Rungsun Bhurayanontachai

Natural disasters place significant strain on hospitals by increasing patient demand while compromising infrastructure, thereby making surge capacity an essential operational requirement. Reverse triage, a protocol-driven approach for identifying hospitalized patients at low short-term risk for adverse outcomes who can be safely discharged, transferred, or relocated to lower-acuity settings, remains an underutilized strategy for rapidly expanding treatment capacity. This review synthesizes current concepts in hospital disaster management and utilizes global case evidence to illustrate how hospitals can transform nominal resources into hazard-specific clinical capabilities. This review employs a narrative, framework-based methodology that integrates the four phases of emergency management (mitigation, preparedness, response, recovery), the 4S surge domains (staff, stuff, space, system), and the anticipate, recruit, retain, adapt, sustain (ARRAS) workforce framework. Evidence from earthquake responses demonstrates that structural survival does not guarantee operational continuity, as non-structural failures and fragmented command structures can render hospitals clinically non-functional. Within the space domain, studies from pediatric and general hospitals show that reverse triage can substantially expand available bed capacity during surges; however, its effectiveness is context-dependent and limited in high-risk services such as neonatal care and labor and delivery, where premature discharge presents significant risks. Reverse triage is a high-impact intervention when integrated into robust governance structures. Service-specific discharge criteria, escalation triggers, and clearly defined Incident Command System (ICS) decision rights are essential to prevent the unsafe expansion of bed capacity. Implementing reverse triage alongside infrastructure mapping, supply chain resilience, tiered staffing models, and decision-support tools can strengthen hospital resilience and improve system-wide disaster response performance.

Disparities in the performance of various kidney function equations in predicting aminoglycoside clearance (CL) have been identified. However, data specific to the Thai population remains limited. This study aimed to evaluate the performance of kidney function equations in estimating aminoglycoside CL in Thai patients. Data were retrospectively collected from hospitalized Thai patients who received amikacin or gentamicin over a 10‐year period. Population pharmacokinetic (PK) analysis was performed using a nonlinear mixed‐effects modeling approach. The association between aminoglycoside CL and kidney function, estimated by various equations, was ranked based on the magnitude of change in the Akaike Information Criterion (AIC) relative to the base model. A total of 138 adult Thai patients treated with either gentamicin (66%) or amikacin (34%) were enrolled. The non‐body surface area (BSA)‐indexed estimated glomerular filtration rate (eGFR) equations showed a stronger association with aminoglycoside CL compared to the 1.73 m ² BSA‐indexed equations. The non‐BSA‐indexed 2021 Chronic Kidney Disease Epidemiology Collaboration eGFR (2021 CKD‐EPI eGFRcr) equation demonstrated the highest association with aminoglycoside CL. The estimated volume of distribution (V) and CL from the final model were 21.91 L and 2.62 L/h, respectively. Among the Thai population, the non‐BSA‐indexed 2021 CKD‐EPI eGFRcr equation of the non‐race demonstrated the highest performance in estimating aminoglycoside CL. Further studies are warranted to confirm these findings with other renally eliminated drugs.

Within intensive care units (ICU), the administration of peptide-based formulas (PBF) may confer nutritional advantages for critically ill patients identified with heightened nutritional risk. This investigation aimed to ascertain the efficacy of PBF in comparison to standard polymeric formulas (SPF) among this patient cohort. A double-blind, randomized controlled trial was conducted across three ICUs, encompassing 63 adult patients characterized by elevated modified Nutrition Risk in Critically Ill (mNUTRIC) scores. Enrollment occurred promptly subsequent to ICU admission, with participants allocated to receive either PBF or SPF. Primary outcome was the duration to achieve caloric targets. Secondary outcomes involved the evaluation of mean daily gastric residual volume, mechanical ventilation period, infection rates within the ICU, length of hospitalization, mortality rates, nutritional status and inflammatory markers, specifically serum albumin and interleukin-6 levels. Patients in the PBF group reached their caloric targets more expeditiously compared to the SPF group (2.06 ± 0.43 days versus 2.39 ± 0.79 days; p = 0.03). No significant differences were discernible between the groups regarding gastric residual volume, duration of mechanical ventilation, ICU length of stay, mortality, or infection rates. Both cohorts exhibited minimal adverse effects and were devoid of any instances of abdominal distension. While not reaching statistical significance, the observed trends in albumin and interleukin-6 levels suggest a potential advantage of PBF utilization. The implementation of PBF enabled swifter attainment of caloric goals in ICU patients at high nutritional risk without adversely impacting other clinical parameters. Given its favorable tolerance profile and potential immunomodulatory properties, PBF may be considered a valuable nutritional intervention in this setting.Thai Clinical Trials Registry TCTR20220221006. Registered 21 February 2022, https://www.thaiclinicaltrials.org/show/TCTR20220221006.

