scholarly journals Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit

2018 ◽  
Author(s):  
Katherine A Doiron ◽  
Tammy C Hoffmann ◽  
Elaine M Beller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Intervention ◽  
Critically Ill ◽  
Critically Ill Adults ◽  
Ill Adults

scholarly journals Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Priscila Bellaver ◽  
Ariell F. Schaeffer ◽  
Diego P. Dullius ◽  
Marina V. Viana ◽  
Cristiane B. Leitão ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glycemic Variability ◽  
Stress Hyperglycemia ◽  
Critically Ill Adults ◽  
Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

scholarly journals The impact of patient delirium in the intensive care unit: patterns of anxiety symptoms in family caregivers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Therese G. Poulin ◽  
Karla D. Krewulak ◽  
Brianna K. Rosgen ◽  
Henry T. Stelfox ◽  
Kirsten M. Fiest ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Family Caregivers ◽  
Critically Ill ◽  
Clinical Assessment ◽  
Anxiety Symptoms ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
The Impact ◽  
Ill Adults

Abstract Background The purpose of this study was to examine the association of patient delirium in the intensive care unit (ICU) with patterns of anxiety symptoms in family caregivers when delirium was determined by clinical assessment and family-administered delirium detection. Methods In this cross-sectional study, consecutive adult patients anticipated to remain in the ICU for longer than 24 h were eligible for participation given at least one present family caregiver (e.g., spouse, friend) provided informed consent (to be enrolled as a dyad) and were eligible for delirium detection (i.e., Richmond Agitation-Sedation Scale score ≥ − 3). Generalized Anxiety Disorder-7 (GAD-7) was used to assess self-reported symptoms of anxiety. Clinical assessment (Confusion Assessment Method for ICU, CAM-ICU) and family-administered delirium detection (Sour Seven) were completed once daily for up to five days. Results We included 147 family caregivers; the mean age was 54.3 years (standard deviation [SD] 14.3 years) and 74% (n = 129) were female. Fifty (34% [95% confidence interval [CI] 26.4–42.2]) caregivers experienced clinically significant symptoms of anxiety (median GAD-7 score 16.0 [interquartile range 6]). The most prevalent symptoms of anxiety were “Feeling nervous, anxious or on edge” (96.0% [95%CI 85.2–99.0]); “Not being able to stop or control worrying” (88.0% [95%CI 75.6–94.5]; “Worrying too much about different things” and “Feeling afraid as if something awful might happen” (84.0% [95%CI 71.0–91.8], for both). Family caregivers of critically ill adults with delirium were significantly more likely to report “Worrying too much about different things” more than half of the time (CAM-ICU, Odds Ratio [OR] 2.27 [95%CI 1.04–4.91]; Sour Seven, OR 2.28 [95%CI 1.00–5.23]). Conclusions Family caregivers of critically ill adults with delirium frequently experience clinically significant anxiety and are significantly more likely to report frequently worrying too much about different things. Future work is needed to develop mental health interventions for the diversity of anxiety symptoms experienced by family members of critically ill patients. Trial registration This study is registered on ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03379129).

Bed Rest in Health and Critical Illness

2009 ◽  
Vol 20 (3) ◽  
pp. 254-266 ◽  
Author(s):  
Chris Winkelman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Functional Outcomes ◽  
Therapeutic Option ◽  
Bed Rest ◽  
Healthy Individuals ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Common Intervention

Bed rest is a common intervention for critically ill adults. Associated with both benefits and adverse effects, bed rest is undergoing increasing scrutiny as a therapeutic option in the intensive care unit. Bed rest has molecular and systemic effects, ultimately affecting functional outcomes in healthy individuals as well as in those with acute and critical illnesses. Using empirical sources, the purpose of this article was to describe the consequences of bed rest and immobility, especially consequences with implications for critically ill adults in the intensive care unit. This review uses body systems to cluster classic and current results of bed rest studies, beginning with cardiovascular and including pulmonary, renal, skin, nervous, immune, gastrointestinal/metabolic, and skeletal systems. It concludes with effects on muscles, a system profoundly affected by immobility and bed rest.

Predictors of New-Onset Physical Restraint Use in Critically Ill Adults

2020 ◽  
Vol 29 (2) ◽  
pp. 92-102
Author(s):  
Thomas N. Lawson ◽  
Alai Tan ◽  
Susan E. Thrane ◽  
Mary Beth Happ ◽  
Lorraine C. Mion ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Tertiary Care ◽  
The United States ◽  
Physical Restraints ◽  
Restraint Use ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
New Onset

Background Physical restraints are frequently used for intensive care patients and are associated with substantial morbidity. The effects of common evidence-based critical care interventions on use of physical restraints remain unclear. Objective To identify independent predictors of new-onset use of physical restraints in critically ill adults. Methods Secondary analysis of a prospective cohort study involving 5 adult intensive care units in a tertiary care medical center in the United States. Use of physical restraints was determined via daily in-person assessments and medical record review. Mixed-effects logistic regression analysis was used to examine factors associated with new-onset use of physical restraints, adjusting for covariates and within-subject correlation among intensive care unit days. Results Of 145 patients who were free of physical restraints within 48 hours of intensive care unit admission, 24 (16.6%) had restraints newly applied during their stay. In adjusted models, delirium (odds ratio [OR], 5.09; 95% CI, 1.83-14.14), endotracheal tube presence (OR, 3.47; 95% CI, 1.22-9.86), and benzodiazepine administration (OR, 3.17; 95% CI, 1.28-7.81) significantly increased the odds of next-day use of physical restraints. Tracheostomy was associated with significantly lowered odds of next-day restraint use (OR, 0.13; 95% CI, 0.02-0.73). Compared with patients with a target sedation level, patients who were in a coma (OR, 2.56; 95% CI, 0.80-8.18) or deeply sedated (OR, 2.53; 95% CI, 0.91-7.08) had higher odds of next-day use of physical restraints, and agitated patients (OR, 0.08; 95% CI, 0.00-2.07) were less likely to experience restraint use. Conclusion Several potentially modifiable risk factors are associated with next-day use of physical restraints.

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