Vajira Medical Journal: Journal of Urban Medicine

173-186

Authors: Suttipong Pearpleum, Yutthana Apichatbutr

Background: Driving pressure is associated with mortality in patients with acute respiratory distress syndrome (ARDS). However, whether driving pressure is associated with outcomes in mechanically ventilated patients without ARDS is unknown. Objective: This study primarily aimed to determine the association between driving pressure and severe lung injury (lung injury score ≥ 2.5). The secondary outcomes were to determine the cutoff point of driving pressure associated with severe lung injury and compare patient mortality between severe and non-severe lung injury score in mechanically ventilated patients without ARDS. Methods: Mechanically ventilated patients without ARDS admitted in the intensive care unit (ICU) of Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, between 2018 and 2020 were enrolled. Baseline characteristics including sex, age, diagnosis, sedative drug, and lung mechanic from the ventilator were recorded. Moreover, the patients’ driving pressure [plateau pressure–positive end expiratory pressure (PEEP)] and lung injury score were obtained. Multivariable logistic regression analysis was performed to determine associations between driving pressure and patient lung severity with lung injury score. The mechanically ventilated patients without ARDS were categorized according to lung injury score ≥ 2.5; then, a severe form of the area under the receiver operating characteristic (AuROC), as a dependent outcome, was observed to determine the association between driving pressure and severe lung injury. The optimal cutoff point of driving pressure that determined severe lung injury was calculated by Youden’s index. Result: In total, 155 mechanically ventilated patients without ARDS were enrolled. Overall mortality was 28.3%. Driving pressure was associated with severe lung injury (OR, 1.28; 95% CI, 1.15–1.42; p-value <0.001). A good discriminative ability of driving pressure to determine severe lung injury was noted (AuROC = 0.859; 95%CI, 0.768–0.950). The optimal cutoff point of driving pressure indicating severe lung injury was 16 cmH2O with, 89.5% sensitivity (95% CI, 66.9–98.7), 75% specificity (95% CI, 66.9–82.0), 33.3% positive predictive value (95% CI, 20.8–47.9), and 98.1% negative predictive value (95% CI, 93.2–99.8). Conclusion: In mechanically ventilated patients without ARDS, increased driving pressure was associated with severe lung injury. A driving pressure >16 cmH2O was associated with severe lung injury.

197-210

Authors: Charnwat Chuantantikamol, Petch Rawdaree

Background: Currently, the prevalence of congestive heart failure in type 2 diabetes mellitus (T2DM) worldwide is increasing continuously. However, risks and incidence of hospital readmission due to congestive heart failure in T2DM are no conclusion. Therefore, this study aimed to evaluate risks of hospital due to congestive heart failure in T2DM patients. Methods: A matched case-control study was conducted to discover risks of hospitalization because of congestive heart failure (CHF) in T2DM patients at Vajira Hospital. Clinical and laboratory data from medical record of diabetic patients hospitalized due to CHF, defined as a case, from 1st January, 2560 BE to 31st December, 2561 BE and T2DM patients who had no history of CHF which age and sex matched, defined as a control, were retrieved from hospital database. Univariate and multivariate analysis controlling for confounders were conducted to identify risk factors for hospitalization from CHF. Results: Among the 180 subjects the average age was 68.38 years and 50% was female. Ninety subjects who had heart failure were recruited as cases (50%) and others 90 subjects without heart failure were in control group. All of the cases were diagnosed congestive heart failure by Framingham criteria. Most of cases had heart failure with preserved ejection fraction (51.9%) and 22.2% were readmission due to heart failure. Risk factors for congestive heart failure in T2DM subjects were Body Mass Index (BMI) (OR = 1.18, 95%CI = 1.03-1.36, p-value = 0.02) but protective factor is statin (OR=0.03, 95%CI = 0.0001-0.71, p-value = 0.03) Conclusions: The risk of hospitalization for heart failure patients with type 2 diabetes mellitus is BMI and protective factor is statin. There was 22.2% of the subjects readmitted due to CHF and smoking is a risk factor for the readmission.

221-234

Authors: Pornertai Rattanamaytanon, Prasit Leewattanapat

Objective: To compared Fracture Risk Assessment Tool (FRAX) score in previous hip fracture patients with type 2 diabetes and non-diabetes patients and to ascertain accuracy of FRAX whether using Rheumatoid Arthritis (RA) substitution of diabetes. Methods: A retrospective study from medical record in patients aged 50 to 100 years with previous osteoporotic hip fracture in Vajira hospital between January 1st, 2014 to January 31st, 2019. Comparing mean of FRAX score between type 2 diabetes and non-diabetes group. Results: A total of 288 participants with previous osteoporotic hip fracture were included in the study, type 2 diabetes (T2DM) 144 patients (50.88%) and non-diabetic 139 patients (49.12%). The significant lower FRAX score between diabetic and control group was observed for both major osteoporotic (MOF) 6.68±4.66 vs. 8.53±5.26, p = 0.02 and hip fracture (HF) 2.42±2.69 vs. 3.96±3.71, p<0.01 respectively. Adjusted FRAX by substitution RA input for diabetes, the fracture risk estimates in both groups were approximately (MOF 9.09±6.32 vs. 8.53±5.26, p = 0.412 and HF 3.87±4.05 vs. 3.96±3.71, p = 0.888) Conclusions: The FRAX tool underestimated fracture risk in T2DM compared to non-diabetes patients. The introduction of a correction factor by selecting RA as equivalent variable for T2DM resulted in mean FRAX values no longer significant to those without diabetes subjects which can improve the performance of the FRAX prediction.

245-252

Authors: Panjit Phothong, Waraporn Somwong, Kongkaew Younboonhlim, Porntipa Kwanraj, Sompit Suvanboon

Objective: To assess nursing factors affecting the solution of dengue hemorrhagic fever patients. Methods: This research was descriptive research by collecting retrospective data from medical records. We studied dengue patients who were admitted to the wards in the Hospital for Tropical Medicine, Mahidol University .To record in case record form . Total 250 patients consisted of 125 DF patients and 125 DHF / DSS patients selected by Hospital number with an even number ending. Data collected from 1 January 2013 to 31 December 2017 from medical record. Results: Among 250 patients, there were 125 cases (50%) in the DF group, 115 (46%) in the DHF group, and 10 (4%) in the DSS group. 53.3 % of patients were female with overall mean age 28 years. Most patients (86.0%) were Thai, Burmese (10%), Lao (2.4%). Nursing Practice up to 99.5% of care could be managed by nurses such as vital sign monitoring, providing supporting care, etc. Only 0.5% of care must be managed by doctors, such as rise in hematocrit, and severely abnormal vital signs, or hepatic encephalopathy. Conclusion: The result of this study showed nurses were able to provide nursing practice to patients in due time, causing no complications and patients can go home as scheduled. Therefore, nurses play an important role in elementary evaluating the symptoms of patients and providing nursing care closely.