Background: Phlebitis-associated peripheral infusion of intravenous amiodarone is common in clinical practice, with an incidence between 5% and 65%. Several factors, including drug concentration, catheter size, and in-line filter used, are significantly associated with phlebitis occurrence. We performed a retrospective propensity score-matched analysis to find out whether in-line filter will reduce the incidence of amiodarone-induced phlebitis (AIP) in high concentration of amiodarone infusion compared to low concentration without in-line filter.Methods: Clinical records of all patients who required intravenous amiodarone infusion for cardiac arrhythmias, between January 2017 to December 2019 were retrieved. The incidence of AIP was recorded and subsequently compared among high concentration (2 mg/ml) with an in-line filter and low concentration (1.5 mg/ml) infusion without an in-line filter after a 1 to 2 propensity score matched.Results: The data indicated that among the 214 cases of amiodarone infusion collected, 28 cases used an in-line filter with high concentration while 186 cases received a low concentration of amiodarone infusion without an in-line filter. After 1:2 propensity score matching, the incidence of phlebitis in the high concentration with in-line filter group was significantly higher than the low concentration without in-line filter group (28.6% vs. 3.6%, P<0.01).Conclusions: Despite the usage of in-line filter, the high concentration of amiodarone infusion resulted in a higher incidence of peripheral phlebitis. Central venous catheterization for a high concentration of amiodarone infusion is recommended.

Copyright © 2022 The Korean Society ofCritical Care MedicineThis is an Open Access article distributedunder the terms of Creative Attributions Non-Commercial License (https://creativecommons.org/li-censes/by-nc/4.0/) which permitsunrestricted noncommercial use, distribution,and reproduction in any medium, provided theoriginal work is properly cited.https://www.accjournal.org 363INTRODUCTIONSepsis is a life-threatening condition and constitutes major health care problems around the world [1,2]. Sepsis was associated with nearly 20% of all global deaths, and the majority of sepsis cases occurred in low- or middle-income countries [1]. In 2017, the World Health Organization recommended actions to reduce the global burden of sepsis [2]. Sepsis has been defined as acute life-threatening organ dysfunction due to dysregulation of host responses toBackground: Some variables of the Sequential Organ Failure Assessment (SOFA) score are not routinely measured in sepsis patients, especially in countries with limited resources. Therefore, this study was conducted to evaluate the accuracy of the modified SOFA (mSOFA) and compared its ability to predict mortality in sepsis patients to that of the original SOFA score.Methods: Sepsis patients admitted to the medical intensive care unit of Songklanagarind Hospital between 2011 and 2018 were retrospectively analyzed. The primary outcome was all-cause in-hospital mortality.Results: A total of 1,522 sepsis patients were enrolled. The mean SOFA and mSOFA scores were 9.7±4.3 and 8.8±3.9, respectively. The discrimination of the mSOFA score was significantly higher than that of the SOFA score for all-cause in-hospital mortality (area under the receiver operating characteristic curve, 0.891 [95% confidence interval, 0.875–0.907] vs. 0.879 [0.862–0.896]; P<0.001), all-cause intensive care unit (ICU) mortality (0.880 [0.863–0.898] vs. 0.871 [0.853–0.889], P=0.01) and all-cause 28-day mortality (0.887 [0.871–0.904] vs. 0.874 [0.856–0.892], P<0.001). The ability of mSOFA score to predict all-cause in-hospital and 28-day mortality was higher than that of the SOFA score within the subgroups of sepsis according to age, sepsis severity and serum lactate levels. The mSOFA score was demonstrated to have a performance similar to the original SOFA score regarding the prediction of mortality in sepsis patients with cirrhosis or hepatic dysfunction.Conclusions: The mSOFA score was a good alternative to the original SOFA core in predicting mortality among sepsis patients admitted to the ICU.

