was assessed. Results showed: an age of (64,79 +/- 18) for AKI and (66,55 +/- 22,5) for CKI. The deference in blood parameters in (2014/2015) was not significant. The decrease in creatinine strongly affect GFR rate, whereas correlation between creatinine and GFR was not statistically significant, but an increase in creatinine levels have influence on increasing BUN levels, this highlight the fact that creatinine value affect GFR ad BUN rate. The highest comorbidities frequency was other diseases including infectious disease and sepsis (40%), kidney disorders (16.7%) and lung involvement (13.3%), which in turn clarify that development of these comorbidities have influence on worse outcome for patients. Staging according creatinine values where (36.7 %) for (< 2,7mg/dl) and (63,3 %) for (>or equal to 2,7mg/dl). Patients with chronic kidney injury required more dialysis than patients with acute kidney injury, as well as they had an increase levels in their creatinine levels and lower levels in GFR rate, worsening the chronic phase. Comorbidities in patients with acute and chronic kidney injury demonstrate that AKI had kidney and liver disorders, cardiovascular diseases and lung manifestations more frequent than CKI. Creatinine values were higher in patients who had more comorbidities, this sum up the concept of developing a comorbidities can worse the phase of injury. The most frequent risk factors in patients with kidney injury was hypertension (70%), which emphasize for us that increase blood pressure has bad influence on kidney injury. Patients with chronic kidney injury had hyperparathyroidism as risk factor more frequent than AKI patients and it was significant (P=0,047), whereas AKI patients were prone to have DM II and hypertensive cardiomyopathy more frequently than CKI patients. Obese patients didn’t had elevation in their creatinine value significantly (P = 0.03) opposing other risk factors, which clarify that a high body mass index doesn’t affect severity of the disease.

This study is done by Tarek Salman in the Department of the Intensive Care Unit about the “outcome of hypothermia in the intensive care unit”. It’s a retrospective study, the aim is to identify the incidence of hypothermia in the intensive care unit, as well as to identify the major causes and outcomes of hypothermia and to analyze the important diagnostic tests in hypothermia.The objective of the study, is to divide hypothermia according to its severity based on the temperature into mild, moderate and severe and compare the diagnostic tests results and outcomes therefore to estimate the association between the severity of hypothermia and its outcome.The data was collected from the patient records for those who were admitted to the intensive care unit at KaunoKlinikos University Hospital between the periods 12-2014/12-2015.Subjects were identified by means of the international classification of diseases version 10 (ICD10) using the code T68.10 patients were identified as hypothermic during this period, and the diagnosis was based by measuring the core body temperature, patient neurological status and by evaluating the clinical symptoms and signs.Descriptive statistics of the laboratory data, diagnostic examination, presence of complications and the cause of hypothermia was done and include the mean values, standard deviation, median and the percentage, also a comparison between the types of hypothermia was done.We found that the incidence of hypothermia in KaunoKlinikos intensive care department is approximately 3.3/100000 cases per year. The major causes of hypothermia were due to cold air exposure with the presence of alcohol intoxication and trauma as a concomitant factors. The presence of complications were high among the patients and the most common complication was pneumonia among most of the patients without a correlation with the severity of hypothermia. The major informative methods to diagnose hypothermia is by measuring the core body temperature and by the presence of Osborn wave on ECG. All the patients had metabolic acidosis and lactate was higher in severe hypothermia than moderate hypothermia. 80% of the patients were unconscious in the admission to the department.

Determine risk factors of ventilator associated pneumonia

Red blood cell transfusion (RBCT) is a widely used method for treatment of the critically ill which helps to raise the pathologically low concentration of hemoglobin (Hb), thus preventing the development of life-threatening condition when oxygen supply to tissues and organs is not sufficient. Up until the last decades of the 20th century, the main parameter when deciding upon the RBCT was low Hb concentration. Today’s medicine, however, emphasizes patient’s overall clinical condition. There was also the decrease in the Hb threshold for the recommended use of RBCT – the earlier level of 100 g/l was dropped to 70-80 g/l. The change in RBCT strategy was determined by dozens of new findings on the complications of transfusion of allogenic blood components. The results of clinical trials, suggesting that patients’ survival rate was similar when using Hb thresholds of 100 g/l and 70-80 g/l, influenced this shift as well. The aim of this study was to assess the RBCT practices among anesthesiologists and surgeons of Hospital of Lithuanian University of Health Sciences and the possible reasons of their judgment. 27 anesthesiologists and 22 surgeons participated in the survey and were asked to analyze 4 specific clinical scenarios. Anesthesiologists mainly chose the Hb threshold of 70-80 g/l in trauma, gastrointestinal bleeding and sepsis scenarios and the threshold of 90 g/l in perioperative myocardial infarction. Surgeons chose to initiate RBCT when Hb was 70-80 g/l in all of the scenarios. Anesthesiologists planned to transfuse more units of red blood cells in the scenarios of trauma and gastrointestinal bleeding, while surgeons planned to transfuse more units in the scenario of perioperative myocardial infarction. Both anesthesiologists and surgeons, who had more years of practice, leaned toward lower Hb level as an indication for RBCT in trauma scenario. Surgeons, that practice medicine longer, were more likely to choose lower Hb threshold for RBCT in sepsis scenario. Anesthesiologists’ Hb thresholds varied between clinical scenarios. Surgeons based their decision to start RBCT on similar Hb thresholds in all situations, less assessing the patient’s overall clinical condition.

