Purpose Although several studies of preperitoneal pelvic packing (PPP) have reported a hemostatic effect in patients with pelvic fractures, the presence of packed surgical tapes may provoke inflammation or infection. In Korean institutions, the delta neutrophil index (DNI) is currently used as a clinical biomarker for identifying sepsis and predicting prognosis. Therefore, this study aimed to evaluate the usefulness of DNI in pelvic fracture patients who underwent PPP.
Methods We retrospectively reviewed 36 hemodynamically unstable patients who underwent PPP between May 2014 and December 2018 at Wonju Severance Christian Hospital. To evaluate differences in postoperative DNI patterns between survivors and nonsurvivors, repeated-measures analysis of variance was performed.
Results Eight patients died, and 16 patients developed PPP-related complications. Packed surgical tapes were maintained for a mean of 46.3 hours. Compared with survivors, nonsurvivors had significantly higher DNI values on postoperative day (POD) 2 (5.3% [range, 0%–40.2%] vs. 36.0% [range, 5.4%–70.2%], P<0.001) and POD 3 (2.6% [range, 0%–16.3%] vs. 29.9% [range, 1.2%–64.2%], P<0.001). The overall pattern of DNI change over time differed significantly between survivors and nonsurvivors (P=0.001). In addition, patients with PPP-related complications exhibited a significantly smaller decrease in DNI between POD 1 and POD 2 compared with those without complications (–1.6% [range, −7.8% to 58.9%] vs. –4.5% [−46.8% to 31.6%], P=0.048).
Conclusion Postoperative DNI may serve as a clinical indicator for predicting mortality and complications in pelvic fracture patients who have undergone PPP.
Fournier gangrene (FG) is a rare life-threatening infection j that can occasionally extend beyond the perineum into the retroperitoneal space. Preperitoneal involvement in female patients is extremely rare. We report a unique case of a 59-year-old female with FG, characterized by atypical preperitoneal extension. Despite initial treatment failure, the patient recovered following emergency debridement, and targeted antibiotic therapy. This case underscores the importance of early diagnosis, timely surgical intervention, and multidisciplinary care in managing atypical FG presentations in female patients. It emphasizes the need for prompt and aggressive management to improve survival in these rare instances.
Purpose It is important to understand changes in energy requirements in critically ill patients with sepsis. This study investigates alterations in energy requirements based on the clinical course of sepsis in patients admitted to the surgical intensive care unit (SICU) using indirect calorimetry.
Methods In this prospective study, 36 patients admitted to the surgical intensive care unit with sepsis were analyzed. Using indirect calorimetry, the resting energy expenditure (REE) and respiratory quotient (RQ) were assessed on the 1st, 3rd, and 7th day of Intensive Care Unit admission. Measured REE through indirect calorimetry was compared with the predictive equations (Weight-based, Harris-Benedict, IretonJones, and Penn state 2003) using intraclass correlation coefficient (ICC) and Bland-Altman analysis.
Results Measured REE was highest on Day 1 and remained unchanged on Day 3 and 7 (Day 1 vs. Day 3 vs. Day 7: 24.29 ± 3.72 kcal/kg vs. 22.42 ± 3.72 kcal/kg vs. 23.26 ± 5.78 kcal/kg). RQ decreased on Day 3 but increased on Day 7 after caloric intake (Day 1 vs. Day 3 vs. Day 7: 0.69 ± 0.06 vs. 0.67 ± 0.05 vs. 0.71 ± 0.06). Comparing the correlation between the 4 predictive equations and the measured REE, the Penn state 2003 equation demonstrated the highest correlation at each time point, although it showed a decreasing trend over time (Penn state equation ICC: Day 1-0.71, Day 3-0.65, Day 7-0.53).
Conclusion In sepsis patients, it is necessary to understand metabolic changes according to the clinical course and provide appropriate calories as determined by using indirect calorimetry when the patients enter the stable phase.
Purpose The objective of this study was to evaluate the effect of Polymyxin B hemoperfusion (PMX-HP) on patients with sepsis.
Methods A systematic review and meta-analysis was performed using relevant articles retrieved from 3 databases (PubMed, Cochrane Library, EMBASE). Randomized studies from 1 January 1999 to 28 February 2022 were examined to determine the clinical results of PMX-HP. A meta-analysis was carried out using the random-effects method, meta-regression with clinical variables, and assessment of risk of bias (ROB) tool (Cochrane ROB assessment tool). Mortality was evaluated within 60 days of hospitalization (in-hospital death 28-day, 30-day, and 60-day mortality) and predictors associated with mortality were determined using meta-regression.
Results There were 11 randomized studies with 548 patients included in the meta-analysis. The pooled mortality was 35% (95% CI, 27%-42%, 95% CI 0.53-0.96). Further subgroup analysis was performed according to the duration of PMX-HP. An extension of PMX-HP treatment beyond 2 hours (pooled mortality, 43%; 95% CI, 9%-76%) compared with a 2-hour session (pooled mortality, 33%. 95% CI, 27%-38%) showed an increase in mortality rates. However, this was not statistically significant. Univariate meta-regression showed that patient’s age, the acute physiology and chronic health evaluation score, and the sequential organ failure assessment score did not significantly impact mortality.
