Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Comparative Study
Use of different approaches of acid-base derangement to predict mortality in critically ill patients.
There have been controversial data regarding the application of acid-base analysis based on Stewart methodology to predict clinical outcome in different populations. ⋯ Compared to the traditional approach, an alternative Stewart approach does not provide any greater advantage to predict mortality in the studied population. Because of complex calculation, the usefulness of such approach on the routine clinical practice may be limited.
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Septic shock is a serious condition leading to high mortality and morbidity. Many varieties of attempts aiming toward improving outcomes have been implemented. However the appropriate therapeutic endpoint of shock resuscitation is still under investigation. The authors report here the dynamics of commonly used parameters, namely central venous oxygen saturation (ScvO2) and lactate concentration during resuscitation. ⋯ Central venous oxygen saturation and its changes during treatment were heterogeneous which made this parameter less reliable than others to monitor management. The lactate clearance, although slow, is uniform and may be used alone or in combination with other parameters to monitor resuscitation.
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Review Case Reports
Pulmonary lipiodol embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma: a case report and literature review.
Acute pulmonary lipiodol embolism is a rare but possibly fatal complication of transcatheter arterial chemoembolization (TACE). The authors report a 63-years-old woman with unresectable large (7.4 x 7.9 cm) hepatocellular carcinoma (HCC) who had been diagnosed pulmonary lipiodol embolism after the first TACE. Intraoperative angiography did not show the communication between pulmonary circulation and tumor feeding artery. ⋯ Two weeks after TACE, follow-up CT of liver revealed the absence of almost lipiodol granule in lungs. The patient did not receive TACE again because of pulmonary metastasis. In this article we reviewed the cases of pulmonary lipiodol embolism that had been reported in the literature including clinical risk factors, possible mechanisms and the pathophysiology of this complication.
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Experience of percutaneous dilatational tracheostomy by using Grigg's technique in Siriraj Hospital.
Percutaneous dilatational tracheostomy (PDT) was increasingly performed after the commercial kit was available in 1985. Several studies showed that PDT was equivalent to surgical tracheostomy considering perioperative and long-term complications and PDT was more cost-effective and provide greater feasibility in terms of bedside capacity and nonsurgical operation. ⋯ PDT is a safe procedure and can be performed easily and rapidly at the bedside either in intensive care unit or general ward with closed monitoring. Proper patient selection and attention to technical detail are necessary in maintaining low complication rates.
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To study the recent trend of health-care associated infections (HAIs) across Thailand. ⋯ Recently, no significant change on nationwide prevalence and trend of HAIs in Thailand were demonstrated. Notably, Acinetobacter spp. emerged as the most common etiologic agents of HAIs.