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Predicting ICU interventions in intentional drug overdose
Abstracts
and 1.64 (1.56-1.72), respectively. When adjusted by other factors known to be associated with survival, the adjusted OR (95% CI) were 1.19 (1.11-1.27) and 1.60 (1.51-1.69), respectively. The adjusted OR of ventilation component (1.38; 1.19-1.59) was as high as compression component (1.31; 1.171.47) in the OHCA subgroup of noncardiac etiology and very high in the pediatric (age b20) OHCA subgroup (1.56; 1.13-2.15). Conclusions: Ventilation is a significant component of BCPR, particularly when the etiology is noncardiac and when the victims are children and adolescents. However, ventilation alone is less effective than compression in improving neurologically favorable survival after OHCAs. Keywords: Cardiopulmonary resuscitation, Out-of-hospital cardiac arrest http://dx.doi.org/10.1016/j.jcrc.2015.04.035
Abstract JPN guidelines for the management of acute abdomen 2015 Toshihiko Mayumia, Masahiro Yoshidab, Kouichi Hiratac a
Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan b Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan c Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Japan Background/Purpose: There have not been the practical guidelines for the management of acute abdomen in the world. Therefore, the Japanese Society for Abdominal Emergency Medicine and collaborated 4 other societies began to make the practical guidelines for the management of acute abdomen (JPN guidelines for acute abdomen) in 2012 and finally published them in 2015. Here, we present brief summary of them. Methods: The working group of JPN guidelines consists of 18 specialists, primary care physicians, surgeons, gastroenterologists, radiologists, vascular surgeon, obstetrician and gynecologist, and epidemiologists. The guidelines were made using EBM methods with level of evidence (body of evidence) and recommendations. Results: JPN guidelines for acute abdomen 2015 contain 108 clinical questions and major topics as described below: (1) definitions, (2) epidemiology, (3) practical algorithms of acute abdomen and tables of pain location and disease, (4) history taking, (5) medical examination, (6) laboratory and radiological examination, (7) differential diagnosis, (8) initial treatment, and (9) educational program. For algorithm of initial treatment for acute abdomen, 2 steps method were proposed (Figure). Conclusions: Since these brand-new JPN guidelines for acute abdomen 2015 are the first guidelines, these need a lot of update to be in line with a clinic in the near future. Keywords: Acute abdomen, Guidelines, Algorithms http://dx.doi.org/10.1016/j.jcrc.2015.04.036
Abstract Predicting ICU interventions in intentional drug overdose Huub van den Oevera, Mirja van Dama, Esther van't Rietb a
Department of Intensive Care, Deventer Hospital, The Netherlands Teaching Hospital, Deventer, The Netherlands
b
Background/Purpose: Many patients visiting the emergency department with intentional drug overdose are admitted to a medium care
833
(MC) or intensive care unit (ICU) without ever requiring ICU interventions. To avoid patient burden and medical costs, it is important to identify at an early stage which patients will benefit from monitoring facilities. Methods: We performed a retrospective cohort study among 255 cases of intentional overdose with drugs having potentially acute effects on neurological, circulatory, or ventilatory function, admitted to the 12-bed ICU of the Deventer Hospital (450 beds) between 2007 and 2013. Interventions requiring MC/ICU admission included intravenous sedation; tracheal intubation; fluid resuscitation; treatment of convulsions; defibrillation; CVVH; or continuous administration of antagonists, vasopressors, inotropes, magnesium, calcium, atropine, or antiarrhythmics. A decision model was developed to predict MC/ICU intervention, based on 9 criteria that could easily be identified in the emergency department (Table 1). Results: Mortality in our cohort was 1 (0.4%) of 255. The average time spent on the emergency department was 2:45 hours. Only 70 (27%) of 255 cases required 1 or more interventions. Using the decision model, 66 of 70 cases could have been predicted (sensitivity, 94.3%), and 80 (31%) of 255 of admissions could have been avoided. Specificity of the model was 43.2% (Table 2). Estimated savings if the model had been used ranged from $12 000 to $16 000 per year. Conclusions: In patients with intentional drug overdose, using a simple decision model with 9 criteria that can be observed in the emergency department, MC/ICU interventions can be predicted. The model would have predicted 94.3% of interventions correctly. Keywords: Emergency medicine, Toxicology, Health economics http://dx.doi.org/10.1016/j.jcrc.2015.04.037
