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Treatment effect of recombinant human soluble thrombomodulin (RTM) alone on septic disseminated intravascular coagulation (DIC)
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PAPERS AND POSTER ABSTRACTS / Australian Critical Care 30 (2017) 109–135
and 2.7 (1.5, 5.7) days for sitting. In-hospital mortality was 14.3% (n=491) for patients who did not participate in exercise interventions, compared to 2.6% (n=89) for patients who exercised whilst in ICU. http://dx.doi.org/10.1016/j.aucc.2017.02.029 Treatment effect of recombinant human soluble thrombomodulin (RTM) alone on septic disseminated intravascular coagulation (DIC) Naotsugu Ohashi ∗ , Kenta Takeda, Aisa Matoi, Takeshi Ide, Naoto Hori, Hanako Kohama, Shinichi Nishi Intensive Care Unit, Hyogo College Of Medicine, Nishinomiya, Japan Introduction Septic disseminated intravascular coagulation (DIC) causes multiple organ dysfunction syndromes and must be controlled with the care of the original illness. In Japan, recombinant human soluble thrombomodulin (rTM) has been produced as a replacement for active protein C since 2008. Objectives To investigate the efficasy and safety of rTM alone without other anticoagulants administration for septic DIC. Methods A retrospective study of 14 septic DIC patients in our ICU from August 2010 to May 2016 was performed. These patients were treated only with rTM for septic DIC. Samples were collected on “day 0” when rTM was administrated and on “day 7”, which was 7 days after rTM administration, or the day of ICU discharge The following parameters were recorded: Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score,Japanese Association for Acute Medicine-defined(JAAM) DIC score, SIRS score, platelet count, prothrombin time ratio, D-dimer, AT activity, side effect of bleeding, and mortality after 28 days. Results The measured mortality rate after 28 days (7.1%) was lower than the predicted mortality rate (47.4%) based on the APACHE II score. The study group showed significantly improvement JAAM-DIC score, prothrombin time ratio, D-dimer at “day7” than “day0” (p<0.05). Conclusion The rTM administration without another DIC drug rather be a safe and effective medical intervention for septic DIC. http://dx.doi.org/10.1016/j.aucc.2017.02.030
The incidence, characteristics and outcomes of pneumothorax in Thai surgical intensive care units (Thai-SICU) study Sujaree Poopipatpab a , Konlawij Trongtrakul b,∗ , Chompunoot Pathonsamit a,∗ , Siriporn Siraklow a , Kaweesak Chittawatanarat c , Thai-SICU study group a
Anaesthesiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj Univeristy b Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok c surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Introduction Pneumothorax, one of the most serious pleural diseases complication in intensive care unit (ICU), is limited report in surgical critically ill patients. Study Objectives To identify incidence, characteristics, and outcomes of pneumothorax among patients who specifically stayed in surgical ICU. Methods This was a multicenter prospective cohort study conducted in 9 University-affiliated SICUs in Thailand. Incidence of pneumothorax and its outcomes were evaluated from June 2010 to March 2011. Result A total of 4,652 patients who were admitted to SICU were enrolled. The incidence of pneumothorax was 0.5% (25 cases) in our study. Significant characteristics were found in the pneumothorax group, including: lower BMI, underlying malignancy and COPD, higher APACHE-II and SOFA score within 24 hours of first ICU admission, pulmonary infiltration pattern of chest imaging and usage of mechanical ventilation. In terms of outcome, there were higher SICU mortality and 28-day hospital mortality in pneumothorax than non-pneumothorax patients at 28% vs 10%, p = 0.002 and at 44% vs 14%, p<0.001, respectively. Conclusions From Thai-SICUs Study, patients admitted to surgical intensive care units who developed pneumothorax had higher risk of intensive care unit mortality and 28-day hospital mortality than non-pneumothorax patients. http://dx.doi.org/10.1016/j.aucc.2017.02.031 Predictors of glyaemic variability in the intensive care unit Anurag Saxena b,∗ , John Moran a a b
ICU, The Queen Elizabeth Hospital, Adelaide Lyell Mcewin Hospital, South Australia
Glycaemic variability is an independent risk factor for adverse outcomes in intensive care (ICU). Little is known about predictors of glycaemic variability in ICU patients. This knowledge may improve management of blood glucose in ICU setting. The objective of the study was to identify the predictors of glucose variability in ICU patients. This was a retrospective cohort study conducted in Flinders Medical Centre (FMC) Adelaide, a tertiary level mixed ICU, from June 2014 till June 2015. We collected blood glucose readings of 60 patients during early (first 48 hours in ICU) and late (last 24 hours in ICU) period and calculated mean blood glucose level, standard deviation and coefficient of variation (COV = SD/Mean). Association of possible predictors including age, gender, systemic steroid prescription, insulin prescription, enteral feeding, preexisting dia-