Conclusion While PMX-HP is valuable in the management of septic shock, treatment duration should be based on careful assessment of the patient's condition, the risks and benefits of prolonged therapy, and the overall treatment strategy including antimicrobial management and source control.
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The endotoxin activity assay as a useful guide for the application of polymyxin B hemoperfusion: a case report Hansol Song, Seong Jong Park Archives of Pediatric Critical Care.2024; 2(2): 108. CrossRef
Purpose Despite guidelines on the prevention of central venous line-associated bloodstream infection, it is left to the clinical judgment of the attending physician to determine the risk of infection and how long a central line should remain in place. This study aimed to identify risk factors for peripherally inserted central venous catheter (PICC)-associated infection.
Methods This retrospective study included 1,136 patients with a PICC who were hospitalized at the National Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medical records were reviewed for patients with positive blood cultures. Patients with suspicion of infection at the PICC insertion site or with unclear infection at other sites were defined as having a PICC-associated infection.
Results Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differences in hypertension (p = 0.026), lung disease (p = 0.001), PICC duration > 14 days, and antibiotic use before PICC insertion (p = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regression analysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, p = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, p = 0.002) as independent risk factors for PICC-associated infection.
Conclusion The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.
Factor V (FV) deficiency is a coagulation disorder (congenital or acquired). Unlike congenital FV deficiency, mixing tests for prothrombin time and activated partial thromboplastin time are not corrected in acquired FV cases. A 79-year-old male was admitted to the intensive care unit after an emergency operation due to gastric ulcer perforation. While receiving antibiotic treatment for septic shock, the coagulation profile began to show prolongation of prothrombin time and activated partial thromboplastin time. FV deficiency (< 1%) following meropenem administration was diagnosed . The patient did not show spontaneous bleeding or bleeding tendency. With fresh frozen plasma transfusion, steroid administration, and discontinuation of meropenem, the blood coagulation profile test result was normalized 20 days after diagnosis. His follow-up FV level increased to 78.7%. Although abnormalities in coagulation profiles are common in sepsis patients, in our patient, timely recognition and hematological consultation allowed early diagnosis and proper management of FV deficiency.
Mucormycosis is a fungal infection that primarily causes opportunistic infections. Gastrointestinal mucormycosis is a rare infection that can occur in immunocompromised patients, nevertheless, prompt diagnosis and treatment is essential because it can be fatal. Gastrointestinal mucormycosis can only be diagnosed based on the findings of a pathological examination. Mucormycosis should be included in the differential diagnosis if the condition of patients with underlying immunocompromised conditions or diseases does not improve with general intensive care.
Intra-abdominal infection is a common, serious complication in patients undergoing emergency abdominal surgery following blunt abdominal trauma. Infectious conditions increase the incidence of autoimmune hemolytic anemia (AIHA), but reports of AIHA occurring after abdominal trauma surgery are rare. Therefore, we report a case of sepsis due to fasciitis and AIHA after abdominal trauma surgery which was successfully managed following the appropriate treatment of both conditions.
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A case of autoimmune hemolytic anemia with cold agglutinin disease post-operation for recurrent ovarian cancer Aisa Sugimoto, Hiroaki Yamada, Kazuto Tasaki, Takahiro Katsuda, Shin Nishio, Naotake Tsuda International Cancer Conference Journal.2025; 14(3): 235. CrossRef
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Purpose Thromboelastography (TEG) was investigated for the diagnosis of coagulopathy compared with traditional coagulation tests, in association with disease severity in patients with severe sepsis or septic shock.
Methods Retrospective data was collected from a single center between January 25th to March 24th, 2016. There were 18 patients with severe sepsis or septic shock admitted to intensive care units included in this study. Laboratory tests including TEG were performed at admission. Disease severity was measured using the Simplified Acute Physiology Score III, Sequential Organ Failure Assessment score, and the level of lactate.
Results There were 18 patients (61% males; median age, 60.5 years) who were diagnosed with severe sepsis, or septic shock requiring a norepinephrine infusion (n = 10, 55.6%). Of these, 4 patients had traditional coagulation tests, and TEG profiles which confirmed hypercoagulability. Eight patients had follow-up tests 48 hours post-admission with a Sequential Organ Failure Assessment score of 6.5 (3-9.5) at admission, decreasing to 4 (2-11) after 48 hours (although not significantly lower), however, the lactate level decreased statistically significantly from 2.965 at admission, to 1.405 mmol/L after 48 hours (p < 0.05). The TEG profiles tended to normalize after 48 hours compared with admission, but there was no statistically significant difference.
Conclusion Coagulopathy with severe sepsis or septic shock patients can be life-threatening, therefore it is important to diagnose coagulopathy early and precisely. TEG can be a feasible tool to confirm coagulopathy with traditional coagulation tests.
, Young Un Choi
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