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Personalized Medicine in Emergency and Intensive Care

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426).

Deadline for manuscript submissions: closed (20 January 2022) | Viewed by 36487

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Special Issue Editors

Dr. Laura Ruggeri

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Guest Editor

Cardiopulmonary Physiopathology Lab, Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
Interests: cardiac arrest; critical care; intensive care; extracorporeal cardiopulmonary resuscitation
Special Issues, Collections and Topics in MDPI journals

Dr. Francesca Fumagalli

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Guest Editor

Cardiopulmonary Physiopathology Lab, Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
Interests: cardiac arrest; resuscitation; cardiopulmonary resuscitation; experimental research; hemodynamics; critical care medicine

Special Issue Information

Dear Colleagues,

Despite valuable advances, the field of emergency and intensive care medicine is still burdened by a high rate of mortality and disabilities. As an example, sepsis is one of the most common syndromes in the setting of intensive care, with a mortality rate as high as 40% in some cases. Also, most patients resuscitated from cardiac arrest die within the first 72 hours; indeed, only about 30% of the patients admitted to hospital survive up to 30 days or until hospital discharge, with a variability from less than 5% to 30% in different countries. Considering these two examples, the variety of responses to pathogens or insults and to the available therapies is commonly known in the clinic and has been documented. Though the mechanisms of such a variety of patients’ responses is only partially understood, it could play a pivotal role in tailoring clinical therapies and resources. In the field of emergency and intensive care medicine, many conditions and diseases present this variety of patient responses, whose mechanisms and/or risk factors are poorly understood.

This Special Issue of the Journal of Personalized Medicine will host valuable contributions aimed at understanding the mechanisms of emergency and critical diseases, explaining the variety of possible responses of the population to insults and current therapies, and hypothesizing risk stratification and tailored approaches to medical issues.

We invite worldwide investigators to contribute with original research articles and reviews on clinical and preclinical experimental observations. Specific attention is dedicated to evidence from experimental and clinical trials, controversial topics, gold standards and experimental treatments and interventions, risk factors, and personalized approaches.

Dr. Laura Ruggeri
Dr. Francesca Fumagalli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Emergency
Intensive care
Critical care
Personalized medicine
Out of hospital setting
Risk stratification

Published Papers (14 papers)

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Research

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10 pages, 836 KiB

Open AccessArticle

Trends in In-Hospital Cardiopulmonary Resuscitation from 2010 through 2019: A Nationwide Cohort Study in South Korea

by Tak Kyu Oh, You Hwan Jo and In-Ae Song

J. Pers. Med. 2022, 12(3), 377; https://doi.org/10.3390/jpm12030377 - 01 Mar 2022

Cited by 2 | Viewed by 1560

Abstract

We aimed to examine recent trends in in-hospital cardiopulmonary resuscitation in South Korea from 2010 to 2019. A population-based sample of all adult patients who experienced in-hospital cardiopulmonary resuscitation between 1 January 2010 and 31 December 2019, was included. In all, 298,676 patients who received in-hospital cardiopulmonary resuscitation were included in the survival analysis. In 2010, 60.7 per 100,000 adults experienced in-hospital cardiopulmonary resuscitation. A similar rate was observed until 2015. The rate increased to 83.5 per 100,000 adults in 2016 and gradually increased to 92.1 per 100,000 adults in 2019. Among all patients, 78,783 (26.2%) were discharged alive after in-hospital cardiopulmonary resuscitation. The 6-month and 1-year survival rates were 9.8% and 8.7%, respectively. In 2010, the mean total cost of hospitalization was USD 5822.80 (United States Dollar) (standard deviation; SD: USD 7493.4), which increased to USD 7886.20 (SD: USD 13,071.6) in 2019. The rate of in-hospital cardiopulmonary resuscitation and cost of care have significantly increased since 2010, while the 6-month and 1-year rates of survival post in-hospital resuscitation remain low. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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10 pages, 999 KiB

Open AccessArticle

Diagnostic Accuracy of the Deep Learning Model for the Detection of ST Elevation Myocardial Infarction on Electrocardiogram

by Hyun Young Choi, Wonhee Kim, Gu Hyun Kang, Yong Soo Jang, Yoonje Lee, Jae Guk Kim, Namho Lee, Dong Geum Shin, Woong Bae and Youngjae Song

