Papers by Sunthiti Morakul
Medical Archives
Aim: The authors aimed to describe nutrition status and energy-delivery characters in multi-cente... more Aim: The authors aimed to describe nutrition status and energy-delivery characters in multi-center THAI-SICU study. Material and Methods: Eligible patients admitted in SICU were 1,686 after excluding 563 of 2,249 participants owing to very short stay or non-alive within 24 hours after admission and missing data. The study was a posthoc analysis and multicenter descriptive design. The analytic methods described categorical data in percentage and the continuous data in the median with interquartile range. Variables divided into baseline characteristics and nutrition data before SICU admission, and the pattern of energy delivery in SICU. Statistical significance accepted as a p-value less than 0.05. Results: The average age was 64 (52-76) years with 57% male. The median of serum albumin level at admission (interquartile range, IQR) was 2.8 (2.2-3.4). There was 46-47 percent of nutrition risk patient. Less than 10 percent of the patient had enteral (EN), parenteral (PN) or their combination before admission. History of weight loss and appetite loss was 27-31 percent. However, seventy percent of the patient could not define the duration of the symptom. EN was initiated early, but the tendency of full feeding was 7-10 days. At that period, supplemental PN was added around 30 percent of total calories. The composition of PN was quite low in these study which contains only 15-16 percent of total calories. The average energy delivery was 20 kcal/kg/day (the recommendation is 25-30 kcal/kg/day). Conclusion: The patient's nutrition status before SICU admission was at risk of 46-47% and weight loss and appetite loss might unreliable in ICU setting. EN is started early with gradually increase up to 7-10 days. The average total calories requirement is lower than a recommendation.
Frontiers in Medicine
IntroductionExcessive or inadequate fluid administration during perioperative period affects outc... more IntroductionExcessive or inadequate fluid administration during perioperative period affects outcomes. Adjustment of volume expansion (VE) by performing fluid responsiveness (FR) test plays an important role in optimizing fluid infusion. Since changes in stroke volume (SV) during lung recruitment maneuver (LRM) can predict FR, and peripheral perfusion index (PI) is related to SV; therefore, we hypothesized that the changes in PI during LRM (ΔPILRM) could predict FR during perioperative period.MethodsPatients who were scheduled for elective non-laparoscopic surgery under general anesthesia with a mechanical ventilator and who required VE (250 mL of crystalloid solution infusion over 10 min) were included. Before VE, LRM was performed by a continuous positive airway pressure of 30 cm H2O for 30 sec; hemodynamic variables with their changes (PI, obtained by pulse oximetry; and ΔPILRM, calculated by using [(PI before LRM—PI after LRM)/PI before LRM]*100) were obtained before and after L...
Additional file 1 Figure S1. Study flow. Table S1. Univariable logistic regression analysis on va... more Additional file 1 Figure S1. Study flow. Table S1. Univariable logistic regression analysis on variables to predict the occurrence of AKI.
Background: Central venous catheters (CVCs) play an important role during cardiac surgery. Topica... more Background: Central venous catheters (CVCs) play an important role during cardiac surgery. Topical tissue adhesives form a thin film of coating that becomes bound to the keratin in the epidermis. The advantage of this “super glue” lies in its antimicrobacterial activity. This study aimed to evaluate fixation of CVCs with topical tissue adhesive in patients (prone to bleed) undergoing cardiac surgery, regarding its ability to reduce the incidence of pericatheter leakage.Methods: This randomized controlled trial included 150 patients >15 years of age who were (1) scheduled to undergo elective cardiac surgery, (2) required CVC insertion at the internal jugular vein, and (3) were scheduled for transfer postoperatively to the cardiac intensive care unit. We randomly assigned patients to a topical tissue adhesive group (TA) or a standard control group (SC). The primary outcome was a change of dressing immediately postoperatively due to pericatheter blood oozing. Secondary outcomes were...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016
