critically ill | Acta Medica Marisiensis

The outcome in critically ill patients admitted for thoracic trauma – A single center analysis over one year

Oana Elena Branea¹, Konrád Ottó Kiss², Mihai Pui², Vlad Dimitrie Cehan², Oana Frandes², Anca Gabriela Vlad², Ioan Alexandru Branea³, Andrei Cristian Fulop⁴, Monica Chis⁵, Alexandra Elena Lazar¹

1. Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Clinic of Anesthesia and Intensive Care, Emergency Clinical County Hospital of Targu Mures, Romania
3. Emergency Medicine Department, Emergency Clinical County Hospital of Targu Mures, Romania
4. Clinic of Radiology, Emergency Clinical County Hospital of Targu Mures, Romania
5. Rheumatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0046

Objective: The main objective of the current study was to examine the outcome of critically ill patients in relation to clinical and thoracic injuries. The secondary objectives were to assess the role of CT in the evaluation of the diaphragm and to provide an analysis of prognostic abilities with respect to diaphragm changes.
Methods: This single-center retrospective observational cohort study was conducted in the ICU of Târgu Mureș County Emergency Clinical Hospital, Romania. This study identified 52 critically ill blunted or penetrating chest trauma patients admitted to the ICU from 01 January 2021 to 31 December 2021. CT scan was used to identify thorax injuries and diaphragm thickness. The outcome of all patients was analyzed.
Results: Most of the patients experienced traffic accidents (44.23%) or falls (26.93%). The predominant characteristics associated with chest trauma were rib fractures (92.30%), lung contusions (63.50%), and pneumothorax (53.80%). The most common injury seen in the study was rib fractures, accounting for 92.30% of cases. This was followed by lung contusions, which were present in 63.50% of patients, and pneumothorax, which occurred in 53.80% of cases. It was examined ROC AUC for thickness of the right and the left diaphragm and severity scores. When assessing the thickness of the diaphragm in deceased and survivors, no statistically significant differences were found.
Conclusion: Although no significant differences were found regarding the prognosis between the survivors and the deceased, diaphragm thickness might potentially serve as a predictor for the severity of the injury.

Computed tomography evaluation of diaphragm alterations in 20 critically ill COVID-19 positive patients

Oana Elena Branea¹, AnaMaria Romina Budeanu², Răzvan Gabriel Budeanu³, Adrian Ștefan Chiuzan⁴, Ioana Lăcrămioara Nazaret⁵, Sanda Maria Copotoiu¹, Alexandra Elena Lazăr¹

1. Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România
2. Department of Anesthesia and Intensive Care, Emergency Clinical County Hospital of Târgu Mureș, România
3. Department of Radiology, Emergency Clinical County Hospital of Târgu Mureș, România
4. Department of Radiology, Emergency Clinical County Hospital of Bistrița, România
5. Department of Anesthesia and Intensive Care, Emergency Clinical County Hospital of Piatra Neamț, România

DOI: 10.2478/amma-2022-0014

Objective: Diaphragmatic dysfunctions are multiple and critical illnesses often lead to the muscular atrophy that affects respiratory and peripheral muscles. The primary objective was to investigate diaphragm thickness in hospitalized patients. Secondary objectives were to assess clinical evolution and outcome. Methods: In a mean time period of 7.9 days, two different chest computed tomographies were used in order to examine diaphragm alterations of right and left diaphragm in 20 critically ill patients tested Real-Time Polymerase Chain Reaction positive to Severe Acute Respiratory Syndrome Coronavirus-2. Patients were divided in two groups (one group <5% decrease in diaphragm thickness and another group ≥5% decrease in diaphragm thickness).
Results: Results showed that patients presented low 10 years predicted survival rate (Charlson Comorbidity Index > 7.7±3.08), marked inflammatory status (C-Reactive Protein = 98.22±73.35, Interleukine-6 = 168.31±255.28), high physiologic stress level (Neutrophil/Lymphocyte Ratio = 31.27±30.45), respectively altered acid-base equilibrium. Half of the investigated patients had decrease in diaphragm thickness by at least 5% (right diaphragm = -7.83%±11.11%, left diaphragm = -5.57%±10.63%). There were no statistically significant differences between those with decrease of diaphragm thickness and those without diaphragm thickness, regarding length of stay in Intensive Care Unit and in hospital, inflammatory markers, and acid-base disorders.
Conclusions: Patients were admitted in Intensive Care Unit for acute respiratory failure and half of the investigated patients displayed diaphragm alterations at CT scan.