Chairat Permpikul - Academia.edu (original) (raw)

Papers by Chairat Permpikul

Research paper thumbnail of The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock

Journal of Health Science and Medical Research

Objective: This study aimed to investigate any association between vasopressor dose and mortality... more Objective: This study aimed to investigate any association between vasopressor dose and mortality, and to identify factors independently associated with 28-day mortality in adult patients with septic shock. Material and Methods: Adult septic shock patients admitted to internal medicine wards; from May 2018-November 2020, were retrospectively included. Collected data included: patient demographics and clinical characteristics, baseline vital signs, source of infection, vasopressor dose, treatment modalities and patient outcomes. The primary outcome was 28-day mortality. Results: From 253 patients, 54.9% survived, and 45.1% died. Compared to survivors, non-survivors had a significantly higher median Acute Physiology and Chronic Health Evaluation II score, higher median baseline serum lactate level and required a higher median-maximum dose of vasopressor. Multivariate analysis showed the maximum dose of vasopressor >0.2 mcg/kg/min (odd ratio (OR): 2.91, 95% confidence interval (CI...

Research paper thumbnail of Effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure: a cohort study

Clinical Critical Care, 2021

Background: Tuberculosis (TB) remains an important and evolving health problem worldwide. Acute ... more Background: Tuberculosis (TB) remains an important and evolving health problem worldwide. Acute respiratory failure, the most severe form of pulmonary tuberculosis, is associated with a high mortality rate. Adjunctive corticosteroid therapy has been reported as an effective treatment in extrapulmonary TB. The aim of this study was to investigate the effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure. Methods: This retrospective cohort study enrolled newly diagnosed pulmonary tuberculosis patients with acute respiratory failure who were admitted to Siriraj Hospital (Bangkok, Thailand) during January 2011 to December 2013. Patients that received corticosteroid as an adjunctive treatment for pulmonary TB were assigned to the steroid group. The control group consisted of patients that did not receive corticosteroid. Collected data included age, gender, body mass index (BMI), Acute Physiology and Chronic Health Evalu...

Research paper thumbnail of High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial

Annals of Intensive Care, 2021

Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can... more Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. Methods We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. Results Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well ...

Research paper thumbnail of In-Hospital Death after Septic Shock Reversal: A Retrospective Analysis of In-Hospital Death among Septic Shock Survivors at Thailand’s Largest National Tertiary Referral Center

The American Journal of Tropical Medicine and Hygiene, 2021

Advances in sepsis resuscitation have significantly improved shock control; however, many patient... more Advances in sepsis resuscitation have significantly improved shock control; however, many patients still die after septic shock reversal. We conducted a retrospective review to examine in-hospital death in whom shock was reversed and vasopressor was discontinued for 72 hours or longer. Factors independently associated with death were determined. Medical records of septic shock survivors from the medical intensive care unit of the

Research paper thumbnail of Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research, 2018

ObjectiveTo compare the outcomes of patients with and without a mean serum potassium (K+) level w... more ObjectiveTo compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L).MethodsThis prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+level, and hospital outcomes were recorded. Patients with a mean K+level of 3.5 to 4.5 mEq/L and with all individual K+values of 3.0 to 5.0 mEq/L were allocated to the normal K+group. The remaining patients were allocated to the abnormal K+group.ResultsIn total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+group comprised 74 (46.3%) patients. The abnormal K+group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal ser...

Research paper thumbnail of High-Flow Nasal Cannula versus Noninvasive Mechanical Ventilation to Prevent Extubation Failure in Sepsis Patients: A Randomised Controlled Trial

SSRN Electronic Journal, 2020

Research paper thumbnail of Efficacy of echocardiography during spontaneous breathing trial with low‐level pressure support for predicting weaning failure among medical critically ill patients