Objective Acute kidney injury (AKI) is one of the most common problems in critically ill patients... more Objective Acute kidney injury (AKI) is one of the most common problems in critically ill patients. AKI associates with poor outcome in ICU. The recognition of the prevalence and risk factors of AKI is important. This could lead to the prevention of AKI and improve patient’s outcome. This study aims to identify the prevalence, outcomes and independent risk factors of AKI in Thai surgical intensive care units. Material and Method We conducted the prospective cohort study from nine university-based SICUs. The patients were diagnosed AKI by Acute Kidney Injury Network (AKIN) classification. The types of RRT and outcomes including mortality were collected. The risk factors of AKI were identified. Results A total cohort of 4,652 patients was included for the present study. AKI was diagnosed in 786 (16.89%) patients. The ICU mortality was higher in patients with AKI (29.90% vs. 5.48%, p-value <0.001). Among patients with AKI staging, we found that those with AKIN III had higher ICU mort...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016
Objective This study is a part of the multi-center Thai university-based Surgical Intensive Care ... more Objective This study is a part of the multi-center Thai university-based Surgical Intensive Care Unit Study (THAI-SICU Study). It aimed to evaluate the patterns of pain management in patients admitted to surgical intensive care units. Material and Method Case record forms (CRFs) were created by the working group. Data regarding pain management in the ICUs were documented on the daily record form. These included types of analgesics used (opioids and non-opioids), routes of administration (oral, intravenous, intramuscular, epidural and intrathecal) and methods of administration (continuous infusion, regular intermittent, as needed, patient-controlled analgesia and patient-controlled epidural analgesia). Results Data were gathered from 4,652 patients. The majority of the patients received analgesics (85.2%). The main stay analgesics were morphine (52.3%) and fentanyl (27%). Analgesics were frequently administered via the intravenous route (76.5%) on an as needed basis (48.6%). Conclusi...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016
Objective The objective of the study is to evaluate the nutrition assessment tool used by Bhumibo... more Objective The objective of the study is to evaluate the nutrition assessment tool used by Bhumibol Nutrition Triage/Nutrition Triage (BNT/NT) for patient outcomes in a surgical intensive care unit (SICU). Material and Method All data were retrieved from the THAI-SICU database. A total of 1,685 patients from three medical centers were participants in the nutrition project and were enrolled onto this study. The parameters needed for BNT/NT scoring were recorded including body mass index (BMI), weight change, energy delivery, age, and disease severity. The BNT/NT calculation was classified into 4 groups as BNT/NT I to IV. An adjusted odds ratio (OR) with 95% confidence interval (CI) of mortality and sepsis occurrence were reported. Results were classed as being statistically significant at p<0.05. Results Regarding the nutrition assessment classification, the patients admitted to SICU were classified as BNT/NT class I48.6%, class II 30.0%, class III 9.3%, and class IV 12.1%. There w...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016
Objective Cigarette smoking is not only has detrimental effects on the respiratory system but als... more Objective Cigarette smoking is not only has detrimental effects on the respiratory system but also contributes to development of atherosclerosis and inflammatory vascular reactions. We hypothesized whether smoking is associated with increased risk of acute respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), sepsis, distant organ dysfunctions, and the increase of total cost of surgical intensive care unit (SICU) in critically ill surgical patients. Material and Method We performed analysis using the THAI-SICU data, a prospective, observational, multicenter study in patients who admitted to SICU in nine university-based hospitals in Thailand. The patients were categorized into 3 groups based on their smoking histories, which were 1) never smoked, 2) former smoker, and 3) current smoker. The primary outcome was probability of ARDS and the secondary outcomes included incidences of SIRS, sepsis, distant organ dysfunction (included acute kidney injury (AK...
Intensive Care Medicine, 2020
Anesthesiology Research and Practice, 2020
Background. Enlarged uterus can compress the inferior vena cava and cause hypotension when lying ... more Background. Enlarged uterus can compress the inferior vena cava and cause hypotension when lying supine. Previous studies have shown a positive association between the abdominal circumference and size of the uterus. Therefore, the aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia. Methods. The study cohort comprised women undergoing cesarean section under spinal anesthesia. Patients were divided into two groups according to the median abdominal circumference (<101 cm and ≥101 cm). Hypotension was defined as a systolic blood pressure of <90 mmHg or mean arterial pressure of <65 mmHg. The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women. Results. The study cohort comprised 100 women. The incidence of hypotension did not differ between the groups (71.42...