Siauro terapinio indekso vaistų vartojimas ir farmakokinetikos tyrimų interpretavimas reikalauja specialių farmakokinetikos žinių. Mokslinės literatūros šaltiniuose teigiama, jog gydymo procese dalyvaujant klinikiniams vaistininkams vaistų vartojimas yra optimizuojamas. Lietuvoje panašios vaistininkų veiklos nėra, todėl tyrimo tikslas buvo įvertinti siauro terapinio indekso vaistų vartojimo racionalumą ir nustatyti klinikinės farmacijos paslaugos poreikį stacionarinio gydymo įstaigoje. Darbo uždaviniai: nustatyti ir įvertinti farmakoterapinių problemų, siejamų su siauro terapinio indekso vaistų (vankomicino, ciklosporino, digoksino, gentamicino) vartojimu, paplitimą tretinio lygio ligoninėje; kiekybiškai ir kokybiškai įvertinti nustatytų farmakoterapinių problemų rizikos veiksnius; įvertinti vankomicino farmakokinetikos stebėsenos praktiką ligoninės skyriuose; įvertinti farmacininko konsultacijos įtaką vankomicino farmakokinetikos stebėsenai. Tyrimui pasirinktų siauro terapinio indekso vaistų farmakokinetikos tyrimų analizė atskleidė klinikinės farmacijos paslaugos poreikį optimizuojant tokių vaistų vartojimą Lietuvos ligoninėse. Nustatytų farmakoterapinių problemų rizikos veiksnių analizė identifikavo praktikoje dar visuotinai nepripažintą padidintą inkstų klirensą ir jo reikšmingą įtaką vaistų veiksmingumui. The prescription of narrow therapeutic index drugs (NTID) and interpretation of pharmacokinetic measurements require special pharmacokinetic knowledge. Scientific publications report that active participation of clinical pharmacists in the treatment process results in optimization of the drugs use. In Lithuania, there are no similar services provided by pharmacists up till now. Aim of the study: to evaluate the rationality of the use of NTIDs and to determine the demand for clinical pharmacy services in hospitals. Objectives of the study: to identify and evaluate the prevalence of drug-related problems associated with the use of NTIDs (vancomycin, cyclosporine, digoxin, and gentamicin) in the tertiary-level hospital; to perform quantitative and qualitative analysis of risk factors for the identified drug-related problems; to evaluate the practice of pharmacokinetic vancomycin monitoring in hospital departments; to evaluate the influence of pharmacist intervention on pharma¬cokinetic vancomycin monitoring. The analysis of pharmacokinetic measurements of NTIDs selected for this study revealed the demand for clinical pharmacy services while optimizing NTIDs use in the Lithuanian hospitals. The analysis of risk factors associated with the identified drug-related problems identified augmented renal clearance, which is not widely acknowledged in practice, and its significant impact on the effectiveness of drugs.

Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.Methods: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.Results: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality.Conclusions: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections. © 2014 De Waele et al. licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Acute liver failure (ALF) is a rather rare clinical syndrome developing due to an acute massive dysfunction of the liver cells in previously healthy persons (at least 8 weeks there was no diagnosis of any liver disease) resulting in rapidly progressing multiple organ dysfunction syndrome. Without liver transplantation 80-95 % of the patients die. Factors, influencing the outcome are etiology, the patient's age and the course of the disease. Spontaneous recovery, however, is possible in 5-60 % of ALF cases when regeneration of the liver starts, therefore the main goal of the treatment is to create the most favorable conditions for regeneration. Causes of ALF may be different. The most common cause of ALF is viral hepatitis, but the prevailing causative agent of hepatitis is different in different countries. Drug-induced (acetaminophen, halotane) liver dysfunction ranks second. The order of other etiological factors according to their frequency is: mushroom (Amanita) poisoning, carbon tetrachloride toxicity, heat stroke, synthetic amphetamine ("Ecstasy") and disorders of liver blood vessels. In cases of unfavorable prognosis for patients with ALF the only method of treatment with good prognosis is liver transplantation (LT). From 50 to 70 % of patients with lethal ALF prognosis survive after emergency LT. There is no unified ALF prognostic system or indications for LT in the world, therefore a precise individual prognosis for every patient and well-timed decision about LT are... [to full text]