Abstract Prognostic significance of hypoventilation index adjusting for the severity of metabolic acidosis Joonghee Kim, Young-sang Ko, Kyuseok Kim Seoul National University Bundang Hospital, Republic of Korea Background/Purpose: Current guidelines recommend narrow target Paco2 range of 40 to 45 mm Hg after ROSC. However, normal physiologic response to metabolic acidosis is respiratory compensation, and its loss can lead to uncompensated acidosis. We developed and tested a new hyperventilation/hypoventilation index adjusting for the severity of metabolic acidosis. Methods: This is a retrospective study of OHCA patients who survived more than 24 hours after ROSC. ECPR patients were excluded. Utstein elements and ABGA results during the first 24 hours after sustained ROSC were collected. Target Paco2 to achieve pH of 7.4 were calculated using Henderson-Hasselbalch equation. The differences between actual Paco2 level and target Paco2 level were plotted against time interval between sustained ROSC and blood drawings. The AUC above x-axis was defined as relative hypoventilation index, and the AUC under x-axis was defined as relative hyperventilation index. Absolute hypoventilation/hyperventilation and hypooxygenation/ hyperoxygenation index were also calculated using fixed target Paco2 (40 mm Hg) and Pao2 (80 mm H2O) level, respectively. Results: A total of 201 patients were included. Univariable logistic regression showed that both relative and absolute hypoventilation indices were significantly associated with long-term (6-month) survival and neurologic outcomes. However, there were significant difference in AUROC for prediction of long-term survival (0.67 vs 0.57, respectively, P = .002) and good neurologic outcome (0.68 vs 0.56, respectively, P b .001). After adjustment with Utstein element variables and arterial HCO3 level, it showed significant (P = .029) association with long-term survival, but not with neurologic outcome (P = .087).
and 1.64 (1.56-1.72), respectively. When adjusted by other factors known to be associated with survival, the adjusted OR (95% CI) were 1.19 (1.11-1.27) and 1.60 (1.51-1.69), respectively. The adjusted OR of ventilation component (1.38; 1.19-1.59) was as high as compression component (1.31; 1.171.47) in the OHCA subgroup of noncardiac etiology and very high in the pediatric (age b20) OHCA subgroup (1.56; 1.13-2.15). Conclusions: Ventilation is a significant component of BCPR, particularly when the etiology is noncardiac and when the victims are children and adolescents. However, ventilation alone is less effective than compression in improving neurologically favorable survival after OHCAs. Keywords: Cardiopulmonary resuscitation, Out-of-hospital cardiac arrest http://dx.doi.org/10.1016/j.jcrc.2015.04.035
Abstract JPN guidelines for the management of acute abdomen 2015 Toshihiko Mayumia, Masahiro Yoshidab, Kouichi Hiratac a
Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan b Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan c Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Japan Background/Purpose: There have not been the practical guidelines for the management of acute abdomen in the world. Therefore, the Japanese Society for Abdominal Emergency Medicine and collaborated 4 other societies began to make the practical guidelines for the management of acute abdomen (JPN guidelines for acute abdomen) in 2012 and finally published them in 2015. Here, we present brief summary of them. Methods: The working group of JPN guidelines consists of 18 specialists, primary care physicians, surgeons, gastroenterologists, radiologists, vascular surgeon, obstetrician and gynecologist, and epidemiologists. The guidelines were made using EBM methods with level of evidence (body of evidence) and recommendations. Results: JPN guidelines for acute abdomen 2015 contain 108 clinical questions and major topics as described below: (1) definitions, (2) epidemiology, (3) practical algorithms of acute abdomen and tables of pain location and disease, (4) history taking, (5) medical examination, (6) laboratory and radiological examination, (7) differential diagnosis, (8) initial treatment, and (9) educational program. For algorithm of initial treatment for acute abdomen, 2 steps method were proposed (Figure). Conclusions: Since these brand-new JPN guidelines for acute abdomen 2015 are the first guidelines, these need a lot of update to be in line with a clinic in the near future. Keywords: Acute abdomen, Guidelines, Algorithms http://dx.doi.org/10.1016/j.jcrc.2015.04.036