Echocardiography, 2019

Background: Echocardiography was reported to be a good predictor of weaning failure when using T-... more Background: Echocardiography was reported to be a good predictor of weaning failure when using T-piece method, but information about its efficacy in a pressure support setting is scarce. This study aimed to investigate the efficacy of echocardiography during spontaneous breathing trial with low-level pressure support for predicting weaning failure among medical critically ill patients. Methods: This prospective cohort study was conducted in adult respiratory failure patients that tolerated low pressure support weaning for 30 minutes. Echocardiogram was performed during pressure support ventilation before extubation. Weaning failure was defined as reintubation within 48 hours. Results: Of the 52 included patients (mean age 65.9 ± 17.8 years), 14 experienced weaning failure. Severe pneumonia, metabolic acidosis, and septic shock were the leading causes of respiratory failure. Univariate analysis identified BMI > 24, peak A wave < 100 cm/s, E/Ea > 14, and inferior vena cava maximum diameter (IVC max) > 17 mm as factors associated with reintubation. Multivariate analysis revealed E/Ea > 14 and IVC max > 17 mm to be independent predictors of weaning failure. Conclusion: Inferior vena cava maximum diameter > 17 and E/Ea ratio ≥ 14 independently predict weaning failure in patients with preserved left ventricular systolic function. This finding confirms that preload status of both ventricles plays a major role in weaning failure. K E Y W O R D S echocardiography, efficacy, low pressure support, medical critically ill patients, predict weaning failure, spontaneous breathing How to cite this article: Tongyoo S, Thomrongpairoj P, Permpikul C. Efficacy of echocardiography during spontaneous breathing trial with low-level pressure support for predicting weaning failure among medical critically ill

Research paper thumbnail of Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial

American Journal of Respiratory and Critical Care Medicine, 2019

Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administra... more Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administration during resuscitation; however, prospective data to support this assertion are scarce. Objectives: To conduct a phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults with sepsis with hypotension increases shock control by 6 hours compared with standard care. Methods: This single-center, randomized, double-blind, placebocontrolled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand. The study enrolled 310 adults diagnosed with sepsis with hypotension. The patients were randomly divided into two groups: early norepinephrine (n = 155) and standard treatment (n = 155). The primary outcome was shock control rate (defined as achievement of mean arterial blood pressure >65 mm Hg, with urine flow >0.5 ml/kg/h for 2 consecutive hours, or decreased serum lactate >10% from baseline) by 6 hours after diagnosis. Measurements and Main Results: The patients in both groups were well matched in background characteristics and disease severity. Median time from emergency room arrival to norepinephrine administration was significantly shorter in the early norepinephrine group (93 vs. 192 min; P , 0.001). Shock control rate by 6 hours was significantly higher in the early norepinephrine group (118/155 [76.1%] vs. 75/155 [48.4%]; P , 0.001). The 28-day mortality was not different between groups: 24/155 (15.5%) in the early norepinephrine group versus 34/155 (21.9%) in the standard treatment group (P = 0.15). The early norepinephrine group was associated with lower incidences of cardiogenic pulmonary edema (22/155 [14.4%] vs. 43/155 [27.7%]; P = 0.004) and new-onset arrhythmia (17/155 [11%] vs. 31/155 [20%]; P = 0.03). Conclusions: Early norepinephrine was significantly associated with increased shock control by 6 hours. Further studies are needed before this approach is introduced in clinical resuscitation practice. Clinical trial registered with www.clinicaltrials.gov (NCT01945983) (CENSER trial).

Research paper thumbnail of Hydrocortisone in Treatment of Severe Sepsis and Septic Shock with Acute Respiratory Distress Syndrome: A Randomised Controlled Trial

Intensive Care Medicine Experimental, 2015

Research paper thumbnail of LB023-MON: Benchmarking Nutrition Practice in a Medical Intensive Care Unit

Research paper thumbnail of The impact of intensive care unit admissions following early resuscitation on the outcome of patients with severe sepsis and septic shock

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-di... more Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-directed therapy" has been reported as the effective treatment. Whether or not an intensive care unit (ICU) admission can improve the outcomes of septic shock patients, has not been elucidated. To evaluate the impact of direct ICU admission after initial resuscitation in the emergency room (ER) on the outcomes of patients in septic shock. A prospective cohort study including severe sepsis and septic shock patients who were admitted from the ER during the period from April 2011 to September 2012. The recorded information includes patients' baseline characteristics, hemodynamic parameters, and outcomes. The comparisons were performed between the ICU versus the non-ICU admission groups. The principal outcome was 28-day mortality. Of the 175 enrolled patients, 50 patients were directly admitted to the ICU and 125 patients were admitted to a general medical ward. The ICU patients were ...