J. Pers. Med. 2022, 12(3), 336; https://doi.org/10.3390/jpm12030336 - 23 Feb 2022

Cited by 1 | Viewed by 1973

Abstract

We aimed to measure the diagnostic accuracy of the deep learning model (DLM) for ST-elevation myocardial infarction (STEMI) on a 12-lead electrocardiogram (ECG) according to culprit artery sorts. From January 2017 to December 2019, we recruited patients with STEMI who received more than one stent insertion for culprit artery occlusion. The DLM was trained with STEMI and normal sinus rhythm ECG for external validation. The primary outcome was the diagnostic accuracy of DLM for STEMI according to the three different culprit arteries. The outcomes were measured using the area under the receiver operating characteristic curve (AUROC), sensitivity (SEN), and specificity (SPE) using the Youden index. A total of 60,157 ECGs were obtained. These included 117 STEMI-ECGs and 60,040 normal sinus rhythm ECGs. When using DLM, the AUROC for overall STEMI was 0.998 (0.996–0.999) with SEN 97.4% (95.7–100) and SPE 99.2% (98.1–99.4). There were no significant differences in diagnostic accuracy within the three culprit arteries. The baseline wanders in false positive cases (83.7%, 345/412) significantly interfered with the accurate interpretation of ST elevation on an ECG. DLM showed high diagnostic accuracy for STEMI detection, regardless of the type of culprit artery. The baseline wanders of the ECGs could affect the misinterpretation of DLM. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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12 pages, 1315 KiB

Open AccessArticle

Association between Initial Serum Cholesterol Levels and Outcomes of Patients Hospitalized after Out-of-Hospital Cardiac Arrest: A Retrospective Multicenter Registry Study

by Juncheol Lee, Heekyung Lee, Jaehoon Oh, Tae Ho Lim, Hyunggoo Kang, Byuk Sung Ko, Yongil Cho and The Korean Cardiac Arrest Research Consortium (KoCARC) Investigators

J. Pers. Med. 2022, 12(2), 233; https://doi.org/10.3390/jpm12020233 - 07 Feb 2022

Cited by 1 | Viewed by 1440

Abstract

Purpose: This study aimed to investigate the association between total serum cholesterol levels and outcomes upon discharge in patients after out-of-hospital cardiac arrest (OHCA). Methods: We performed a retrospective observational study using the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. Patients after OHCA whose total serum cholesterol levels were measured within 24 h after arriving at the emergency department were included in the analysis. The association between total serum cholesterol level and neurological outcomes upon discharge and survival to discharge was estimated. Results: Of the 12,321 patients after OHCA enrolled in the registry from October 2015 to June 2020, 689 patients were included. The poor neurologic outcome upon discharge group had a statistically significant lower total serum cholesterol level compared to the good neurologic outcome group (127.5 ± 45.1 mg/dL vs. 155.1 ± 48.9 mg/dL, p < 0.001). As a result of multivariate logistic regression analysis, the odds ratio for the neurologic outcome of total serum cholesterol levels was 2.00 (95% confidence interval [CI] 1.01–3.96, p = 0.045). The odds ratio for in-hospital death was 1.72 (95% CI 1.15–2.57, p = 0.009). Conclusions: Low total serum cholesterol levels could be associated with poor neurologic outcomes upon discharge and in-hospital death of patients hospitalized after OHCA. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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10 pages, 1262 KiB

Open AccessArticle

Comparative Evaluation of the Prognosis of Septic Shock Patients from Before to After the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis

by Jae Hwan Kim, Chiwon Ahn and Myeong Namgung

J. Pers. Med. 2022, 12(1), 103; https://doi.org/10.3390/jpm12010103 - 13 Jan 2022

Cited by 8 | Viewed by 1826

Abstract

In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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9 pages, 1128 KiB

Open AccessArticle

Invasive Candidiasis in Hospitalized Patients with Major Burns

by Yi-Ling Lin, I-Chen Chen, Jung-Hsing Yen, Chih-Sheng Lai, Yueh-Chi Tsai, Chun-Te Lu, Cheng-Yeu Wu, Wei-Szu Lin, Ching-Heng Lin and Yung-Chieh Huang

J. Pers. Med. 2022, 12(1), 47; https://doi.org/10.3390/jpm12010047 - 04 Jan 2022

Cited by 1 | Viewed by 1549

Abstract

Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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9 pages, 999 KiB