Abstract Predicting ICU interventions in intentional drug overdose Huub van den Oevera, Mirja van Dama, Esther van't Rietb a
Department of Intensive Care, Deventer Hospital, The Netherlands Teaching Hospital, Deventer, The Netherlands
b
Background/Purpose: Many patients visiting the emergency department with intentional drug overdose are admitted to a medium care
833
(MC) or intensive care unit (ICU) without ever requiring ICU interventions. To avoid patient burden and medical costs, it is important to identify at an early stage which patients will benefit from monitoring facilities. Methods: We performed a retrospective cohort study among 255 cases of intentional overdose with drugs having potentially acute effects on neurological, circulatory, or ventilatory function, admitted to the 12-bed ICU of the Deventer Hospital (450 beds) between 2007 and 2013. Interventions requiring MC/ICU admission included intravenous sedation; tracheal intubation; fluid resuscitation; treatment of convulsions; defibrillation; CVVH; or continuous administration of antagonists, vasopressors, inotropes, magnesium, calcium, atropine, or antiarrhythmics. A decision model was developed to predict MC/ICU intervention, based on 9 criteria that could easily be identified in the emergency department (Table 1). Results: Mortality in our cohort was 1 (0.4%) of 255. The average time spent on the emergency department was 2:45 hours. Only 70 (27%) of 255 cases required 1 or more interventions. Using the decision model, 66 of 70 cases could have been predicted (sensitivity, 94.3%), and 80 (31%) of 255 of admissions could have been avoided. Specificity of the model was 43.2% (Table 2). Estimated savings if the model had been used ranged from $12 000 to $16 000 per year. Conclusions: In patients with intentional drug overdose, using a simple decision model with 9 criteria that can be observed in the emergency department, MC/ICU interventions can be predicted. The model would have predicted 94.3% of interventions correctly. Keywords: Emergency medicine, Toxicology, Health economics http://dx.doi.org/10.1016/j.jcrc.2015.04.037
Abstract Prognostic significance of hypoventilation index adjusting for the severity of metabolic acidosis Joonghee Kim, Young-sang Ko, Kyuseok Kim Seoul National University Bundang Hospital, Republic of Korea Background/Purpose: Current guidelines recommend narrow target Paco2 range of 40 to 45 mm Hg after ROSC. However, normal physiologic response to metabolic acidosis is respiratory compensation, and its loss can lead to uncompensated acidosis. We developed and tested a new hyperventilation/hypoventilation index adjusting for the severity of metabolic acidosis. Methods: This is a retrospective study of OHCA patients who survived more than 24 hours after ROSC. ECPR patients were excluded. Utstein elements and ABGA results during the first 24 hours after sustained ROSC were collected. Target Paco2 to achieve pH of 7.4 were calculated using Henderson-Hasselbalch equation. The differences between actual Paco2 level and target Paco2 level were plotted against time interval between sustained ROSC and blood drawings. The AUC above x-axis was defined as relative hypoventilation index, and the AUC under x-axis was defined as relative hyperventilation index. Absolute hypoventilation/hyperventilation and hypooxygenation/ hyperoxygenation index were also calculated using fixed target Paco2 (40 mm Hg) and Pao2 (80 mm H2O) level, respectively. Results: A total of 201 patients were included. Univariable logistic regression showed that both relative and absolute hypoventilation indices were significantly associated with long-term (6-month) survival and neurologic outcomes. However, there were significant difference in AUROC for prediction of long-term survival (0.67 vs 0.57, respectively, P = .002) and good neurologic outcome (0.68 vs 0.56, respectively, P b .001). After adjustment with Utstein element variables and arterial HCO3 level, it showed significant (P = .029) association with long-term survival, but not with neurologic outcome (P = .087).