Research paper thumbnail of Non-invasive estimated continuous cardiac output (escCO) during severe sepsis and septic shock resuscitation

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Cardiac output (CO) is an important hemodynamic parameter during sepsis and septic shock resuscit... more Cardiac output (CO) is an important hemodynamic parameter during sepsis and septic shock resuscitation. Conventionally, this value is obtained at bedside by the thermodilution technique, which requires a pulmonary artery catheter (PAC). Estimated Continuous Cardiac Output (esCCO, Nihon Kohden, Japan) calculated from pulse-wave transit time (PWTT) was examined here as an alternative. A prospective study was performed in a 14-bed ICU facility. Patients with severe sepsis and septic shock who had PAC placed were included. Serial thermodilution cardiac outputs (CO(IBT)) and esCCO (COesCCO) were obtained at the beginning of resuscitation (t0), at 48 hours (t48), and at 72 hours (t72). Other parameters from the tested device; namely, estimated continuous cardiac index (esCCI), estimated stroke volume (esSV), and estimated stroke volume index (esSVI), were also achieved. A total of 90-paired readings from ten ICU patients were collected. The overall correlation coefficient (R) between COes...

Research paper thumbnail of Therapeutic goal achievements during severe sepsis and septic shock resuscitation and their association with patients' outcomes

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Severe sepsis and septic shock are associated with high mortality. "Early goal-directed ther... more Severe sepsis and septic shock are associated with high mortality. "Early goal-directed therapy" (EGDT) has been shown to improve survival. The authors report here the goal achievements in the protocol and their association with patients' outcomes. A prospective cohort study of patients with severe sepsis and septic shock who were admitted from the Emergency Department from April 2011 to September 2012. All underwent the resuscitation protocol aimed to achieve hemodynamic goals within 6 hours after diagnosis. These goals included: 1) mean arterial > 65 mmHg, 2) urine output > 0.5 ml/kg/hour and 3) superior vena cava O2 saturation > 70% or serum lactate clearance > 10%. The primary outcome was 28-day mortality Of the 175 enrolled patients, 23 (13.1%) achieved all 3 goals at 6 hour while 75 (42.8%) achieved 2 goals and 52 (29.8%) achieved only 1 goal. The 28-day mortality of these patients was 8.7%, 16% and 35.5%, respectively while 44% of those who did not a...

Research paper thumbnail of Predicting factors, incidence and prognosis of cardiac arrhythmia in medical, non-acute coronary syndrome, critically ill patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013

Cardiac arrhythmia is an important complication of critically ill patients, especially in periope... more Cardiac arrhythmia is an important complication of critically ill patients, especially in perioperative period and early after myocardial infarction. However, the information regarding this condition in medical critically ill without active coronary artery disease patients is limited. To identify the predictive factors, incidence, and prognosis of tachyarrhythmia and bradyarrhythmia in non-coronary critically ill medical patients. A single center prospective cohort study, included medical critically ill patients, age > or = 18 year-old, admitted in a 15-bed medical ICU between September 2010 and August 2011. The patients with active coronary artery disease, end stage organ failure and not expected to survive > or = 48 hours were excluded. The patients' baseline characteristic, APACHE II score, laboratory investigations in the first 24 hours and treatment modalities were recorded. Continuous electrocardiographic monitoring was performed during ICU admission. The arrhythmic ...

Research paper thumbnail of Dynamics of central venous oxygen saturation and serum lactate during septic shock resuscitation

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013

Septic shock is a serious condition leading to high mortality and morbidity. Many varieties of at... more 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. Adult patients admitted with severe sepsis and septic shock from October 1, 2009 to January 31, 2009 were enrolled. During hemodynamic resuscitation, the central venous blood was drawn for ScvO2 and lactate measurement right after the CVC was placed (T1) and at the point where the blood pressure goal was achieved (T2). The third and the fourth measurements were obtained at 1 and 2 hours thereafter (T3 and T4). These samples were ice chilled and were sent to central laboratory for blood gas analysis and lactate determination. Twenty patients underwent the study. There was...

Research paper thumbnail of Right ventricular dysfunction in septic shock

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011

Right ventricular dysfunction (RVD) is common in critically ill patients and the presence of this... more Right ventricular dysfunction (RVD) is common in critically ill patients and the presence of this condition affects patients' outcomes. Improving the knowledge background and establishing the incidence of RVD in septic shock patients would render the management more efficacious. This study was performed to evaluate the incidence and outcomes of RVD in septic shock patients. A single center retrospective observational study was performed in the Medical ICU, Siriraj Hospital, Mahidol University between January 2007 and October 2009. Patients with septic shock in whom pulmonary artery catheter (PAC) was inserted were included in the study. The PAC was placed in 118 patients during the study period. The patients' mean age was 58.0 +/- 18.5 years and 71 of them (59.3%) were male. The mean body mass index was 25.0 +/- 6.6 Kg/m2 and the mean APACHE II score was 26.1 +/- 7.7. The admission diagnoses were severe sepsis or septic shock (70%), severe pneumonia (38%), acute respiratory ...