Open AccessArticle

Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge

by Won-Young Kim and Moon Seong Baek

J. Pers. Med. 2021, 11(12), 1257; https://doi.org/10.3390/jpm11121257 - 25 Nov 2021

Cited by 1 | Viewed by 1410

Abstract

Data regarding the long-term outcomes for tracheostomized patients receiving home mechanical ventilation (HMV) are limited. We aimed to determine the 1-year mortality rate for critically ill tracheostomized patients with and without HMV. Data of tracheostomized patients between 1 January 2015 and 31 December 2019 were analyzed. A Kaplan-Meier analysis was performed to assess the survival curve of the patients. Among the 124 tracheostomized patients, 102 (82.3%) were weaned from mechanical ventilation (MV), and 22 (17.7%) required HMV at discharge. The overall 1-year mortality rate was 47.6%, and HMV group had a significantly higher 1-year mortality rate than those weaned from MV (41.2% vs. 77.3%, p = 0.002). In the Cox proportional hazards regression, BMI (HR 0.913 [95% CI 0.850–0.980], p = 0.012), Sequential Organ Failure Assessment (SOFA) score (HR 1.114 [95% CI 1.040–1.193], p = 0.002), transfer to a nursing facility (HR 5.055 [95% CI 1.558–16.400], p = 0.007), and HMV at discharge (HR 1.930 [95% CI 1.082–3.444], p = 0.026) were significantly associated with 1-year mortality. Critically ill tracheostomized patients with HMV at discharge had a significantly higher 1-year mortality rate than those weaned from MV. Low BMI, high SOFA score, transfer to a nursing facility, and HMV at discharge were significantly associated with 1-year mortality. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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9 pages, 512 KiB

Open AccessArticle

Statistical Analysis of the Main Risk Factors of an Unfavorable Evolution in Gastroschisis

by Elena Ţarcă, Solange Tamara Roșu, Elena Cojocaru, Laura Trandafir, Alina Costina Luca, Valeriu Vasile Lupu, Ștefana Maria Moisă, Valentin Munteanu, Lăcrămioara Ionela Butnariu and Viorel Ţarcă

J. Pers. Med. 2021, 11(11), 1168; https://doi.org/10.3390/jpm11111168 - 09 Nov 2021

Cited by 6 | Viewed by 1628

Abstract

Gastroschisis is a congenital abdominal wall defect that presents an increasing occurrence at great cost for the health system. The aim of the study is to detect the main factors of an unfavorable evolution in the case of gastroschisis and to find the best predictors of death. Methods: we conducted a retrospective cohort study of neonates with gastroschisis treated in a tertiary pediatric center during the last 30 years; 159 patients were eligible for the study. Logistic regression was used to determine the risk of death, estimated based on independent variables previously validated by the chi-square test. Results: if the birth weight is below normal, then we find an increased risk (4.908 times) of evolution to death. Similarly, the risk of death is 7.782 times higher in the case of developing abdominal compartment syndrome, about 3 times in the case of sepsis and 7.883 times in the case of bronchopneumonia. All four independent variables contributed 47.6% to the risk of death. Conclusion: although in the past 30 years in our country we have seen transformational improvements in outcome of gastroschisis, survival rates increasing from 26% to 52%, some factors may still be ameliorated for a better outcome. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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11 pages, 1724 KiB

Open AccessArticle

The Feasibility and Efficiency of Remote Spirometry System on the Pulmonary Function for Multiple Ribs Fracture Patients

by Chien-An Liao, Tai-Horng Young, Chi-Tung Cheng, Ling-Wei Kuo, Chih-Yuan Fu, Chih-Po Hsu, Szu-An Chen, Yu-San Tee, Chih-Hsun Hsieh, Chih-Chi Chen and Chien-Hung Liao

