Ahmed Mukhtar

Background & objective: Most of the COVID-19 patients suffered from moderate to severe respiratory symptoms. Many of them needed oxygen supplementation or even mechanical ventilation. There is little data available about the use of either end-tidal CO2 (EtCO2) or integrated pulmonary index (IPI) in these patients. The aim of this study to investigate the difference in IPI values for subjects requiring mechanical ventilation compared to those managed without ventilation and the correlation between EtCO2 and SpO2. Methods: This prospective observational study involved adult COVID-19 patients admitted to the ICU with moderate to severe respiratory symptoms. All patients were connected to a portable respiratory monitor with the IPI algorithm (Medtronic Capnostream 35) and treated according to a standardized protocol. Oxygen flow was adjusted to maintain oxygen saturation (92–96%). If the respiratory rate did not fall below 30 breaths per minute and/or the SpO2 did not reach the target, non-invasive ventilation (NIV) was initiated. Patients with NIV failure was eligible for invasive mechanical ventilation. Results: SpO2 was significantly lower, while RR was significantly higher in intubated group compared to non- intubated group (P < 0.001 and 0.018, respectively). However, IPI, EtCO2, and HR did not differ among both groups. There was a significant positive correlation between EtCO2 and SpO2 at baseline before oxygen therapy (r = 0.419; P = 0.007). There was a significant negative correlation between CT score and SpO2 (r = -0.408; P = 0.01); however, there was no correlation between CT score and both IPI and end tidal CO2 at baseline (r = 0.017; P = 0.9). Conclusion: The integrated pulmonary index cannot be used as a single parameter for assessing respiratory severity in COVID-19 patients. Abbreviations: EtCO2 - end-tidal CO2; IPI - integrated pulmonary index; NIV - non-invasive ventilation; Keywords: Integrated Pulmonary Index, COVID-19, EtCO2, CT severity score. Citation: Kasem SM, Ahmed MK, Mukhtar AM, Eladawy AS, Maher MA, Farouk S. Role of integrated pulmonary index in respiratory monitoring of spontaneously breathing COVID-19 patients with moderate to severe respiratory symptoms. Anaesth. pain intensive care 2024;28(2):446−451; DOI: 10.35975/apic.v28i3.2460 Received: January 09, 2024; Reviewed: March 24, 2024; Accepted: March 24, 2024

Article: Effect of norepinephrine on blood volume, cardiac output, and systemic filling pressure in patients undergoing liver transplantation - Minerva Anestesiologica 2022 Jul 14 - Minerva Medica - Journals

Introduction: During the COVID-19 pandemic, most of the published reports on COVID-19 emphasized that health care workers (HCWs) get infected more than the general population representing one of the most vulnerable groups. However, that the real percentage of HCWs infected by SARS-CoV2 in Egypt remains unknown. The researchers conducted the current study to assess seroprevalence of SARS-CoV-2 IgG among HCWs working in a hospital with no SARS-CoV-2 patients, and to identify the potential factors associated with SARS-CoV2 IgG seropositivity. Design and methods: The current study is a cross-sectional study carried out among 455 HCWs at Cairo University Hospital. The researchers administered a questionnaire shortly before the SARS-CoV-2 rapid test is performed using closed-ended question format to obtain information on demographic data of the study participants including age, sex, specialty, clinical information including questions about medical conditions, and. history of previous exposure with a confirmed or suspected case of COVID-19, and history of COVID-19- compatible symptoms during the previous 14 days (cough, sore throat, runny nose, fatigue, shortness of breath, fever, headache, vomiting, diarrhea, anosmia, ageusia, and chills). Results: We screened 455 HCWs for SARS-CoV-2 antibodies, 31.4% were in the high-risk group, and 68.6% in the low-risk group. The overall IgG seroprevalence was, 36 (7.9%) (95% CI 5.8 to 10.8). The IgG seroprevalence was significantly higher in low-risk group 11% (35/312) versus high-risk group 0.7% (1/143, p<0.001. Conclusion: Low seropositivity rates for SARS-CoV-2 among HCWs is suggestive of lack of immunity and we are still far from herd immunity.

