Effect of High-Dose Vitamin D3on Hospital Length of Stay in Critically Ill Patients With Vitamin D Deficiency

Summary Background Sarcopenia, defined as loss of muscle mass, quality and function, is a part of the frailty syndrome. In critical illness, sarcopenia has rarely been evaluated regarding clinical outcomes. Therefore, we evaluated the association of sarcopenia with both hospital length of stay (HLOS) and 6‑month mortality in critically ill patients using abdominal computed tomography (CT) scans. Methods In a post hoc analysis from the high dose vitamin D3 vs. placebo in adult vitamin D deficient patients (VITdAL-ICU) trial, we retrospectively reviewed all available abdominal CT scans (18 women, 19 men). We measured and calculated total psoas area (TPA), psoas muscle density (PMD), skeletal muscle index (SMI) and bone mineral density (BMD) and analyzed the relation of these endpoints with HLOS and mortality. Defining sarcopenia we used cut-off values for TPA as 642.1 mm2/m2 in women and 784 mm2/m2 in men and PMD as 31.1 Hounsfield units (HU) in women and 33.3 HU in men, both measured at the level of L3, as well as for SMI (38.5 cm2/m2 in women and 52.4 cm2/m2 in men). Likely osteoporosis was defined by L1 trabecular attenuation of ≤110 HU. Values for TPA, PMD and SMI could not be obtained in 11 patients and BMD in 1 patient. Results Mean adjusted TPA was lower in women versus men (478 vs. 749 mm2/m2) as well as PMD (34.6 vs. 41.3 HU), SMI (62.36 vs. 76.81 cm2/m2) and BMD (141.1 vs. 157.2 HU). No significant influence on hospital length of stay and on 6‑month mortality was found, irrespective of the morphometric parameter used (TPA, PMD, SMI, BMD; p > 0.05). Survivors showed statistically nonsignificantly better values than nonsurvivors: TPA: 652 vs. 530 mm2/m2 (p = 0.27); PMD: 38.4 vs. 37.4 HU (p = 0.85); SMI: 70.32 vs. 69.54 cm2/m2 (p = 0.91); BMD: 156 vs. 145.8 HU (p = 0.81). Conclusion Although the study is limited by the small sample size, our data do not support a strong predictive value for TPA/PMD/SMI or BMD for HLOS or mortality in critically ill patients with vitamin D deficiency.

Download Full-text

HIGH DOSE VITAMIN D3 VS PLACEBO IN CRITICALLY ILL PATIENTS WITH VITAMIN D DEFICIENCY

CHEST Journal ◽

10.1016/j.chest.2021.07.935 ◽

2021 ◽

Vol 160 (4) ◽

pp. A1005

Author(s):

Metri Haddaden ◽

Ibrahim Haddad ◽

Mohammad Darweesh ◽

David Weisman

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Critically Ill ◽

Vitamin D3 ◽

Critically Ill Patients ◽

High Dose ◽

High Dose Vitamin

Download Full-text

Comparison of High-Dose Versus Standard Dose Oseltamivir in Critically Ill Patients With Influenza

Journal of Intensive Care Medicine ◽

10.1177/0885066616638649 ◽

2016 ◽

Vol 32 (10) ◽

pp. 574-577 ◽

Cited By ~ 13

Author(s):

Zachary R. Noel ◽

Melissa L. Thompson Bastin ◽

Ashley A. Montgomery ◽

Alexander H. Flannery

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Standard Dose ◽

Cohort Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

High Dose ◽

Drug Shortages ◽

Icu Length Of Stay

Background: Limited data support high-dose oseltamivir in critically ill patients with influenza. In several recent influenza seasons, there were oseltamivir drug shortages. Methods: This was a retrospective cohort analysis of 57 patients admitted to the intensive care unit (ICU) with confirmed influenza. Patients receiving high-dose oseltamivir were compared to those receiving standard dosing. Results: When adjusted for clinically relevant predictors of disease severity, including age, duration of therapy, Acute Physiology and Chronic Health Evaluation II score, and receipt of extracorporeal membrane oxygenation, there was no difference in the duration of mechanical ventilation, oxygenation, ICU length of stay, or hospital length of stay between the high-dose and standard dose groups. Conclusions: As compared to the standard doses of oseltamivir, higher-dose (ie, double dose) oseltamivir was not associated with improvement in any clinical outcomes. Using higher doses empirically on all patients during influenza season may exacerbate local drug shortages.

