Rungsun Bhurayanontachai

Prediction of fluid responsiveness in septic shock patients: comparing stroke volume variation by FloTrac/Vigileo and automated pulse pressure variation.

Objectives The aim of this study was to assess and compare the ability of the automatically and continuously measured stroke volume variation (SVV) obtained by FloTrac/Vigileo, and pulse pressure variation (PPV) measured by an IntelliVue MP monitor, to predict fluid responsiveness in mechanically ventilated septic shock patients. Method We conducted a prospective study on 42 septic shock patients. SVV, PPV and other haemodynamic data were recorded before and after fluid administration of 500 ml of 6% hydroxyethyl starch. Responders were defined as patients with an increase in stroke volume index of at least 15% after fluid loading. Results Twenty-four (57.1%) patients were classified as fluid responders. The baseline SVV correlated with the baseline PPV (r = 0.96, P < 0.001). SVV and PPV were significantly higher in responders than in nonresponders (15.5 ± 4.5 vs. 8.2 ± 3.3% and 16.4 ± 5.2 vs. 8.3 ± 3.5, respectively, P < 0.001 for both). There was no difference between the area under the receiver operating characteristic curves of SVV [0.92, 95% confidence interval 0.832–1.00] and PPV (0.916, 95% confidence interval 0.829–1.00). The optimal threshold values in predicting fluid responsiveness were 10% for SVV (sensitivity 91.7% and specificity 83.3%) and 12% for PPV (sensitivity 83.3% and specificity 83.3%). Our results were independent of the site of arterial catheterisation. Conclusion The SVV, obtained by FloTrac/Vigileo, and the automated PPV, obtained by the IntelliVue MP monitor, showed comparable performance in terms of predicting fluid responsiveness in passively ventilated septic shock patients, with a regular cardiac rhythm and a tidal volume not less than 8 ml kg−1.

Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country

Introduction: The Sepsis‐3 definition provides a change of two or more scores from zero or a known baseline of the Sequential Organ Failure Assessment (SOFA) as criteria of sepsis. The aim of this study was to compare the SOFA score and the quick SOFA (qSOFA) to Systemic Inflammatory Response Syndrome (SIRS) criteria in predictive ability of mortality and organ failure. Methods: A‐10 year retrospective cohort study was conducted in a teaching hospital in Thailand. Results: A total of 2350 of mixed sepsis patients by Sepsis‐2 definition were included. The all‐cause hospital mortality rate was 44.5%. Of the total sample, 95.6% (n = 2247) of patients met criteria for sepsis under the Sepsis‐3 definition. The SOFA score presented the best discrimination with an area under the receiver operating characteristic curve (AUC) of 0.839. The AUC of SOFA score for hospital mortality was significantly higher than qSOFA (AUC 0.814, P = 0.003) and SIRS (AUC 0.587, P < 0.0001). Also, the SOFA score had superior performance than other scores for predicting intensive care unit (ICU) mortality and organ failure. Conclusions: The SOFA is a superior prognostic tool for predicting mortality and organ failure than qSOFA and SIRS criteria among sepsis patients admitted to the ICU. HighlightsSOFA score provide a better predictive ability to predict mortality than qSOFA and SIRS criteria among ICU sepsis patients.qSOFA score had a better prognostic accuracy for mortality and organ failure than SIRS criteria.SIRS criteria more than 2 were common in ICU sepsis patients but offered poor outcome prediction.This study results support the application of SOFA for screening diagnosis of ICU sepsis patients as Sepsis‐3 recommendation.

The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock

PURPOSE The costs of severe sepsis care from middle-income countries are lacking. This study investigated direct intensive care unit (ICU) costs and factors that could affect the financial outcomes. METHODS A prospective cohort study was conducted in the medical ICU of a tertiary referral university teaching hospital in Thailand. RESULTS A total of 897 patients were enrolled in the study, with 683 (76.1%) having septic shock. Community-, nosocomial, and ICU-acquired infections were documented in 574, 282, and 41 patients, respectively. The median ICU costs per patient were

Possible life-threatening adverse reaction to monovalent H1N1 vaccine.

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National Early Warning Score (NEWS) at ICU discharge can predict early clinical deterioration after ICU transfer

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Nutrition therapy for critically ill patients across the Asia-Pacific and Middle East regions: A consensus statement

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Clinical outcomes of 3-year experience of targeted temperature management in patients with out-of-hospital cardiac arrest at Songklanagarind Hospital in Southern Thailand: an analysis of the MICU-TTM registry

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Comparison of glycemic control between continuous regular insulin infusion and single-dose subcutaneous insulin glargine injection in medical critically ill patients

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Quality of dying in the medical intensive care unit: Comparison between thai buddhists and thai muslims

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High-fidelity medical simulation training improves medical students' knowledge and confidence levels in septic shock resuscitation

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