No abstract

Background. Thoracic trauma comprises 20–25% of all traumas worldwide and constitutes the third most common cause of death after abdominal injury and head trauma in polytrauma patients. Pulmonary contusion (PC) is a common injury seen after blunt trauma that is associated with significant morbidity and mortality. The aim of this prospective study was to determine the value of PC extent measurements using lung ultrasound in predicting high risk patients for ARDS development. Methods. In one year, 50 polytrauma patients with blunt chest trauma were admitted to the ICU at Damanhur Institute. Lung contusion extent was evaluated using a lung US score (LUS) and was compared to the CT contusion score. The ability of the LUS to predict ARDS was tested. The diagnostic accuracy of LUS was compared with chest radiography for lung contusion and pneumothorax with thoracic CT scan as a reference. Patients were restratified by LUS into two groups: severe and nonsevere contusion group. The two groups' data were compared with respect to difference in mortality and injury characteristics. Results. Lung contusion assessed by LUS score was well correlated to thoracic CT scan measurements (r = 0.78). A LUS of 4 was defined as a cut-off value for predicting ARDS development within 72 hours of trauma with sensitivity and specificity (91.67% and 84.21%), respectively. Patients with severe lung contusions had a lower hypoxic index on admission, more ventilator days, a higher risk of ARDS development, more fractured ribs; higher rate of hemothorax and a higher ISS score than patients with nonsevere lung contusions. Conclusion. LUS on admission can quantify lung contusion extent and the high risk of developing ARDS after blunt thoracic trauma.

Hair dye poisoning is a significant emerging problem in Upper Egypt. The main component of hair dye causing toxicity is para-phenylenediamine (PPD). Ingestion of PPD could be accidental or suicidal. After oral intake, it is metabolized in the liver into N-mono-(MAPPD) and N, N′diacetylated (DAPPD) metabolites. Tissue damage after PPD ingestions occurs due to increased free radical and oxidative stress that depletes tissue glutathione. Cardiac toxicity is a complication of PPD poisoning. It could be manifested by hypotension, different arrhythmia; besides, myocarditis and elevated cardiac biomarkers were also found. Serum and urinary levels of PPD, N-acetyl-p-phenylenediamine (MAPPD), and N--diacetylp-phenylenediamine (DAPPD) were measured by HPLC. A prospective cohort study was planned to determine the relationship between the serum and urinary PPD, N-acetyl-pphenylenediamine (MAPPD) and N, on -diacetyl-p-phenylenediamine (DAPPD) levels with cardiac manifestations of the poisoned patient. Forty patients completed the diagnosis to have acute poisoning following hair dye ingestion. PPD and its metabolite concentrations did not show any significant correlation with the prevalence of cardiac toxicity and could not predict its occurrence among studied patient (p-value< .05

BACKGROUND: Elevation of the left ventricular (LV) filling pressure can occur during weaning of mechanical ventilation due to increase in LV preload and/or changes in LV compliance and LV afterload. AIM: The aim of the study was to evaluate respiratory changes in internal jugular vein and inferior vena cava during weaning from mechanical ventilation. METHODS: Prospective observational study conducted on 80 consecutive patients. Patients were divided randomly into two groups who met the readiness criteria to start spontaneous breathing trial (SBT) either on pressure support ventilation (PS/CPAP) for 30 min or T-piece for 120 min. Weaning failure was defined as a failed SBT or reintubation within 48 h. Echocardiographic evaluation was done on assisted controlled ventilation and at the end of SBT for preload assessment. RESULTS: Mitral Septal E/E’ Cutoff value ≥6.1 with sensitivity 81% and specificity 84.2%, and AUC 0.73 for predicting weaning failure. IVC distensibility index on CPAP cutoff value ≥66.5% with sensitivity 100% and specificity 68.4%, and AUC 0.85. In Group II, Mitral Septal E/E’ Cut off value ≥5.8 with sensitivity 83% and specificity 90.9%, AUC 0.83, IVC collapsibility index Cut off value ≥45.5% with sensitivity 72% and specificity 86%, AUC 0.73. CONCLUSION: Mitral Septal E/E’ could predict weaning-induced diastolic dysfunction. IVC plays an important role in predicting weaning failure.