Background: Lung protective ventilation with low tidal volume is beneficial in patients with inte... more Background: Lung protective ventilation with low tidal volume is beneficial in patients with intermediate to high risk of postoperative pulmonary complications. However, during low tidal volume ventilation, pulse pressure variation (PPV) and stroke volume variation (SVV) do not predict fluid responsiveness. We aimed to determine whether changes in PPV and SVV after transient increases in tidal volume can predict fluid responsiveness in these patients. Methods: We recorded 22 measurements from 15 patients who experienced postoperative acute circulatory failure. We performed a tidal volume challenge by transiently increasing tidal volume (VT) from 6 to 8 mL/kg (VT6–8), 8 to 10 mL/kg (VT8–10), and 6 to 10 mL/kg (VT6–10) of patients' predicted body weight. The change in PPV (∆PPV) at VT6–8 (∆PPV6–8), VT8–10 (∆PPV8–10), VT6–10 (∆PPV6–10) and the change in SVV (∆SVV) at VT6–8 (∆SVV6–8), VT8–10 (∆SVV8–10), and VT6–10 (∆SVV6–10) were recorded. Patients were classified as fluid responder...
Archives of Trauma Research, 2019
Original Article Background: Organ failure (OF) and sepsis are important causes of late death in ... more Original Article Background: Organ failure (OF) and sepsis are important causes of late death in trauma. Previous studies reported the methods that could predict OF at the time of patient arrival. However, most of the evidence is from high-income countries, where health-care systems were different from developing countries. This research aimed to identify the factors to predict late complications in trauma patients in surgical intensive care units (SICUs). Methods: This study was a secondary data analysis from the THAI-SICU study, which was a prospective cohort study in nine university-based-SICUs in Thailand. Late complications were defined as any OF or sepsis that occurred after 48 h of ICU admission. Multivariable logistic regression was conducted to identify the significant factors. Results: Three hundred and fourteen patients were eligible for the analysis. Late complications occurred in 60 patients (19%). Patients who had complications had higher Acute Physiology and Chronic Health Enquiry (APACHE II) (15.8 vs. 12.4, P = 0.02) and Sequential OF Assessment (SOFA) scores on admission (6.7 vs. 3.8, P < 0.001). Multivariable analysis showed that current smoking (odds ratio [OR] =1.9, 95% confidence interval [CI]; 1.03-3.67, P = 0.04) and SOFA score on admission (OR = 1.2, 95% CI; 1.12-1.29, P < 0.001) increased the risk of late complications. Late complications had hazards ratio of mortality of 5.9 (95% CI; 2.53-13.88, P < 0.001). Conclusions: The incidence of late complications in trauma patients in the SICU was 19%. Current smoking and SOFA score might be valuable in future prediction of late complications during admission.
Nutrition, 2019
The aim of this study was to demonstrate the role of nutrition factors on a 28-d mortality outcom... more The aim of this study was to demonstrate the role of nutrition factors on a 28-d mortality outcome and sepsis occurrence in surgical intensive care unit. Methods: The data was extracted from a THAI-SICU study that prospectively recruited participants (18 y of age) from three Thai surgical intensive care units (SICUs) of university-based hospitals. The demographic data and nutrition factors at SICU admission included energy delivery deficit, weight loss severity, route of energy delivery, and albumin and nutrition risk screening (NRS-2002). The outcomes were 28-d hospital mortality and sepsis occurrence. The statistical analysis was performed using Cox regression. Results: The study included 1503 eligible patients with a predominantly male population. The 28-d mortality and sepsis occurrences were 211 (14%) and 452 (30%), respectively. Regarding multivariable analysis, for mortality outcome, the protective effects of nutrition variables were higher body mass index (BMI; hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.68À0.99; P = 0.039), tube feeding (HR, 0.46; 95% CI, 0.26À0.83; P = 0.010), and a combination of enteral and parenteral nutrition (HR, 0.24; 95% CI, 0.07À0.77; P = 0.016). The harmful effects were severe weight loss (HR, 1.61; 95% CI, 1.16À2.22; P = 0.004), albumin 2.5 (HR, 2.15; 95% CI, 1.20À3.84; P = 0.010), and at risk according to NRS-2002 (HR, 1.34; 95% CI, 0.98À1.85; P = 0.071). For the sepsis occurrence, only tube feeding had a protective effect (HR, 0.58; 95% CI, 0.39À0.88; P = 0.009), and only albumin 2.5 had a harmful effect (HR, 1.71; 95% CI, 1.20À2.45; P = 0.003). Conclusion: Nutrition factors affecting the mortality or sepsis occurrence in this study were BMI, enteral feeding or combination with parenteral nutrition, severe weight loss, preadmission albumin 2.5, and at risk according to NRS-2002.