Research paper thumbnail of Evaluation of correlation between vascular pedicle width and intravascular volume status in Thai critically ill patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011

To evaluate the correlation between vascular pedicle widths (VPW) measured from portable chest ro... more To evaluate the correlation between vascular pedicle widths (VPW) measured from portable chest roentgenogram (CXR) and intravascular volume status in Thai critically ill patients. A prospective cohort study included the critically ill patients in whom pulmonary artery catheter was placed in the Medical Intensive Care Units of Siriraj Hospital, Mahidol University between June 2009 and January 2010. The patient's baseline characteristics, hemodynamic data measured from pulmonary artery catheter (PAC) and CXR parameters were collected. From thirty-four patients, thirteen (38.2%) had high pulmonary artery occlusive pressure (PAOP > or =18 mmHg). The patients with high PAOP were older (69.8 +/- 8.8 years vs. 59.2 +/- 15.4 years, p = 0.02), taller (163.2 +/- 5.3 cm vs. 157.0 +/- 10.4 cm, p = 0.03) and higher weight (67.4 +/- 12.9 kg vs. 57.1 +/- 7.8 kg, p = 0.007) than the low PAOP group. The correlations between PAOP and VPW (r = 0.68, p < 0.001) as well as between PAOP and car...

Research paper thumbnail of Prediction of mortality by using the standard scoring systems in a medical intensive care unit in Thailand

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005

In order to evaluate and compare the predictive ability of the APACHE II (Acute Physiology and Ch... more In order to evaluate and compare the predictive ability of the APACHE II (Acute Physiology and Chronic Health Evaluation II) and the SAPS (Simplified Acute Physiology Score) scoring systems in relation to outcome in a medical intensive care unit (ICU). The authors reviewed consecutive medical ICU admissions (n = 482) at a tertiary hospital over a 2-year period. For each patient, demographic data, diagnosis, APACHE II score, SAPS score and ICU outcome complied during the first 24 hrs of the ICU stay were obtained. The comparison of predictive ability between APACHE II and SAPS was assessed by forward stepwise logistic regression and area under the receiver operating characteristic (ROC) curves. Overall ICU mortality was 36.93%. Mean APACHE II and SAPS scores were 21.17 +/- 9.35 and 14.61 +/- 6.47, respectively. APACHE II and SAPS scores of nonsurvivors (26.97 +/- 8.27 and 18.01 +/- 5.84 respectively) were significantly higher than those of survivors (17.77 +/- 8.22 and 12.62 +/- 5.99...

Research paper thumbnail of Thrombocytopenic purpura associated with miliary tuberculosis

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003

The authors report a case of thrombocytopenia associated with miliary tuberculosis. The patient w... more The authors report a case of thrombocytopenia associated with miliary tuberculosis. The patient was a 28-year-old woman who was admitted because of massive upper gastrointestinal hemorrhage and acute respiratory failure. Chest radiographs revealed diffuse bilateral reticulonodular infiltration and complete blood count was significant for severe thrombocytopenia. Bone marrow biopsy was performed to investigate the cause of thrombocytopenia and demonstrated multiple tiny caseating granulomas suggesting miliary tuberculosis (TB). She received anti-TB therapy and a short course of steroid with good response. Platelet count returned to normal limit within 10 days. Although isolated thrombocytopenia is uncommon in TB, it is still important to consider TB in the differential diagnosis of thrombocytopenia, particularly in patients with abnormal chest radiographs. Bone marrow examination is very helpful in this situation.

Research paper thumbnail of Blood lactate determined by a portable device in critically ill patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2000

Patients with tissue perfusion deficit usually have lactic acidosis or hyperlactacidemia and bloo... more Patients with tissue perfusion deficit usually have lactic acidosis or hyperlactacidemia and blood lactate level has been used to diagnose this condition and to monitor the disease progression. We conducted a study to examine the diagnostic accuracy of capillary and arterial lactate (C LAC and strip A LAC) obtained by using a portable lactate analyzer (Accusport) compared with the standard method (A LAC) in this condition. Forty eight patients were included in the study. Strong correlation between C LAC and A LAC as well as strip A LAC and A LAC were demonstrated (r = 0.89 and 0.98 respectively, p <0.05). When determining agreement between C LAC and strip A LAC with the standard method, all but 2 of C LAC - A LAC differences and 2 of strip A LAC - A LAC differences were within the agreement limits (mean +/- 2SD). We conclude that capillary and arterial lactate determined by the tested device, when used and interpreted cautiously, can substitute arterial lactate in the diagnosis o...

