High frequency oscillatory ventilation may not rescue ARDS patients: an observational study

HFOV is a rescue mode of ventilation. Our objective was to assess usage and mortality predictors of HFOV. Observational study of ARDS patients, with data extracted from an ICU database. Analysis was carried out using SPSS version 20.0. Of 136 ARDS patients, 29.4% (40) were placed on HFOV. Use of HFOV correlated with age (38.7±14.8 vs 49.7±19.4 years, p=0.002, 95% CI 4.2, 17.8) and pulmonary insults (Chi2 value 44.3, p<0.001). Earlier placement was associated with levels of support on conventional ventilation (PIP - 0.343, p=0.029, PEEP - 0.322, p=0.043, FiO2 - 0.404, p=0.010, tidal volumes - 0.4, p=0.009). ICU mortality was 58.8% (80) with 53% in patients on conventional ventilation and 72.5% (29) in patients on HFOV. Multivariate regression identified APACHE IV (score≤70 OR 0.97, 95% CI 0.96, 0.98, p<0.001) and use of HFOV (OR 2.4, 95% CI 1.05, 5.5, p=0.038) as independent predictors of mortality. Baseline PaO2/FiO2 ratio (p=0.006), concurrent iNO (p=0.001), tidal volumes on conventional ventilation (p=0.016) and improved oxygenation (p=0.001) correlated significantly with survival. HFOV is associated with increased ICU mortality in patients with ARDS.High frequency oscillatory ventilation may not rescue ARDS patients- an observational study


The effect of thrombocytopenia on outcome in critically ill children

Objective: Thrombocytopenia is common in pediatric intensive care unit. We aimed to investigate thrombocytopenia and risk factors associated with mortality in the pediatric intensive care unit.

Design: One year hospital records were investigated retrospectively.

Setting: Present study was performed in the pediatric intensive care unit in Çukurova University, Faculty of Medicine.

Patients and participants: A total of 94 patients, 50 (53.2 %) boys and 44 girls (46.8%), were included in this study. The median age was 24 months with a range from 1 to 240 months. Thrombocytopenia was defined as platelet counts <150x109/L. PRISM II score, mechanical ventilation (MV), use of central venous (CVC) or arterial catheters (AC), presence or absence of sepsis, coagulopathy, hemorrhage and receiving of transfusion were recorded at the time of admission. White blood cell count (WBC), aspartate aminotransferase (AST), alanin aminotransferase (ALT), total protein, albumin/globulin ratio, blood urea nitrogen (BUN), serum creatinine (Cr), total bilirubin, C reactive protein (CRP), procalcitonin (PCT) and lactate were recorded.

Measurements and results: The incidence of thrombocytopenia was 59.57%. MV, CVC, coagulopathy, hemorrhage and transfusion were found to be significant factors for thrombocytopenia. Leukocytosis and leucopenia were significant in thrombocytopenic patients (p=0.024). Increased ALT, AST, BUN, total bilirubin and decreased total protein levels significantly were related to thrombocytopenia. Hospital mortality rate was 37.2%. There was a significant association between mortality and the presence of MV, CVC and AC. Sepsis, coagulopathy, hemorrhage and transfusion had strong correlation with mortality. Increased ALT, AST, BUN, bilirubin, PCT, lactate and decreased total protein levels were related to the mortality.

Conclusions: The present study suggested that thrombocytopenia could be related to mortality and an indicator of poor prognosis in the pediatric intensive care unit. Therefore thrombocytopenia-associated risk factors should be closely followed up by physicians in critically ill children.The effect of thrombocytopenia on outcome in critically ill children


Ethambutol-induced nephrotoxicity: case report and review of the literature

Ethambutol is a common component in the treatment of mycobacteria infections worldwide, and is rarely associated with nephrotoxicity. We report a patient presenting with acute kidney injury due to ethambutol as well as its management and a comprehensive review of the pertinent literature.Ethambutol-induced nephrotoxicity- case report and review of the literature