J. Pers. Med. 2021, 11(11), 1067; https://doi.org/10.3390/jpm11111067 - 23 Oct 2021

Cited by 1 | Viewed by 2250

Abstract

Background: Multiple rib fractures is a common chest trauma with a significant and sustained impact on pulmonary function and quality of life. Continuous monitoring of the pulmonary function parameter was necessary to adjust the therapeutic goals in these patients. We developed an internet-based remote system for lung function monitoring with a remote spirometry and smart device application to follow up these patients consecutively. Method: From Jan 2021 to April 2021, we conducted a prospective study that applied an intelligent spirometry system for patients with multiple rib fractures. With informed consent, we collected clinical data from them and introduced the remote spirometry system. We followed up with these patients for 12 weeks after trauma and compared the recovery of pulmonary function parameters and clinical outcomes. Result: A total of 21 patients were enrolled in our study. We divided them into two groups by the compliance to this remote spirometry system. The improvement of forced vital capacity was better in the good compliance group than the poor compliance group (110% versus 21%, p value 0.049). Moreover, the complication rate was also lower in the good compliance group than the poor compliance group (10% versus 66.7% p value 0.017). Conclusions: Remote spirometry system is a novel system that can help in lung rehabilitation in patients with multiple rib fractures. Patients that cooperate well with this system presented superior lung function improvement and inferior complication rate. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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12 pages, 1112 KiB

Open AccessArticle

Association between Domperidone Administered via Feeding Tube and Feeding Success in Critically Ill Patients with Enteral Feeding Intolerance

by Yisong Cheng, Chaoyue Chen, Hao Yang, Min Fu, Xi Zhong, Bo Wang, Zhi Hu, Min He, Zhongwei Zhang, Xiaodong Jin, Yan Kang and Qin Wu

J. Pers. Med. 2021, 11(9), 846; https://doi.org/10.3390/jpm11090846 - 27 Aug 2021

Cited by 2 | Viewed by 2459

Abstract

One nutritional challenge in critically ill patients is enteral feeding intolerance (EFI), but current prokinetic agents have uncertain efficacy and safety profiles. We conducted a longitudinal, single-center, retrospective study to evaluate the efficacy and safety of domperidone administered via the feeding tube versus intravenous (IV) metoclopramide among adult patients with EFI. The primary outcome was feeding success, defined as the proportion of patients with average percentage of daily protein prescription >80% of the target dose. The secondary outcomes were safety endpoints. Among 28,814 intensive care unit (ICU) admissions, 552 patients with EFI were included, 38 receiving IV metoclopramide and 514 receiving tube feeding domperidone. The proportion of feeding success in patients receiving tube feeding domperidone and IV metoclopramide was 42.02% and 21.05%, respectively. After 1:2 matching (IV metoclopramide to tube feeding domperidone), the proportion of feeding success was 40.79% in patients receiving tube feeding domperidone. Basically, after matching, there were no differences in any safety endpoints (mortality and length of stay during ICU and hospitalization, organ-support-treatment free days) or adverse events (recurrence of EFI, electrolyte disturbance, abdominal and other symptoms) between the two groups (p > 0.05). A logistic regression analysis in the matched cohort indicated that domperidone administered via the feeding tube was independently associated with feeding success. We found that tube feeding domperidone was efficient in increasing enteral nutrition delivery performance among critically ill adult patients with EFI. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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12 pages, 650 KiB

Open AccessArticle

Prognostic Value of Circadian Rhythm of Brain Temperature in Traumatic Brain Injury

by Lu-Ting Kuo, Hsueh-Yi Lu and Abel Po-Hao Huang

J. Pers. Med. 2021, 11(7), 620; https://doi.org/10.3390/jpm11070620 - 30 Jun 2021

Cited by 5 | Viewed by 1876

Abstract

Hypothermia has been used in postoperative management of traumatic brain injury (TBI); however, the rhythmic variation and prognostic value of brain temperature after TBI have never been studied. This study describes diurnal brain temperature patterns in comatose patients with TBI. Mesors of brain temperature, amplitude, and acrophase were estimated from recorded temperature measurements using cosinor analysis. The association of these patterns with clinical parameters, mortality, and functional outcomes in a 12-month follow-up was examined. According to the cosinor analysis, 59.3% of patients presented with circadian rhythms of brain temperature in the first 72 h postoperatively. The rhythm-adjusted mesor of brain temperature was 37.39 ± 1.21 °C, with a diminished mean amplitude of 0.28 (±0.25) °C; a shift of temperature acrophase was also observed. Multivariate logistic regression analysis revealed that initial Glasgow coma scale score, age, elevated blood glucose level, and circadian rhythm of brain temperature seemed to be predictive and prognostic factors of patients’ functional outcomes. For the prediction of survival status, younger patients or those patients with mesor within the middle 50% of brain temperature were more likely to survive. The analysis of brain temperature rhythms in patients with moderate and severe TBI provided additional predictive information related to mortality and functional outcomes. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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15 pages, 2105 KiB