International Journal of Environmental Research and Public Health, 2016
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
The problem of a shortage of intensivists in Thailand is increasing annually. As stated in The Th... more The problem of a shortage of intensivists in Thailand is increasing annually. As stated in The Thai Society of Critical Care Medicine Database, 2013, the number of qualified intensivists currently is 163, working in 76 provinces in Thailand. This disproportion in the ratio of intensivists has affected patient outcomes. In an attempt to solve this problem, there has been an increased number of hospitalists working in place of the intensivists. Medical specialties are not available in many hospitals of Thailand. Thus, the hospitalists, who care for Intensive Care Unit (ICU) patients, are not trained to care for the acutely ill, hospitalized patients. Their competencies vary depending on their experience and training. In other countries, there has been evidence that properly trained hospitalists can work effectively in the ICU. This awareness of the importance of intensivists in Thailand is one of the stifling factors; the improvement of the hospitalists, determining the hospitalists&#...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
In addition to cardiopulmonary monitoring, non-cardiopulmonary monitoring (non-CPM) is considered... more In addition to cardiopulmonary monitoring, non-cardiopulmonary monitoring (non-CPM) is considered to be an important parameter in intensive care units (ICUs). However no data on this subject has been reported for Thai ICUs. The objective of the present study is to describe the non-CPM situation in Thai ICUs. ICU RESOURCE I survey database released during the year 2012 was used for the present study. Non-CPMo refers to neurological monitoring, renal function monitoring, metabolic monitoring, perfusion monitoring and identifying biomarkers. Academic hospital (ACAD), availability grading (AG), numeric frequency grading scale (FGS) and device availability per bed (DPB) were used for categorization of non-CPM collected data. Significant differences between the groups are defined as p < 0.05. Advanced monitoring, including; indirect calorimetry, near infrared spectroscopy, peripheral nerve stimulation, gut mucosal tonometry and sublingual side stream darkfield imaging are currently una...
BMJ Open
ObjectiveTo internally and externally validate a delirium predictive model for adult patients adm... more ObjectiveTo internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.DesignA prospective, observational, multicentre study.SettingThree university-affiliated teaching hospitals in Thailand.ParticipantsAdults aged over 18 years were enrolled if they were admitted to a surgical ICU (SICU) and had the surgery within 7 days before SICU admission.Main outcome measuresPostoperative delirium was assessed using the Thai version of the Confusion Assessment Method for the ICU. The assessments commenced on the first day after the patient’s operation and continued for 7 days, or until either discharge from the ICU or the death of the patient. Validation was performed of the previously developed delirium predictive model: age+(5×SOFA)+(15×benzodiazepine use)+(20×DM)+(20×mechanical ventilation)+(20×modified IQCODE>3.42).ResultsIn all, 380 SICU patients were recruited. Internal validation on 150 patients with the...
Additional file 1: Figure 1. Changes of SOFA scores within 7 days. Figure 2. Changes of the Vasop... more Additional file 1: Figure 1. Changes of SOFA scores within 7 days. Figure 2. Changes of the Vasopressor Dependency index within 7 days.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016
Objective The objective of this study was to compare the differences of nutrition status, nutriti... more Objective The objective of this study was to compare the differences of nutrition status, nutrition delivery, and the outcomes between the metropolis (MUH) and regional university based hospitals (RUH) in Thailand. Material and Method The nutrition data were retrieved from the THAI-SICU database. A total of 1,686 patients (MUH 927 patients vs. RUH 759 patients) with completion of nutrition status and nutrition delivery data were included in this analysis. The enrolled patients from study centers located in Bangkok were defined as MUH, and the patients from Chiang Mai were defined as RUH. Patient characteristics, nutrition status using the subjective global assessment (SGA) and nutrition risk screening (NRS), nutrition delivery, and outcomes of treatment were recorded. The outcome associations were analyzed by a multivariable regression model. Results At admission, there were significant differences of age, gender, body mass index, disease severity, albumin level, and diagnosis. RUH ...
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Papers by Sunthiti Morakul