SUMMARY Background The subjectivity of the West-Haven criteria (WHC) hinders hepatic encephalopathy (HE) evaluation. The new HE classification has emphasised assessment of orientation. The modified-orientation log (MO-log, eight questions, scores 0–24; 24 normal) is adapted from a validated brain injury measure. Aim To validate MO-log for HE assessment in cirrhosis. Methods Cirrhotics admitted with/without HE were administered MO-log. We collected cirrhosis/HE details, admission/daily MO-logs and WHC (performed by different examiners), time to reach normal mentation (MO-log ≥23) and MO-log/WHC change (Δ) over day 1. Outcomes were in-hospital mortality, duration to normal mentation and length-of-stay (LOS). Regressions were performed for each outcome. MO-log inter-rater reliability was measured. Results Ninety-six HE (55 ± 8 years, MELD 21) and 20 non-HE (54 ± 5 years, MELD 19) in-patients were included. In HE patients, median admission WHC was 3 (range 1–4). Mean MO-log was 12 ± 8 (range 0–22). Their LOS was 6 ± 5 days and 13% died. Time to reach normal mentation was 2.4 ± 1.7 days. Concurrent validity: there was a significant negative correlation between admission MO-log and WHC (r = −0.79, P < 0.0001). Discriminant validity: admission MO-logs were significantly lower in those who died (7 vs. 12, P = 0.03) and higher in those admitted without HE (23.6 vs. 12, P < 0.0001). MO-log improved in 69% on day 1 (ΔMO-log 4 ± 8) which was associated with lower duration to normal mentation (2 vs. 3.5 days, P = 0.03) and mortality (3% vs.43%, P < 0.0001), not ΔWHC. Regression models for all outcomes included admission/ΔMO-log but not WHC as a predictor. Inter-rater reliability: ICC for MO-log inter-rater observations was 0.991. Conclusions Modified-orientation log is a valid tool for assessing severity and is better than West-Haven criteria in predicting outcomes in hospitalised hepatic encephalopathy patients.

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Background Mechanical ventilation is a daily event in any ICU, using HFNO as a weaning facilitating strategy for mechanically ventilated patients after passing Spontaneous Breathing Trial (SBT) recently considered to reduce complications associated with invasive ventilation. Objectives To compare high-flow conditioned oxygen therapy versus non -invasive ventilation using continuous positive airway pressure (CPAP) for preventing post-extubation respiratory failure and reintubation in acute exacerbation of chronic obstructive pulmonary disease patients after weaning from mechanical ventilation and to follow patients for ICU and hospital lengh of stay ICU and hospital mortality. Patients and Methods This prospective randomized controlled study, including 60 patients admitted to the intensive care unit at Al- Mataria teaching hospital. Approval of the ethical committee of Al-Mataria teaching hospital was obtained before the start of patient’s recruitment. Patients who successfully extubated were equally randomized (sequential) to enter either group I or group II. Study group (I): included 30 patients subjected to high flow nasal oxygen after extubation for 24 hrs. Control group (II): included another 30 patients on non-invasive CPAP after extubation for 24 hrs. Results Our results showed lower rate of reintubation in HFNO group (n = 6) 20%, compared to NIV group(n = 7) 23. 3 %, higher PaO2 in HFNO group immediate, 2 hrs post extubation. No significant differences found regarding mortality rate between both study groups (8/30) 26. 6 % in HFNO group, while (9/30) 30 % in NIV group, p (Ns). Arterial PH was significantly lower in NIV group immediately after extubation. Conclusion HFNO compared to NIV alone showed lower rate of reintubation when used immediately after planned extubation. Patients weaned using HFNO showed higher PaO2 2hrs postextubation. HFNO compared to NIV alone didn’t affect hospital stay.

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