Research paper thumbnail of The Association of High Dose Vasopressor and Delayed Vasopressor Titration with 28-Day Mortality in Adult Patients with Septic Shock

Journal of Health Science and Medical Research

Objective: This study aimed to investigate any association between vasopressor dose and mortality... more Objective: This study aimed to investigate any association between vasopressor dose and mortality, and to identify factors independently associated with 28-day mortality in adult patients with septic shock. Material and Methods: Adult septic shock patients admitted to internal medicine wards; from May 2018-November 2020, were retrospectively included. Collected data included: patient demographics and clinical characteristics, baseline vital signs, source of infection, vasopressor dose, treatment modalities and patient outcomes. The primary outcome was 28-day mortality. Results: From 253 patients, 54.9% survived, and 45.1% died. Compared to survivors, non-survivors had a significantly higher median Acute Physiology and Chronic Health Evaluation II score, higher median baseline serum lactate level and required a higher median-maximum dose of vasopressor. Multivariate analysis showed the maximum dose of vasopressor >0.2 mcg/kg/min (odd ratio (OR): 2.91, 95% confidence interval (CI...

Research paper thumbnail of Effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure: a cohort study

Clinical Critical Care, 2021

Background: Tuberculosis (TB) remains an important and evolving health problem worldwide. Acute ... more Background: Tuberculosis (TB) remains an important and evolving health problem worldwide. Acute respiratory failure, the most severe form of pulmonary tuberculosis, is associated with a high mortality rate. Adjunctive corticosteroid therapy has been reported as an effective treatment in extrapulmonary TB. The aim of this study was to investigate the effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure. Methods: This retrospective cohort study enrolled newly diagnosed pulmonary tuberculosis patients with acute respiratory failure who were admitted to Siriraj Hospital (Bangkok, Thailand) during January 2011 to December 2013. Patients that received corticosteroid as an adjunctive treatment for pulmonary TB were assigned to the steroid group. The control group consisted of patients that did not receive corticosteroid. Collected data included age, gender, body mass index (BMI), Acute Physiology and Chronic Health Evalu...

Research paper thumbnail of High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial

Annals of Intensive Care, 2021

Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can... more Background High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. Methods We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. Results Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well ...

Research paper thumbnail of In-Hospital Death after Septic Shock Reversal: A Retrospective Analysis of In-Hospital Death among Septic Shock Survivors at Thailand’s Largest National Tertiary Referral Center

The American Journal of Tropical Medicine and Hygiene, 2021

Advances in sepsis resuscitation have significantly improved shock control; however, many patient... more Advances in sepsis resuscitation have significantly improved shock control; however, many patients still die after septic shock reversal. We conducted a retrospective review to examine in-hospital death in whom shock was reversed and vasopressor was discontinued for 72 hours or longer. Factors independently associated with death were determined. Medical records of septic shock survivors from the medical intensive care unit of the

Research paper thumbnail of Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research, 2018

ObjectiveTo compare the outcomes of patients with and without a mean serum potassium (K+) level w... more ObjectiveTo compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L).MethodsThis prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+level, and hospital outcomes were recorded. Patients with a mean K+level of 3.5 to 4.5 mEq/L and with all individual K+values of 3.0 to 5.0 mEq/L were allocated to the normal K+group. The remaining patients were allocated to the abnormal K+group.ResultsIn total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+group comprised 74 (46.3%) patients. The abnormal K+group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal ser...

Research paper thumbnail of High-Flow Nasal Cannula versus Noninvasive Mechanical Ventilation to Prevent Extubation Failure in Sepsis Patients: A Randomised Controlled Trial

SSRN Electronic Journal, 2020

Research paper thumbnail of Efficacy of echocardiography during spontaneous breathing trial with low‐level pressure support for predicting weaning failure among medical critically ill patients

Echocardiography, 2019

Background: Echocardiography was reported to be a good predictor of weaning failure when using T-... more Background: Echocardiography was reported to be a good predictor of weaning failure when using T-piece method, but information about its efficacy in a pressure support setting is scarce. This study aimed to investigate the efficacy of echocardiography during spontaneous breathing trial with low-level pressure support for predicting weaning failure among medical critically ill patients. Methods: This prospective cohort study was conducted in adult respiratory failure patients that tolerated low pressure support weaning for 30 minutes. Echocardiogram was performed during pressure support ventilation before extubation. Weaning failure was defined as reintubation within 48 hours. Results: Of the 52 included patients (mean age 65.9 ± 17.8 years), 14 experienced weaning failure. Severe pneumonia, metabolic acidosis, and septic shock were the leading causes of respiratory failure. Univariate analysis identified BMI > 24, peak A wave < 100 cm/s, E/Ea > 14, and inferior vena cava maximum diameter (IVC max) > 17 mm as factors associated with reintubation. Multivariate analysis revealed E/Ea > 14 and IVC max > 17 mm to be independent predictors of weaning failure. Conclusion: Inferior vena cava maximum diameter > 17 and E/Ea ratio ≥ 14 independently predict weaning failure in patients with preserved left ventricular systolic function. This finding confirms that preload status of both ventricles plays a major role in weaning failure. K E Y W O R D S echocardiography, efficacy, low pressure support, medical critically ill patients, predict weaning failure, spontaneous breathing How to cite this article: Tongyoo S, Thomrongpairoj P, Permpikul C. Efficacy of echocardiography during spontaneous breathing trial with low-level pressure support for predicting weaning failure among medical critically ill

Research paper thumbnail of Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial

American Journal of Respiratory and Critical Care Medicine, 2019

Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administra... more Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administration during resuscitation; however, prospective data to support this assertion are scarce. Objectives: To conduct a phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults with sepsis with hypotension increases shock control by 6 hours compared with standard care. Methods: This single-center, randomized, double-blind, placebocontrolled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand. The study enrolled 310 adults diagnosed with sepsis with hypotension. The patients were randomly divided into two groups: early norepinephrine (n = 155) and standard treatment (n = 155). The primary outcome was shock control rate (defined as achievement of mean arterial blood pressure >65 mm Hg, with urine flow >0.5 ml/kg/h for 2 consecutive hours, or decreased serum lactate >10% from baseline) by 6 hours after diagnosis. Measurements and Main Results: The patients in both groups were well matched in background characteristics and disease severity. Median time from emergency room arrival to norepinephrine administration was significantly shorter in the early norepinephrine group (93 vs. 192 min; P , 0.001). Shock control rate by 6 hours was significantly higher in the early norepinephrine group (118/155 [76.1%] vs. 75/155 [48.4%]; P , 0.001). The 28-day mortality was not different between groups: 24/155 (15.5%) in the early norepinephrine group versus 34/155 (21.9%) in the standard treatment group (P = 0.15). The early norepinephrine group was associated with lower incidences of cardiogenic pulmonary edema (22/155 [14.4%] vs. 43/155 [27.7%]; P = 0.004) and new-onset arrhythmia (17/155 [11%] vs. 31/155 [20%]; P = 0.03). Conclusions: Early norepinephrine was significantly associated with increased shock control by 6 hours. Further studies are needed before this approach is introduced in clinical resuscitation practice. Clinical trial registered with www.clinicaltrials.gov (NCT01945983) (CENSER trial).

Research paper thumbnail of Hydrocortisone in Treatment of Severe Sepsis and Septic Shock with Acute Respiratory Distress Syndrome: A Randomised Controlled Trial

Intensive Care Medicine Experimental, 2015

Research paper thumbnail of LB023-MON: Benchmarking Nutrition Practice in a Medical Intensive Care Unit

Research paper thumbnail of The impact of intensive care unit admissions following early resuscitation on the outcome of patients with severe sepsis and septic shock

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-di... more Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-directed therapy" has been reported as the effective treatment. Whether or not an intensive care unit (ICU) admission can improve the outcomes of septic shock patients, has not been elucidated. To evaluate the impact of direct ICU admission after initial resuscitation in the emergency room (ER) on the outcomes of patients in septic shock. A prospective cohort study including severe sepsis and septic shock patients who were admitted from the ER during the period from April 2011 to September 2012. The recorded information includes patients' baseline characteristics, hemodynamic parameters, and outcomes. The comparisons were performed between the ICU versus the non-ICU admission groups. The principal outcome was 28-day mortality. Of the 175 enrolled patients, 50 patients were directly admitted to the ICU and 125 patients were admitted to a general medical ward. The ICU patients were ...