PAPERS AND POSTER ABSTRACTS / Australian Critical Care 30 (2017) 109–135
and 2.7 (1.5, 5.7) days for sitting. In-hospital mortality was 14.3% (n=491) for patients who did not participate in exercise interventions, compared to 2.6% (n=89) for patients who exercised whilst in ICU. http://dx.doi.org/10.1016/j.aucc.2017.02.029 Treatment effect of recombinant human soluble thrombomodulin (RTM) alone on septic disseminated intravascular coagulation (DIC) Naotsugu Ohashi ∗ , Kenta Takeda, Aisa Matoi, Takeshi Ide, Naoto Hori, Hanako Kohama, Shinichi Nishi Intensive Care Unit, Hyogo College Of Medicine, Nishinomiya, Japan Introduction Septic disseminated intravascular coagulation (DIC) causes multiple organ dysfunction syndromes and must be controlled with the care of the original illness. In Japan, recombinant human soluble thrombomodulin (rTM) has been produced as a replacement for active protein C since 2008. Objectives To investigate the efficasy and safety of rTM alone without other anticoagulants administration for septic DIC. Methods A retrospective study of 14 septic DIC patients in our ICU from August 2010 to May 2016 was performed. These patients were treated only with rTM for septic DIC. Samples were collected on “day 0” when rTM was administrated and on “day 7”, which was 7 days after rTM administration, or the day of ICU discharge The following parameters were recorded: Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score,Japanese Association for Acute Medicine-defined(JAAM) DIC score, SIRS score, platelet count, prothrombin time ratio, D-dimer, AT activity, side effect of bleeding, and mortality after 28 days. Results The measured mortality rate after 28 days (7.1%) was lower than the predicted mortality rate (47.4%) based on the APACHE II score. The study group showed significantly improvement JAAM-DIC score, prothrombin time ratio, D-dimer at “day7” than “day0” (p<0.05). Conclusion The rTM administration without another DIC drug rather be a safe and effective medical intervention for septic DIC. http://dx.doi.org/10.1016/j.aucc.2017.02.030
The incidence, characteristics and outcomes of pneumothorax in Thai surgical intensive care units (Thai-SICU) study Sujaree Poopipatpab a , Konlawij Trongtrakul b,∗ , Chompunoot Pathonsamit a,∗ , Siriporn Siraklow a , Kaweesak Chittawatanarat c , Thai-SICU study group a
Anaesthesiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj Univeristy b Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok c surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Introduction Pneumothorax, one of the most serious pleural diseases complication in intensive care unit (ICU), is limited report in surgical critically ill patients. Study Objectives To identify incidence, characteristics, and outcomes of pneumothorax among patients who specifically stayed in surgical ICU. Methods This was a multicenter prospective cohort study conducted in 9 University-affiliated SICUs in Thailand. Incidence of pneumothorax and its outcomes were evaluated from June 2010 to March 2011. Result A total of 4,652 patients who were admitted to SICU were enrolled. The incidence of pneumothorax was 0.5% (25 cases) in our study. Significant characteristics were found in the pneumothorax group, including: lower BMI, underlying malignancy and COPD, higher APACHE-II and SOFA score within 24 hours of first ICU admission, pulmonary infiltration pattern of chest imaging and usage of mechanical ventilation. In terms of outcome, there were higher SICU mortality and 28-day hospital mortality in pneumothorax than non-pneumothorax patients at 28% vs 10%, p = 0.002 and at 44% vs 14%, p<0.001, respectively. Conclusions From Thai-SICUs Study, patients admitted to surgical intensive care units who developed pneumothorax had higher risk of intensive care unit mortality and 28-day hospital mortality than non-pneumothorax patients. http://dx.doi.org/10.1016/j.aucc.2017.02.031 Predictors of glyaemic variability in the intensive care unit Anurag Saxena b,∗ , John Moran a a b
ICU, The Queen Elizabeth Hospital, Adelaide Lyell Mcewin Hospital, South Australia
Glycaemic variability is an independent risk factor for adverse outcomes in intensive care (ICU). Little is known about predictors of glycaemic variability in ICU patients. This knowledge may improve management of blood glucose in ICU setting. The objective of the study was to identify the predictors of glucose variability in ICU patients. This was a retrospective cohort study conducted in Flinders Medical Centre (FMC) Adelaide, a tertiary level mixed ICU, from June 2014 till June 2015. We collected blood glucose readings of 60 patients during early (first 48 hours in ICU) and late (last 24 hours in ICU) period and calculated mean blood glucose level, standard deviation and coefficient of variation (COV = SD/Mean). Association of possible predictors including age, gender, systemic steroid prescription, insulin prescription, enteral feeding, preexisting dia-