Download Full-text

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066620940274 ◽

2020 ◽

pp. 088506662094027

Author(s):

Jeremy Cheuk Kin Sin ◽

Lillian King ◽

Emma Ballard ◽

Stacey Llewellyn ◽

Kevin B. Laupland ◽

...

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Cochrane Library ◽

Secondary Outcome ◽

Icu Length Of Stay ◽

Newcastle Ottawa Scale

Purpose: Hypophosphatemia is reported in up to 5% of hospitalized patients and ranges from 20% to 80% in critically ill patients. The consequences of hypophosphatemia for critically ill patients remain controversial. We evaluated the effect of hypophosphatemia on mortality and length of stay in intensive care unit (ICU) patients. Methods: MEDLINE, EMBASE, Cochrane Library (Reviews and Trials), and PubMed were searched for articles in English. The primary outcome was mortality and secondary outcome was length of stay. The quality of evidence was graded using a modified Newcastle-Ottawa Scale. Results: Our search yielded 828 articles and ultimately included 12 studies with 7626 participants in the analysis. Hypophosphatemia was associated with increased hospital length of stay (2.19 days [95% CI, 1.74-2.64]) and ICU length of stay (2.22 days [95% CI, 1.00-3.44]) but not mortality (risk ratio: 1.13 [95% CI, 0.98-1.31]; P = .09). Conclusions: Hypophosphatemia in ICU was associated with increased hospital and ICU length of stay but not all-cause mortality. Hypophosphatemia appears to be a marker of disease severity. Limited number of available studies and varied study designs did not allow for the ascertainment of the effect of severe hypophosphatemia on patient mortality.

Download Full-text

Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066617741470 ◽

2017 ◽

Vol 35 (3) ◽

pp. 257-263 ◽

Cited By ~ 2

Author(s):

Teresa Poon ◽

Daryl Glick Paris ◽

Samuel L. Aitken ◽

Paru Patrawalla ◽

Eric Bondarsky ◽

...

Keyword(s):

Length Of Stay ◽

Treatment Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Short Course ◽

Extended Course

Background: Previous literature has suggested that a short course of corticosteroids is similarly effective as an extended course for managing an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, there are limited data regarding the optimal corticosteroid regimen in critically ill patients and the dosing strategies remain highly variable in this population. Methods: This retrospective cohort study evaluated patients with AECOPD admitted to the intensive care unit within a 2-year period. Patients were divided into short-course (≤5 days) or extended-course (>5 days) corticosteroid taper groups. The primary end point was treatment failure, defined as the need for intubation, reintubation, or noninvasive mechanical ventilation. Secondary end points included the duration of mechanical ventilation, hospital and intensive care unit length of stay, and adverse events. Results: Of the 151 patients who met the inclusion criteria, 94 received an extended taper and 57 received a short taper. Treatment failure occurred in 3 patients, who were all in the extended taper group ( P = .17). In a propensity score-matched cohort, the hospital length of stay was 7 days in the short taper group compared to 11 days in the extended taper group ( P < .0001). No differences in adverse events were observed. Conclusion: A short-course corticosteroid taper in critically ill patients with AECOPD is associated with reduced hospital length of stay and decreased corticosteroid exposure without increased risk of treatment failure. A prospective randomized trial is warranted.

Download Full-text

PP014-MON NUTRITIONAL GOALS IN CRITICALLY ILL PATIENTS AND HOSPITAL LENGTH OF STAY

Clinical Nutrition ◽

10.1016/s0261-5614(13)60326-x ◽

2013 ◽

Vol 32 ◽

pp. S128

Author(s):

M. Castro ◽

C. Antunes ◽

K. Kawamura ◽

L.M. Horie ◽

F.S. de Souza ◽

...

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Hospital Length ◽

Hospital Length Of Stay

Download Full-text

Delirium and Associated Length of Stay and Costs in Critically Ill Patients

Critical Care Research and Practice ◽

10.1155/2021/6612187 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Claudia Dziegielewski ◽

Charlenn Skead ◽

Toros Canturk ◽

Colleen Webber ◽

Shannon M. Fernando ◽

...

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Hospital Costs ◽

Hospital Length ◽

Mean Difference ◽

Hospital Length Of Stay ◽

The Mean ◽

The Impact

Purpose. Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods. Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results. Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days ( p < 0.001 ); for hospital LOS, this was significant at 6.67 days ( p < 0.001 ). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 ( p < 0.001 ); for hospital costs, the mean difference was $5,936 ( p < 0.001 ). Conclusion. ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.

Download Full-text