Research paper thumbnail of Non-invasive estimated continuous cardiac output (escCO) during severe sepsis and septic shock resuscitation

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Cardiac output (CO) is an important hemodynamic parameter during sepsis and septic shock resuscit... more Cardiac output (CO) is an important hemodynamic parameter during sepsis and septic shock resuscitation. Conventionally, this value is obtained at bedside by the thermodilution technique, which requires a pulmonary artery catheter (PAC). Estimated Continuous Cardiac Output (esCCO, Nihon Kohden, Japan) calculated from pulse-wave transit time (PWTT) was examined here as an alternative. A prospective study was performed in a 14-bed ICU facility. Patients with severe sepsis and septic shock who had PAC placed were included. Serial thermodilution cardiac outputs (CO(IBT)) and esCCO (COesCCO) were obtained at the beginning of resuscitation (t0), at 48 hours (t48), and at 72 hours (t72). Other parameters from the tested device; namely, estimated continuous cardiac index (esCCI), estimated stroke volume (esSV), and estimated stroke volume index (esSVI), were also achieved. A total of 90-paired readings from ten ICU patients were collected. The overall correlation coefficient (R) between COes...

Research paper thumbnail of Therapeutic goal achievements during severe sepsis and septic shock resuscitation and their association with patients' outcomes

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Severe sepsis and septic shock are associated with high mortality. "Early goal-directed ther... more Severe sepsis and septic shock are associated with high mortality. "Early goal-directed therapy" (EGDT) has been shown to improve survival. The authors report here the goal achievements in the protocol and their association with patients' outcomes. A prospective cohort study of patients with severe sepsis and septic shock who were admitted from the Emergency Department from April 2011 to September 2012. All underwent the resuscitation protocol aimed to achieve hemodynamic goals within 6 hours after diagnosis. These goals included: 1) mean arterial > 65 mmHg, 2) urine output > 0.5 ml/kg/hour and 3) superior vena cava O2 saturation > 70% or serum lactate clearance > 10%. The primary outcome was 28-day mortality Of the 175 enrolled patients, 23 (13.1%) achieved all 3 goals at 6 hour while 75 (42.8%) achieved 2 goals and 52 (29.8%) achieved only 1 goal. The 28-day mortality of these patients was 8.7%, 16% and 35.5%, respectively while 44% of those who did not a...

Research paper thumbnail of Predicting factors, incidence and prognosis of cardiac arrhythmia in medical, non-acute coronary syndrome, critically ill patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013

Cardiac arrhythmia is an important complication of critically ill patients, especially in periope... more Cardiac arrhythmia is an important complication of critically ill patients, especially in perioperative period and early after myocardial infarction. However, the information regarding this condition in medical critically ill without active coronary artery disease patients is limited. To identify the predictive factors, incidence, and prognosis of tachyarrhythmia and bradyarrhythmia in non-coronary critically ill medical patients. A single center prospective cohort study, included medical critically ill patients, age > or = 18 year-old, admitted in a 15-bed medical ICU between September 2010 and August 2011. The patients with active coronary artery disease, end stage organ failure and not expected to survive > or = 48 hours were excluded. The patients' baseline characteristic, APACHE II score, laboratory investigations in the first 24 hours and treatment modalities were recorded. Continuous electrocardiographic monitoring was performed during ICU admission. The arrhythmic ...

Research paper thumbnail of Dynamics of central venous oxygen saturation and serum lactate during septic shock resuscitation

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013

Septic shock is a serious condition leading to high mortality and morbidity. Many varieties of at... more 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. Adult patients admitted with severe sepsis and septic shock from October 1, 2009 to January 31, 2009 were enrolled. During hemodynamic resuscitation, the central venous blood was drawn for ScvO2 and lactate measurement right after the CVC was placed (T1) and at the point where the blood pressure goal was achieved (T2). The third and the fourth measurements were obtained at 1 and 2 hours thereafter (T3 and T4). These samples were ice chilled and were sent to central laboratory for blood gas analysis and lactate determination. Twenty patients underwent the study. There was...

Research paper thumbnail of Right ventricular dysfunction in septic shock

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011

Right ventricular dysfunction (RVD) is common in critically ill patients and the presence of this... more Right ventricular dysfunction (RVD) is common in critically ill patients and the presence of this condition affects patients' outcomes. Improving the knowledge background and establishing the incidence of RVD in septic shock patients would render the management more efficacious. This study was performed to evaluate the incidence and outcomes of RVD in septic shock patients. A single center retrospective observational study was performed in the Medical ICU, Siriraj Hospital, Mahidol University between January 2007 and October 2009. Patients with septic shock in whom pulmonary artery catheter (PAC) was inserted were included in the study. The PAC was placed in 118 patients during the study period. The patients' mean age was 58.0 +/- 18.5 years and 71 of them (59.3%) were male. The mean body mass index was 25.0 +/- 6.6 Kg/m2 and the mean APACHE II score was 26.1 +/- 7.7. The admission diagnoses were severe sepsis or septic shock (70%), severe pneumonia (38%), acute respiratory ...