Background Fluid challenge test is a widely used method for the detection of fluid responsiveness in acute circulatory failure. However, detection of the patient's response to the fluid challenge requires monitoring of cardiac output which is not feasible in many settings. We investigated whether the changes in the pulse oximetry-derived peripheral perfusion index (PPI), as a non-invasive surrogate of cardiac output, can detect fluid responsiveness using the fluid challenge test or not. Methods We prospectively enrolled 58 patients with septic shock on norepinephrine infusion. Fluid challenge test, using 200 mL crystalloid solution, was performed in all study subjects. All patients received an additional 300 mL crystalloid infusion to confirm fluid responsiveness. Velocity time integral (VTI) (using transthoracic echocardiography), and PPI were measured at the baseline, after 200 mL fluid challenge, and after completion of 500 mL crystalloids. Fluid responsiveness was defined by 10% increase in the VTI after completion of the 500 mL. The predictive ability of ∆PPI [Calculated as (PPI after 200 mL − baseline PPI)/baseline PPI] to detect fluid responders was obtained using the receiver operating characteristic curve. Results Forty-two patients (74%) were fluid responders; in whom, the mean arterial pressure, the central venous pressure, the VTI, and the PPI increased after fluid administration compared to the baseline values. ∆PPI showed moderate ability to detect fluid responders [area under receiver operating characteristic curve (95% confidence interval) 0.82 (0.70–0.91), sensitivity 76%, specificity 80%, positive predictive value 92%, negative predictive value 54%, cutoff value ≥ 5%]. There was a significant correlation between ∆PPI and ∆VTI induced by the fluid challenge. Conclusion ∆PPI showed moderate ability to detect fluid responsiveness in patients with septic shock on norepinephrine infusion. Increased PPI after 200 mL crystalloid challenge can detect fluid responsiveness with a positive predictive value of 92%; however, failure of the PPI to increase does not exclude fluid responsiveness. Clinical trial identifier NCT03805321. Date of registration: 15 January 2019. Clinical trial registration URL: https://clinicaltrials.gov/ct2/show/NCT03805321?term=ahmed+hasanin&rank=9.

Objectives: Accurate estimation of a critically ill patient's caloric requirements is essential for a proper nutritional plan. This study aimed to evaluate the use of point‐of‐care ultrasound (US) to predict the resting energy expenditure (REE) in critically ill patients.Methods: In 69 critically ill patients, we measured the REE using indirect calorimetry (REE_IC), muscle layer thicknesses (MLTs), and cardiac output (CO). Muscle thickness was measured at the biceps and the quadriceps muscles. Patients were randomly split into a model development group (n = 46) and a cross‐validation group (n = 23). In the model development group, a multiple regression analysis was applied to generate REE using US (REE_US) values. In the cross‐validation group, REE was calculated by the REE_US and the resting energy expenditure using the Harris‐Benedict equation (REE_HB), and both were compared to the REE_IC.Results: In the model development group, the REE_US was predicted by the following formula: predicted REE_US (kcal/d) = 206 + 173.5 × CO (L/min) + 137 × MLT (cm) – 230 × (women = 1; men = 0) (R² = 0.8; P < .0001). In the cross‐validated group, the REE_IC and REE_US values were comparable (mean difference, −66 [−3.3%] kcal/d; P = .14). However, the difference between the mean REE_IC and the mean REE_HB was 455.8 (26%) kcal/d (P < .001). According to a Bland–Altman analysis, the REE_US agreed well with the REE_IC, whereas the REE_HB did not.Conclusions: Resting energy expenditure could be estimated from US measurements of MLTs and CO. Our point‐of‐care US model explains 80% of the change in the REE in critically ill patients.

Background: Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension.Methods: A prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 min before the hemodialysis session, 15 min before the start of hemodialysis session, every 5 min during the session, and 15 min after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation.Results: Twenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4–136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59–0.88)}, and 0.721(0.547–0.857)} respectively.Conclusions: Each of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension.