Introduction: The characteristics for the planned ICU admissions were not surprising. However, the reasons for unplanned ICU admission are multi-factorial and may be beyond the scope of the anaesthesiologist's role in patient care. Unplanned intensive care admission may be a useful indicator of the quality of the overall process of peri-operative care. With this background, this study was undertaken to do a prospective evaluation, analysis of post-op admissions in the Intensive Care Unit of a tertiary care hospital. Material and Methods: The present observational study was conducted in the Intensive Care Unit of a defence Tertiary Care Hospital for a period of one-year wef 1Apr 18 to 31 March 19 and all the post-operative patients were divided into two groups: Group 1 – Planned Admissions: This included those patients where surgeon and/or the anaesthesiologist had decided pre-operatively for post-op ICU admission. Group 2 – Unplanned Admissions and Emergency admission: This included those patients, whose admissions were not anticipated pre-operatively, however, due to some unexpected peri-op complications arising within 48 hours of surgery led them to ICU admission. This group also comprised of patients who were admitted after forty-eight hours of primary surgery for post-operative complications. Result: In one year, the total operated patients (excluding paediatric, cardiac) in various OTs were 18157 and out of which, 261 patients were admitted to ICU. In planned group, maximum patients were of ASA III and in unplanned/emergency admissions ASA II patients were predominant. Post-operative gastrointestinal surgery patients formed a substantial percentage of the ICU admissions in both planned (94/211; 44.55%) and unplanned admission (20/50; 40.00%). GA with endotracheal intubation was technique of anaesthesia in both planned and unplanned admission. The predominant reason for unplanned ICU admission was post-operative care and treatment following unanticipated intra-operative complications. Conclusion: Thorough pre-operative evaluation and pre-operative optimization of patients whenever possible can reduce the incidence of unplanned admission to ICU. Early recognition of complications, timely intervention and timely intensive care and monitoring are essential to improve outcomes.

Tissue fibrosis is initially an adaptive response to organ injury, but eventually, parenchymal scarring and subsequent cellular dysfunction and organ failure ensue. Few therapies currently exist for fibrosis, especially those that target fibrogenesis. Galectin-3 (Gal-3) is a member of the lectin family of proteins, is produced predominantly by macrophages, and has essential functions in inflammation and angiogenesis. Gal-3 is activated in fibrotic models and abnormally elevated in fibrotic patients. Gal-3 inhibitors help to ameliorate or prevent fibrosis. For this review, we searched for original articles and reviews published between Jul 1, 2014, and Nov 1, 2019, using the following search terms (or combination of words) in PubMed: “galectin 3”, “fibrosis”, “heart”, “cardiac”, “liver”, “hepatic”, “lung”, “pulmonary”, “kidney”, and “renal”.

Biomarkers play important roles in clinical practices including diagnosis and treatment selection. With regard to acute kidney injury (AKI), the use of biomarkers to guide clinical trials is very promising. The committee of the 19th Acute Dialysis Quality Initiative (ADQI) conference met in April 2017 and discussed the integration of biomarkers within clinical trials of acute kidney injury. Consensus had been reached for the significant benefits of integration of biomarkers in clinical trials as well as some potential limitations. Authors concluded the potential role of biomarkers from risk stratification to identification of AKI as well as to monitor therapeutic effects. The group also concluded that biomarkers included within clinical trails could provide both sensitivity and specificity to facilitate trial design. Then the group discussed the role of biomarkers within the PICO (Patient, Intervention, Comparator, Outcome) framework, including the use of biomarkers in patient selection, intervention guidance, comparator and end-point decision. Finally, the committee concluded both the benefits and potential drawbacks of implementing biomarkers in clinical trials of acute kidney injury.

