Mirosław Ziętkiewicz

Fluorescent in situ hybridization and Gram‑stained smears of whole blood as complementary screening tools in the diagnosis of sepsis

122 even several days, and has low sensitivity, which allows to detect microbial growth only in 15% to 30% of the culture.2 To improve the effectiveness of identifying the etiological agent in blood, attempts have been undertaken to detect lipopolysaccharide for Gram ‐negative bacteria or mannan and ga‐ lactomannan for fungi, using serological meth‐ ods. Other promising diagnostic tools are signif‐ icantly faster and more precise molecular meth‐ ods based on polymerase chain reaction (PCR). Molecular biology techniques are independent of prior antibiotic treatment and do not require bacterial or fungal growth in a culture medium.3,4 Serological or molecular diagnosis based on the PCR methods is costly and requires special‐ ized diagnostic laboratories. Screening methods would be extremely valuable as they could quickly reveal the presence of bacteria in the direct smear. Such methods include Gram staining and fluo‐ rescent in situ hybridization (FISH). Therefore, the objective of this study was to compare cul‐ turing with the modified method for blood sam‐ ple preparation for Gram staining and FISH in the direct smear from blood.

A comparison of the ultrasound measurement of the inferior vena cava obtained with cardiac and convex transducers

Background Ultrasound measurement of the inferior vena cava diameter and its respiratory variability are amongst the predictors of fluid volume status. The primary purpose of the present study was to compare the consistency of inferior vena cava diameter measurements and the collapsibility index, obtained with convex and cardiac transducers. A secondary aim was to assess the agreement of the patient’s allocation to one of the two groups: “fluid responder” or “fluid non-responder”, based on inferior vena cava collapsibility index calculation made with two different probes. Methods 20 experienced clinicians blinded to the purpose of the study analysed forty anonymized digital clips of images obtained during ultrasound examination of 20 patients. For each patient, one digital loop was recorded with a cardiac and the second with a convex probe. The participants were asked to determine the maximal and minimal diameters of the inferior vena cava in all presented films. An independent researcher performed a comparative analysis of the measurements conducted with both probes by all participants. The calculation of the collapsibility index and allocation to “fluid responder” or “fluid non-responder” group was performed at this stage of the study. Results The comparison of measurements obtained with cardiac and convex probes showed no statistically significant differences in the measurements of the maximal and minimal dimensions and in the collapsibility index. We also noticed that the decision of allocation to the “fluid responder” or “non-responder” group was not probe-dependent. Conclusion Both transducers can be used interchangeably for the estimation of the studied dimensions.

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

BACKGROUND Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. METHODS We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. RESULTS In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. CONCLUSION Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.

Create a Chain of Survival: Extracorporeal Life Support Treatment of Severe Hypothermia Victims

class II. Echocardiography showed an improvement of the left ventricular ejection fraction (45%) and the complete resolution of the residual VSD. Herein, the theoretical and speculative rationale of our strategy to systematically implant a VA ECMO at the end of the operation was to provide an effective hemodynamic stabilization in the immediate postoperative period and to possibly reduce the left ventricular stroke volume enhancing the chance of healing of the sutures on the weak infarcted myocardium. The benefits of this strategy must be weighted with the risk of bleeding because two surgical re-explorations were needed in our patient under unfractioned heparin and antiplatelet therapy. In conclusion, the strategy of delayed surgery and systematic implantation of VA ECMO at the end of the operation could represent a reasonable solution in stable patients with VSD complicating AMI. Further studies with larger patient populations are needed to best define the role of this strategy. Author contributions: Concept/design: Pozzi M, Obadia JF; Data analysis/interpretation: Pozzi M; Drafting article: Pozzi M; Critical revision of article: Lantelme P, Obadia JF; Approval of article: Lantelme P, Obadia JF Conflict of interest: The authors declare no conflict of interest.