International-focused Online Forum: A Good Way to Jointly Manage the COVID-19 Pandemic for Global Critical Care Community.

How to cite this article: Xiao-Bo H, Poonyathawon S, Semedi BP, Xiao-Yi Z, Wei F, Da-Wei W, et al. International-focused Online Forum: A Good Way to Jointly Manage the COVID-19 Pandemic for Global Critical Care Community. Indian J Crit Care Med 2020;24(4):283-284.

Lactate Non-Clearance versus Lactate Clearance: A Comparison of Hospital Mortality in High-Risk Surgical Patients.

Objective: The optimal endpoints of resuscitation in high-risk surgical patients remain controversial. Specifically, it is difficult to establish the effective predictive markers as the endpoints of resuscitation in this patient group. Therefore, the study was conducted to assess the predictive value of early lactate non-clearance condition on hospital mortality in high-risk surgical patients. Material and Method: The study is a prospective analytic study. The data were collected in one university-based surgical intensive care unit (SICU) over a 5-month period. All consecutive adult high-risk surgical patients admitted to SICU in postoperative period were recruited to the study. Blood lactate levels were measured on SICU admission (0-hour), 12 hours later, and then calculated for 12-hour blood lactate clearance. The authors categorized the patients into two groups: lactate clearance (LC) and lactate non-clearance (LNC). After that, the patients were monitored until hospital discharge or inhospital death. Results: There were 122 high-risk surgical patients recruited to the study. As concerns the factors of interest, higher incidences of suspected or confirmed infection and mechanical ventilation were found among the LNC group. Regarding the main outcomes, hospital mortality was 5.3% among the LNC group and 3.9% among the LC group (p = 0.578), with no statistical significant differences in hospital mortality, hospital length of stay and SICU length of stay. The independent risk factors associated with LNC condition were considered. The factor of interest was suspected or confirmed infection by multiple logistic regression analysis after adjustment for age and sex revealed that the adjusted odds ratio was 2.70 with a 95% confidence interval of 0.85-8.55, p = 0.092. Conclusion: In high-risk surgical patients, 12-hour LNC cannot demonstrate the prognostic value for hospital morbidity and mortality. However, there is a trend for the suspected or confirmed infection group to associate with the LNC condition, but with no statistical significance.

Cocktail sedation containing propofol versus conventional sedation for ERCP: a prospective, randomized controlled study.

BACKGROUND: ERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail) of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP. METHODS: ERCP patients were randomized into 2 groups; the cocktail group (n = 103) and the controls (n = 102). For induction, a combination of 25 mg of meperidine and 2.5 mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1 mg/kg was administered and continuously infused. In the controls, 25 mg of meperidine or 2.5 mg/kg of midazolam were titrated to maintain the level of sedation. RESULTS: In the cocktail group, the average administration rate of propofol was 6.2 mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03 mg/kg and 0.12 mg/kg, respectively. Recovery times and patients' satisfaction scores in the cocktail and control groups were 9.67 minutes and 12.89 minutes (P = 0.045), 93.1and 87.6 (P <0.001), respectively. Desaturation rates in the cocktail and conventional groups were 58.3% and 31.4% (P <0.001), respectively. All desaturations were corrected with temporary oxygen supplementation without the need for scope removal. CONCLUSIONS: Cocktail sedation containing propofol provides faster recovery time and better patients' satisfaction for patients undergoing ERCP. However, mild degree of desaturation may still develop. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01540084.