Many patients suffer from multiple organ dysfunction syndrome (MODS), which represents a dominant cause of death in the intensive care unit. Current theories about the mechanisms of MODS include inflammation, dysregulated immune response, reduced cellular oxygen utilization, cytopathic hypoxia, and apoptosis. Moreover, an increasing number of studies have shown that endoplasmic reticulum stress (ERS) is related to organ dysfunction. The endoplasmic reticulum is an organelle that is responsible for secretion and membrane protein synthesis and assembly as well as some other physiological activities. Under certain conditions, the homeostasis of ER can be lost, causing the accumulation of unfolded or misfolded protein, which is termed as ERS. During ERS, unfolded protein response (UPR) is activated. Once UPR fails to rebuilt cellular homeostasis, cell function will be impaired and apoptosis will be induced. To better understand the relationship between ERS and severe diseases, we summarize the current research in the context of ERS and UPR signaling associated with various organ dysfunction and severe diseases, including acute lung injury, hepatic injury, heart failure, hemorrhagic shock with multiple organ dysfunction, sepsis, and some other diseases. We also discuss ERS or UPR as a novel therapeutic target and their future directions.

Liver injury is one of the most common critical clinical illnesses and is one of the manifestations of multiple organ dysfunction induced by sepsis. The liver plays a central role in the development of sepsis. The role of the liver in removing bacteria and regulating immune inflammation is crucial, and the liver is the target of sepsis-related injuries. However, the mechanism of liver injury in sepsis is still not clear. This review discusses the pathophysiology, clinical manifestations, and treatment of sepsis-related liver injury. Liver injury, pathophysiological mechanism, sepsis, sepsis-related liver injury

Myxedema coma is a rare life-threatening form of severe hypothyroidism with physiological decompensation. It occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by an acute event similar to infection, cerebrovascular accident, myocardial infarction, trauma, cold exposure, surgery, or drug therapy. Patients with myxedema coma are generally severely ill with hypothermia and depressed mental status. It is a medical emergency with a high mortality rate. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis. Patients with myxedema coma should be treated in an intensive care unit with continuous cardiac monitoring. Initial steps in management include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone assays. The following presentation is a case of postoperative myxedema coma that was successfully managed with multidisciplinary effort. The patient has had a complete recovery.

Introduction: The importance of blood ammonia detection and nonhepatic hyperammonemia (NHH) in the treatment and prognosis of patients has been neglected clinically. The purpose of this study was to evaluate the etiology, diagnosis, treatment, and prognosis of NHH in intensive care unit adults in Heilongjiang province, China. To solve this problem, we designed a provincial-level survey of severe adult NHH, including its etiology, risk factors, incidence, prognosis, and treatment strategies. Methods: The present study refers to a cross-sectional survey of the whole province, involving five cities in Heilongjiang province. All patients who met the inclusion criteria were eligible to apply to participate in the study, which included baseline demographics, clinical presentation, and follow-up related to diagnosis and treatment. Results: The total number of patients to be recruited in this study was estimated to reach 759. All patients who met the inclusion criteria were eligible to apply to participate in the study, which included baseline demographics, clinical presentation, and follow-up related to diagnosis and treatment. Conclusion: This study is expected to provide a theoretical basis for the development of more scientific and standardized NHH diagnosis and treatment methods. Ethics and Dissemination: Ethical approval was obtained from the ethics committee of The Second Affiliated Hospital of Harbin Medical University (registration number KY2019-184). The findings of this review will be communicated through peer-reviewed publications and scientific presentations. Trial Registration Number: ChiCTR1900026632.

Neurotoxicity has been an adverse effect described for almost all B-lactams; since its launch in 1994, there are numerous reports of patients treated with cefepime, covering a wide spectrum of clinical manifestations ranging from delirium to a nonconvulsive status epilepticus (NCSE), being the most of them reported in patients with decreased renal function, but also in patients with preserved renal function. We attempted to illustrate the clinical spectrum of cefepime neurotoxicity in relation to neurocritical care. We identified 13 publications describing neurotoxicity following cefepime administration from PubMed using search terms were cefepime, neurotoxicity, seizures, delirium, encephalopathy, NCSE, myoclonus, confusion, aphasia, agitation, coma, disability, and death. Two reviewers independently assessed identified articles for eligibility and used for this review writing. Most reports occur in elderly patients, although cases have been described in children and newborns. In general, patients recover soon after stopping beta-lactams or after reducing the dose or replacing them with another antibiotic; however, there is a likelihood of recurrence of symptoms after reintroducing Cefepime again at a dose low.