Open AccessFeature PaperArticle

Hexosylceramides and Glycerophosphatidylcholine GPC(36:1) Increase in Multi-Organ Dysfunction Syndrome Patients with Pediatric Intensive Care Unit Admission over 8-Day Hospitalization

by Mara Leimanis-Laurens, Emily Wolfrum, Karen Ferguson, Jocelyn R. Grunwell, Dominic Sanfilippo, Jeremy W. Prokop, Todd A. Lydic and Surender Rajasekaran

J. Pers. Med. 2021, 11(5), 339; https://doi.org/10.3390/jpm11050339 - 24 Apr 2021

Cited by 2 | Viewed by 1720

Abstract

Glycero- and sphingo-lipids are important in plasma membrane structure, caloric storage and signaling. An un-targeted lipidomics approach for a cohort of critically ill pediatric intensive care unit (PICU) patients undergoing multi-organ dysfunction syndrome (MODS) was compared to sedation controls. After IRB approval, patients meeting the criteria for MODS were screened, consented (n = 24), and blood samples were collected from the PICU at HDVCH, Michigan; eight patients needed veno-arterial extracorporeal membrane oxygenation (VA ECMO). Sedation controls were presenting for routine sedation (n = 4). Plasma lipid profiles were determined by nano-electrospray (nESI) direct infusion high resolution/accurate mass spectrometry (MS) and tandem mass spectrometry (MS/MS). Biostatistics analysis was performed using R v 3.6.0. Sixty-one patient samples over three time points revealed a ceramide metabolite, hexosylceramide (Hex-Cer) was high across all time points (mean 1.63–3.19%; vs. controls 0.22%). Fourteen species statistically differentiated from sedation controls (p-value ≤ 0.05); sphingomyelin (SM) [SM(d18:1/23:0), SM(d18:1/22:0), SM(d18:1/23:1), SM(d18:1/21:0), SM(d18:1/24:0)]; and glycerophosphotidylcholine (GPC) [GPC(36:01), GPC(18:00), GPC(O:34:02), GPC(18:02), GPC(38:05), GPC(O:34:03), GPC(16:00), GPC(40:05), GPC(O:36:03)]. Hex-Cer has been shown to be involved in viral infection and may be at play during acute illness. GPC(36:01) was elevated in all MODS patients at all time points and is associated with inflammation and brain injury. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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Review

Jump to: Research

10 pages, 1398 KiB

Open AccessReview

Association between Glasgow Coma Scale in Early Carbon Monoxide Poisoning and Development of Delayed Neurological Sequelae: A Meta-Analysis

by Myeong Namgung, Jaehoon Oh, Chiwon Ahn, Chan Woong Kim, Heekyung Lee and Hyunggoo Kang

J. Pers. Med. 2022, 12(4), 635; https://doi.org/10.3390/jpm12040635 - 14 Apr 2022

Cited by 4 | Viewed by 2051

Abstract

A significant number of people experience delayed neurologic sequelae after acute carbon monoxide (CO) poisoning. The Glasgow Coma Scale (GCS) can be used to predict delayed neurologic sequelae occurrence efficiently and without any restrictions. Here, we investigated the association between a low GCS score observed in cases of early CO poisoning and delayed neurologic sequelae development through a meta-analysis. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies on GCS as a predictor of delayed neurologic sequelae occurrence in patients with CO poisoning in June 2021. Two reviewers independently extracted study characteristics and pooled data. We also conducted subgroup analyses for the cutoff point for GCS. To assess the risk of bias of each included study, we used the quality in prognosis studies tool. We included 2328 patients from 10 studies. With regard to patients with acute CO poisoning, in the overall pooled odds ratio (OR) of delayed neurologic sequelae development, those with a low GCS score showed a significantly higher value and moderate heterogeneity (OR 2.98, 95% confidence interval (CI) 2.10–4.23, I² = 33%). Additionally, in subgroup analyses according to the cutoff point of GCS, the development of delayed neurologic sequelae was still significantly higher in the GCS < 9 group (OR 2.80, 95% CI 1.91–4.12, I² = 34%) than in the GCS < 10 or GCS < 11 groups (OR 4.24, 95% CI 1.55–11.56, I² = 48%). An initial low GCS score in patients with early CO poisoning was associated with the occurrence of delayed neurologic sequelae. Additionally, GCS was quickly, easily, and accurately assessed. It is therefore possible to predict delayed neurologic sequelae and establish an active treatment strategy, such as hyperbaric oxygen therapy, to minimize neurological sequelae using GCS. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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14 pages, 2462 KiB

