Janne H. Liisanantti

Aspiration pneumonia following severe self-poisoning

PURPOSE To investigate the risk factors of aspiration pneumonia following severe self-poisoning. MATERIALS AND METHODS Patients treated due to severe self-poisoning in the ICU of Oulu University Hospital, Oulu, Finland during 1.11.1989-31.10.2000 were analyzed retrospectively. RESULTS 28.4% of 257 patients fulfilled the criteria of aspiration pneumonia. An unconscious patient who was not intubated until arrival at the emergency room (ER) had an odds ratio (OR) of 3.34 (CI 1.3-8.7) for aspiration pneumonia. If the patient was intubated at the first contact with health care providers, OR was 1.8 (CI 0.6-5.7). The use of gastric lavage or activated charcoal in the case of a non-intubated unconscious patient led to ORs of 2.7 (CI 0.8-9.3) and 3.7 (CI 1.01-12.5), respectively. The mean length of ICU stay was 0.9 (CI 0.8-0.9) days among patients without aspiration pneumonia and 1.9 (CI 1.3-2.6) days among those with aspiration pneumonia. The mean length of hospital stay was 2.8 (CI 2.5-3.1) days among the patients without aspiration pneumonia and 6.5 (CI 5.3-7.6) days among those with aspiration pneumonia. CONCLUSION To avoid aspiration pneumonia intubation of an unconscious patient on scene before arrival at the ER is recommended. The use of gastric lavage and activated charcoal increase the risk of aspiration pneumonia if the patient is unconscious and not intubated. Aspiration pneumonia significantly prolongs the length of ICU and hospital stay.

Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: An evaluation of the physiologic and laboratory parameters on admission

BACKGROUND The share of patients receiving intensive care treatment because of acute drug poisoning is 2% to 14% of all patients receiving intensive care. The outcome is mainly good and the length of intensive care is usually less than 2 days. Our aim was to recognize the risks for prolonged intensive care and hospital mortality using admission Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring in acute drug-poisoned patients. METHODS A national, prospectively collected intensive care unit (ICU) data registry was used for analysis. Data from 28 ICUs in university and secondary nonteaching hospitals from 1998 to 2004 were available. RESULTS There were 255 admissions because of acute drug poisoning, which represented 4.5% of all admissions. The mean length of the ICU stay was 32.1 hours. Of the patients, 11.5% had a prolonged ICU stay (>48 hours). Hospital mortality was 2.3%. The mean Acute Physiology and Chronic Health Evaluation II score was 14.4 (SD, 8.1) and the mean Sequential Organ Failure Assessment score was 4.8 (SD, 3.0). The mean Glasgow Coma Scale score on admission was 9.7 (SD, 4.7). In the multivariate analysis, the highest odds ratios for prolonged ICU stay were respiratory failure, lowered platelet count, and renal dysfunction. In the multivariate analysis, the highest odds ratios for hospital mortality were respiratory failure, renal failure, and hypotension. CONCLUSIONS In acute intoxication, respiratory and renal dysfunction and failure are risk factors for poor outcome.

Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study

Abstract Introduction Low levels of vitamin D have been associated with increased mortality in patients that are critically ill. This study explored whether vitamin D levels were associated with 90-day mortality in severe sepsis or septic shock. Methods Plasma vitamin D levels were measured on admission to the intensive care unit (ICU) in a prospective multicentre observational study. Results 610 patients with severe sepsis were included; of these, 178 (29%) had septic shock. Vitamin D deficiency (<50 nmol/L) was present in 333 (55%) patients. The 90-day mortality did not differ among patients with or without vitamin D deficiency (28.3% vs. 28.5%, p = 0.789). Diabetes was more common among patients deficient compared to those not deficient in vitamin D (30% vs. 18%, p < 0.001). Hospital-acquired infections at admission were more prevalent in patients with a vitamin D deficiency (31% vs. 16%, p < 0.001). A multivariable adjusted Cox regression model showed that low vitamin D levels could not predict 90-day mortality (<50 nmol/L: hazard ratio (HR) 0.99 (95% CI: 0.72–1.36), p > 0.9; and <25 nmol/L: HR 0.44 (95% CI: 0.22–0.87), p = 0.018). Conclusions Vitamin D deficiency detected upon ICU admission was not associated with 90-day mortality in patients with severe sepsis or septic shock. Key messages In severe sepsis and septic shock, a vitamin D deficiency upon ICU admission was not associated with increased mortality. Compared to patients with sufficient vitamin D, patients with deficient vitamin D more frequently exhibited diabetes, elevated C-reactive protein levels, and hospital-acquired infections upon ICU admission, and they more frequently developed acute kidney injury.

Contributing Factors in Self-Poisoning Leading to Hospital Admission in Adolescents in Northern Finland

Aim: To evaluate the frequencies of different agents used in self-poisonings and acute factors contributing to intoxication of patients aged 12–18 years in northern Finland. Material: Retrospective medical record review of all hospitalized patients during the period from January 1, 1991 to December 31, 2006. Outcome measures: Cause of the admission, contributing factors, readmissions within one year. Results: There were 309 admissions during the period, 54% were females. The leading cause of admission was alcohol, in 222 cases (71.8%). Hospitalizations related to alcohol consumption were associated with accidental poisoning in recreational use. There were no acute contributing factors in the majority of all patients. Over one-third of all intoxications were intentional self-harm, although previously diagnosed psychiatric diseases were rare. Conclusions: It is crucial to recognize adolescent psychiatric disorders in time and consult child and adolescent psychiatrist in case of poisoning.