Severely ill neurosurgical patients are those who present with pathologies of the nervous system associated with either a high mortality or that which leaves significant sequelae in those who survive. Desmopressin is a synthetic analog of the antidiuretic hormone that is stored in neurohypophysis. Its function is to decrease urinary volume by increasing reabsorption of water in the convoluted tubules and nephron collectors, additionally increasing the expression of coagulation factor VII and the von Willebrand factor. For this reason, its usefulness in the management of various pathologies has been tested, from coagulopathies to posttraumatic and postsurgical diabetes insipidus. It contributes in improving hyponatremia and in maintaining the balance of fluids and electrolytes in traumatic brain injury and subarachnoid hemorrhage (SAH) patients. It has been additionally studied for its role in the risk of rebleeding in SAH patients and in those with coagulopathies, where its implicated mechanism of action is through platelet anti-aggregation.

Acute pulmonary embolism is an uncommon complication after pacemaker insertion. This report describes, in view of multiple finding, we found the exact cause of the present scenario of the patient which is rare and successfully managed.

Objective: The information about the critically ill coronavirus disease 2019 (COVID-19) was limited and controversy. This study was to analyze the clinical feature and predictors for outcome in critically ill COVID-19. Design: This was a descriptive study from two hospitals. Setting: This study was conducted in intensive care units (ICUs) from university hospitals. Methods: Critically ill COVID-19 patients admitted in ICU from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8 to February 20, 2020, were screened. Interventions: None. Measurements and Main Results: Clinical, laboratory data were collected with management strategies and outcomes. Sixty-eight critically ill patients were enrolled. Their median age was 64 (interquartile range, 54–72) years, and 67.65% were male. In this cohort, 44 (65%) patients survived for 28 days. The invasive mechanical ventilator was used in 51 (75%) patients, with 20 of them requiring prone positioning, and 17 switched to extracorporeal membrane oxygenation. The compliance scores of lungs on the day of intubation among survivors were higher than those in nonsurvivors (25.00 [13.50–39.00] vs. 17.00 [12.00–22.00], P = 0.01). The blood interlukin-6 (IL-6) levels at the ICU admission were significantly higher in nonsurvivors compared to survivors (71.27 [51.48–144.15] vs. 18.15 [7.55–68.02] ng/ml, P = 0.025). The heart rates, lung injury scale, and positive end-expiratory pressure were constantly higher for 10 days in nonsurvivors. The frequency of vasopressor uses and neuromuscular blockers was higher in nonsurvivors from day 5 to day 10 (P < 0.05). In the whole cohort, the most common complications were acute respiratory distress syndrome (95.59%), shock (48.53%), arrhythmia (33.82%), acute cardiac injury (33.82%), and acute kidney injury (27.94%). Multivariate analysis indicated that lower lung compliance at the day of intubation and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) at ICU admission were related to higher mortality (P = 0.02 and 0.05, respectively). Conclusion: COVID-19-related critical illness predominantly affected old individuals and was characterized by severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies. High APACHE II scores and low lung compliance indicated poor outcomes.

Circulatory shock is characterized by a decrease in oxygen delivery to the tissues associated with impairment in oxygen metabolism and tissue hypoxia. Clinical and biological signs of impaired tissue perfusion and tissue hypoxia are used as bedside to detect circulatory failure and trigger resuscitation procedures. The most popular signs of tissue hypoperfusion include mean arterial pressure, capillary refill time and mottling score, central venous oxygen saturation (ScvO₂), veno-arterial difference in PCO₂ (PvaCO₂), microcirculation assessment, and lactate. Both the severity and duration of the alterations in any of these variables are associated with a poor outcome so that it sounds logical to trigger therapy based on these. Using these variables as target for therapy is much more complex. Some of the limits for using some of these variables as targets include an incertitude about the target to reach (should we aim at normalizing or improving the variable, and by how much?) and the time lag between resolution of impaired tissue perfusion/hypoxia and normalization of the variable. The ideal target variable should have a well-defined end point and a rapid response time. Interestingly, hemodynamic resuscitation targeting these variables gave variable results. In this review, we will discuss the interest and limitations of the above-mentioned indices of tissue perfusion and hypoxia as trigger as well as end point of resuscitation in critically ill patients.