Background: Determining kidney function in critically ill patients is paramount for the dose adjustment of several medications. When assessing kidney function, the glomerular filtration rate (GFR) is generally estimated either by calculating urine creatinine clearance (UCrCl) or using a predictive equation. Unfortunately, all predictive equations have been derived for medical outpatients. Therefore, the validity of predictive equations is of concern when compared with that of the UCrCl method, particularly in medical critically ill patients. Therefore, we conducted this study to assess the agreement of the estimated GFR (eGFR) using common predictive equations and UCrCl in medical critical care setting.Methods: This was the secondary analysis of a nutrition therapy study. Urine was collected from participating patients over 24 h for urine creatinine, urine nitrogen, urine volume, and serum creatinine measurements on days 1, 3, 5, and 14 of the study. Subsequently, we calculated UCrCl and eGFR using four predictive equations, the Cockcroft–Gault (CG) formula, the four and six-variable Modification of Diet in Renal Disease Study (MDRD-4 and MDRD-6) equations, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The correlation and agreement between eGFR and UCrCl were determined using the Spearman rank correlation coefficient and Bland–Altman plot with multiple measurements per subject, respectively. The performance of each predictive equation for estimating GFR was reported as bias, precision, and absolute percentage error (APE).Results: A total of 49 patients with 170 urine samples were included in the final analysis. Of 49 patients, the median age was 74 (21–92) years-old and 49% was male. All patients were hemodynamically stable with mean arterial blood pressure of 82 (65–108) mmHg. Baseline serum creatinine was 0.93 (0.3–4.84) mg/dL and baseline UCrCl was 46.69 (3.40–165.53) mL/min. The eGFR from all the predictive equations showed modest correlation with UCrCl (r: 0.692 to 0.759). However, the performance of all the predictive equations in estimating GFR compared to that of UCrCl was poor, demonstrating bias ranged from −8.36 to −31.95 mL/min, precision ranged from 92.02 to 166.43 mL/min, and an unacceptable APE (23.01% to 47.18%). Nevertheless, the CG formula showed the best performance in estimating GFR, with a small bias (−2.30 (−9.46 to 4.86) mL/min) and an acceptable APE (14.72% (10.87% to 23.80%)), especially in patients with normal UCrCl.Conclusion: From our finding, CG formula was the best eGFR formula in the medical critically ill patients, which demonstrated the least bias and acceptable APE, especially in normal UCrCl patients. However, the predictive equation commonly used to estimate GFR in critically ill patients must be cautiously applied due to its large bias, wide precision, and unacceptable error, particularly in renal function impairment.

Duplicated inferior vena cava (DIVC) is a rare anomaly of the venous system, which is mostly found accidentally during intra-abdominal surgery and radiographic study. This anomaly is asymptomatic but may be related to venous thromboembolism in some patients. We present a case of a patient who had inadequate drainage for extracorporeal membrane oxygenation, which was found to be related to duplicated inferior vena cava.

Background: This study aimed to report the characteristics and outcomes of severe leptospirosis patients admitted to the ICU and to find the predictors of ICU admission. Methods: This is a retrospective study of patients diagnosed as leptospirosis either from a serology diagnosis or Thai Lepto score (TLS) > 4. Patients were divided into ICU and general ward cases. All data were compared. Results: Sixty-eight patients with severe leptospirosis were included. Thirty-two patients were ICU admission. ICU patients had higher SOFA score (9.8 +/- 2.7 vs 4.6+/-2.7; p = 0.001), higher TLS (7.6 +/- 2.7 vs 5.7 +/- 2.4; p < 0.001), lower hematocrit ( 32.7 +/- 7.5% vs 36.6 +/- 7.9%; p = 0.04), lower platelet count (88.7 +/- 92.2 vs 173.3 +/- 84.6 x 1000 cell/mm3; p = 0.008), higher total bilirubin (6.2 +/- 6.3 vs 3.0 +/- 3.6 mg/dL; p = 0.01), lower serum albumin (3.0 +/- 0.5 vs 3.4 +/- 0.7 g/dL; p = 0.03), higher creatinine (4.2 +/- 2.4 vs 2.8 +/-2.1 mg/dL; p = 0.02), higher requirements for vasopressor or inotrope (90.6% vs 11.1%; p < 0.001), more mechanical ventilator support (84.4% vs 5.5%; p < 0.001), more renal replacement therapy (37.5% vs 0%; p < 0.001), higher hospital mortality (12.5% vs 0%; p = 0.03), and greater length of hospital stay (10.2 +/- 5.1 vs 6.5 +/- 5.1 days; p = 0.004). The TLS, mechanical ventilator support, and inotrope or vasopressor support were among the independent factors for ICU admission. A TLS > 6 indicated ICU admission. Conclusion: The TLS, inotrope or vasopressor requirement, and mechanical ventilator support were the independent factors for ICU admission. TLS > 6 indicated ICU admission.