Research paper thumbnail of Evaluation of correlation between vascular pedicle width and intravascular volume status in Thai critically ill patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011

To evaluate the correlation between vascular pedicle widths (VPW) measured from portable chest ro... more To evaluate the correlation between vascular pedicle widths (VPW) measured from portable chest roentgenogram (CXR) and intravascular volume status in Thai critically ill patients. A prospective cohort study included the critically ill patients in whom pulmonary artery catheter was placed in the Medical Intensive Care Units of Siriraj Hospital, Mahidol University between June 2009 and January 2010. The patient's baseline characteristics, hemodynamic data measured from pulmonary artery catheter (PAC) and CXR parameters were collected. From thirty-four patients, thirteen (38.2%) had high pulmonary artery occlusive pressure (PAOP > or =18 mmHg). The patients with high PAOP were older (69.8 +/- 8.8 years vs. 59.2 +/- 15.4 years, p = 0.02), taller (163.2 +/- 5.3 cm vs. 157.0 +/- 10.4 cm, p = 0.03) and higher weight (67.4 +/- 12.9 kg vs. 57.1 +/- 7.8 kg, p = 0.007) than the low PAOP group. The correlations between PAOP and VPW (r = 0.68, p < 0.001) as well as between PAOP and car...

Research paper thumbnail of Prediction of mortality by using the standard scoring systems in a medical intensive care unit in Thailand

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005

In order to evaluate and compare the predictive ability of the APACHE II (Acute Physiology and Ch... more In order to evaluate and compare the predictive ability of the APACHE II (Acute Physiology and Chronic Health Evaluation II) and the SAPS (Simplified Acute Physiology Score) scoring systems in relation to outcome in a medical intensive care unit (ICU). The authors reviewed consecutive medical ICU admissions (n = 482) at a tertiary hospital over a 2-year period. For each patient, demographic data, diagnosis, APACHE II score, SAPS score and ICU outcome complied during the first 24 hrs of the ICU stay were obtained. The comparison of predictive ability between APACHE II and SAPS was assessed by forward stepwise logistic regression and area under the receiver operating characteristic (ROC) curves. Overall ICU mortality was 36.93%. Mean APACHE II and SAPS scores were 21.17 +/- 9.35 and 14.61 +/- 6.47, respectively. APACHE II and SAPS scores of nonsurvivors (26.97 +/- 8.27 and 18.01 +/- 5.84 respectively) were significantly higher than those of survivors (17.77 +/- 8.22 and 12.62 +/- 5.99...

Research paper thumbnail of Thrombocytopenic purpura associated with miliary tuberculosis

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003

The authors report a case of thrombocytopenia associated with miliary tuberculosis. The patient w... more The authors report a case of thrombocytopenia associated with miliary tuberculosis. The patient was a 28-year-old woman who was admitted because of massive upper gastrointestinal hemorrhage and acute respiratory failure. Chest radiographs revealed diffuse bilateral reticulonodular infiltration and complete blood count was significant for severe thrombocytopenia. Bone marrow biopsy was performed to investigate the cause of thrombocytopenia and demonstrated multiple tiny caseating granulomas suggesting miliary tuberculosis (TB). She received anti-TB therapy and a short course of steroid with good response. Platelet count returned to normal limit within 10 days. Although isolated thrombocytopenia is uncommon in TB, it is still important to consider TB in the differential diagnosis of thrombocytopenia, particularly in patients with abnormal chest radiographs. Bone marrow examination is very helpful in this situation.

Research paper thumbnail of Blood lactate determined by a portable device in critically ill patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2000

Patients with tissue perfusion deficit usually have lactic acidosis or hyperlactacidemia and bloo... more Patients with tissue perfusion deficit usually have lactic acidosis or hyperlactacidemia and blood lactate level has been used to diagnose this condition and to monitor the disease progression. We conducted a study to examine the diagnostic accuracy of capillary and arterial lactate (C LAC and strip A LAC) obtained by using a portable lactate analyzer (Accusport) compared with the standard method (A LAC) in this condition. Forty eight patients were included in the study. Strong correlation between C LAC and A LAC as well as strip A LAC and A LAC were demonstrated (r = 0.89 and 0.98 respectively, p <0.05). When determining agreement between C LAC and strip A LAC with the standard method, all but 2 of C LAC - A LAC differences and 2 of strip A LAC - A LAC differences were within the agreement limits (mean +/- 2SD). We conclude that capillary and arterial lactate determined by the tested device, when used and interpreted cautiously, can substitute arterial lactate in the diagnosis o...