Open AccessReview

Optic Nerve Sheath Diameter for Predicting Outcomes in Post-Cardiac Arrest Syndrome: An Updated Systematic Review and Meta-Analysis

by Jae-Guk Kim, Wonhee Kim, Hyungoo Shin, Tae-Ho Lim, Bo-Hyoung Jang, Youngsuk Cho, Kyu-Sun Choi, Min-Kyun Na, Chiwon Ahn and Juncheol Lee

J. Pers. Med. 2022, 12(3), 500; https://doi.org/10.3390/jpm12030500 - 20 Mar 2022

Cited by 2 | Viewed by 2173

Abstract

We aimed to identify the efficacy of optic nerve sheath diameter (ONSD) in predicting mortality and poor neurological outcomes (PNO) in post-cardiac arrest syndrome (PCAS) by the measurement time of outcomes. We conducted an extensive literature search in EMBASE, MEDLINE, and Cochrane Library, which included studies on the prognostic accuracy of ONSD in predicting PNO and mortality in PCAS by the measured time of outcomes. A total of 791 patients from nine studies were included. Increased ONSD was weakly associated with PNO by a high heterogeneity (standardized mean difference with 95% confidence interval = 0.74 (0.22, 1.27); I² = 87%). The analysis by the measurement time of PNO and mortality for ONSD had no significant difference due to insufficient articles or high heterogeneities. The prognostic accuracy of ONSD was 23.97 (pooled diagnostic odds ratio, I² = 0%) and 0.94 (area under the curve) for short-term PNO. The pooled results showed low or very low quality and very low quality of evidence for PNO and mortality, respectively. ONSD measurement might be an effective predictor for short-term PNO in PCAS. An analysis by measurement time of outcomes showed no significant evidence for ONSD measurement effectiveness in predicting mortality and PNO. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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29 pages, 1971 KiB

Open AccessReview

Comparisons of Videolaryngoscopes for Intubation Undergoing General Anesthesia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

by Juncheol Lee, Youngsuk Cho, Wonhee Kim, Kyu-Sun Choi, Bo-Hyoung Jang, Hyungoo Shin, Chiwon Ahn, Jae Guk Kim, Min Kyun Na, Tae Ho Lim and Dong Won Kim

J. Pers. Med. 2022, 12(3), 363; https://doi.org/10.3390/jpm12030363 - 26 Feb 2022

Cited by 4 | Viewed by 10946

Abstract

Background: The efficacy and safety of videolaryngoscopes (VLs) for tracheal intubation is still conflicting and changeable according to airway circumstances. This study aimed to compare the efficacy and safety of several VLs in patients undergoing general anesthesia. Methods: Medline, EMBASE, and the Cochrane Library were searched until 13 January 2020. The following VLs were evaluated compared to the Macintosh laryngoscope (MCL) by network meta-analysis for randomized controlled trials (RCTs): Airtraq, Airwayscope, C-MAC, C-MAC D-blade (CMD), GlideScope, King Vision, and McGrath. Outcome measures were the success and time (speed) of intubation, glottic view, and sore throat (safety). Results: A total of 9315 patients in 96 RCTs were included. The highest-ranked VLs for first-pass intubation success were CMD (90.6 % in all airway; 92.7% in difficult airway) and King Vision (92% in normal airway). In the rank analysis for secondary outcomes, the following VLs showed the highest efficacy or safety: Airtraq (safety), Airwayscope (speed and view), C-MAC (speed), CMD (safety), and McGrath (view). These VLs, except McGrath, were more effective or safer than MCL in moderate evidence level, whereas there was low certainty of evidence in the intercomparisons of VLs. Conclusions: CMD and King Vision could be relatively successful than MCL and other VLs for tracheal intubation under general anesthesia. The comparisons of intubation success between VLs and MCL showed moderate certainty of evidence level, whereas the intercomparisons of VLs showed low certainty evidence. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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