Fatal injuries in rural and urban areas in northern Finland: a 5-year retrospective study

Finland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’.

Evaluating helicopter emergency medical missions: a reliability study of the HEMS benefit and NACA scores

The benefits of the Helicopter Emergency Medical Service (HEMS) and dispatch accuracy are continuously debated, and a widely accepted score to measure the benefits of the mission is lacking. The HEMS Benefit Score (HBS) has been used in Finnish helicopter emergency medical services, but studies are lacking. The National Advisory Committee for Aeronautics (NACA) score is widely used to measure the severity of illness or injury in the pre‐hospital setting, but it has many critics due to its subjectivity. We investigated the inter‐rater and rater‐against‐reference reliability of these scores.

Spinal or general anaesthesia for lower-limb amputation in peripheral artery disease – a retrospective cohort study

The present study aimed to determine which method of anaesthesia (spinal anaesthesia or general anaesthesia) is better in reducing post‐operative analgesic requirements in patients undergoing major limb amputation for lower‐limb ischaemia. Another aim was to find out if anaesthesiologists use neuraxial anaesthesia in high‐risk patients despite abnormal coagulation profile or use of anticoagulation.

Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis

BackgroundMost fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In particular, we wanted to analyze differences between pre-hospital and in-hospital deaths.MethodsAll fatal poisonings that occurred in Northern Finland in 2007–2011 were retrieved from the Cause of Death Registry provided by Statistics Finland. We noted the patient demographics, causal agents, and other characteristics of the poisoning events.ResultsA total of 689 fatal poisonings occurred during the study period, of which only 42 (6.1%) reached the hospital alive. Those who died pre-hospital were significantly younger (50 vs. 56 years, p = 0.04) and more likely to be male (77% vs. 57%, p = 0.003). Cardiopulmonary resuscitation was attempted less often in pre-hospital cases (9.9% vs. 47.6%, p < 0.001). Ethanol was more frequently the main toxic agent in pre-hospital deaths (58.4% vs. 26.2%, p < 0.001), and multiple ingestions were more common (52.2% vs. 35.7%, p < 0.001) in pre-hospital deaths.DiscussionMost of the pre-hospital fatal poisoning victims are found dead and the majority of in-hospital victims are admitted to hospital in an already serious condition. According to results of this and former studies, prevention seems to be the most important factor in reducing deaths due to poisoning.ConclusionsThe majority of poisoning-related deaths occur pre-hospital and are related to alcohol intoxication and multiple ingestions.

Identification of tele-ICU system requirements using a content validity assessment

OBJECTIVES Telemedicine in intensive care (tele-ICU) involves the use of information technologies to deliver care instructions from a command center to remote hospitals. To ensure acceptance and usability, clinicians should participate early in the design. This study surveyed clinical professionals to identify and rank important functions for a tele-ICU system. METHODS This cross-sectional, prospective, structured, two-round survey included European intensive-care professionals that were not familiar with tele-ICU systems. In the first round, statements of system function specifications were evaluated for validity; in the second round, unclear items were rephrased and new items were added. Item-level content validity indexes (I-CVI) were calculated, and values above a 0.75 threshold were considered relevant. Weighted ranking points (WRP) was calculated from the ranking data. RESULTS A total of 26 responses were received from professionals for four European countries; the majority were intensive-care specialists (77%). A total set of 50 items were selected for the survey. Thirty-six functional specifications were identified with I-CVIs above 0.75, including online access to all patient data (13 items), related risks and alarms (8 items), audio-visual contact for consultations and for monitoring patient beds (5 items), information security (5 items), and resource allocation (5 items). The highest ranking system functions were real time monitoring, alarms, audio-visual connections, and data security. CONCLUSIONS Professionals not familiar with tele-ICUs regarded full patient data access, alarms, data security, and audio-visual connections the most important functions in pre-implementation phase.

The impact of antemortem computed tomographic scanning on postmortem examination rate and frequency of missed diagnosis: A retrospective analysis of postmortem examination data.

PURPOSE The present study was conducted to explore the impact of computed tomographic (CT) scanning on the diagnostic discrepancy rate. MATERIALS AND METHODS This single-center, retrospective study reviewed postmortem examination results, clinical diagnoses, and radiologic imaging data for patients admitted to the intensive care unit (ICU) in 2008 to 2013. The Goldman criteria were used to classify diagnostic discrepancies. RESULTS The data of 577 patients who died during their ICU stay were retrieved. The postmortem examination rate was 42.9% (n=248). Significant diagnostic discrepancies (Goldman I and II) were recorded in 24 cases (9.7%). The postmortem examination rate decreased significantly from the first half (n=143; 51.1%) to the second half (n=105; 35.4%) of the study period (P<.0001). Among those with postmortem examinations, the use of antemortem body CT scans increased significantly from the first half (n=59; 41.3%) to the second half (n=64; 51.0%; P=.002) of the study period. The significant diagnostic discrepancy rate did not change with time (8.4% vs 11.4%, respectively; P=.424). CONCLUSION The postmortem examination rate has decreased, whereas antemortem CT scans has increased.