Candidemia in critically ill patients: difference of outcome between medical and surgical patients

2003 ◽  
Vol 29 (12) ◽  
pp. 2162-2169 ◽  
Author(s):  
Pierre Emmanuel Charles ◽  
Jean Marc Doise ◽  
Jean Pierre Quenot ◽  
Hervé Aube ◽  
Frédéric Dalle ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Patients

scholarly journals The association between culture positivity and long-term mortality in critically ill surgical patients

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Yu-Cheng Wu ◽  
Li-Ting Wong ◽  
Chieh-Liang Wu ◽  
Wen-Cheng Chao
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Culture ◽  
Surgical Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Culture Positivity ◽  
Critically Ill Surgical Patients ◽  
Long Term Mortality

Abstract Background The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. Methods We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). Results A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. Conclusions We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

scholarly journals Pulmonary Artery Catheterization was not Associated with Survival Benefits in Critically Ill Patients with Cardiac Disease: An Analysis of the MIMIC-IV Database

2021 ◽  
Author(s):  
Jie Wu ◽  
Shiyu Zhou ◽  
Hongbin Hu ◽  
Yuan Zhang ◽  
Sheng An ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Pulmonary Artery Catheterization

Abstract Background: It is not clear whether pulmonary artery catheter (PAC) placement is beneficial for critically ill patients with heart disease. This study aims to investigate the association of PAC use with 28-day mortality in that population.Methods: The MIMIC-IV database was employed to identify critically ill patients with cardiac disease with or without PAC insertion. The primary outcome was 28-day mortality. Multivariate regression was modeled to examine the association between PAC and outcomes. Additionally, we examined the effect modification by cardiac surgeries. Propensity score matching (PSM) was conducted to validate our findings.Results: No improvement in 28-day mortality was observed among the PAC group compared to the non-PAC group (odds ratio=1.18, 95% CI=1.00-1.38, P=0.049). When stratified by cardiac surgeries, the results were consistent. Patients in the PAC group had fewer ventilation-free days and vasopressor-free days than those in the non-PAC group after surgery stratification. In surgical patients, PAC insertion was not associated with the occurrence of acute kidney injury (AKI), and was associated with a higher daily fluid input (mean difference=0.13, 95% CI=0.05-0.20, P=0.001). In non-surgical patients, the PAC group had a higher risk of AKI occurrence (odds ratio=1.94, 95% CI=1.32-2.84, P=0.001).Conclusion: PAC placement was not associated with survival benefits in critically ill patients with cardiac diseases, either in surgical and non-surgical patients.

scholarly journals Association of Serum Albumin Concentration and Mortality Risk in Critically Ill Patients

2002 ◽  
Vol 30 (2) ◽  
pp. 202-207 ◽  
Author(s):  
F. H. Y. Yap ◽  
G. M. Joynt ◽  
T. A. Buckley ◽  
E. L. Y. Wong
Keyword(s):  
Serum Albumin ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Roc Curves ◽  
Apache Ii ◽  
Surgical Patients ◽  
Apache Ii Score ◽  
Albumin Concentration ◽  
Serum Albumin Concentration

In this study we aimed to examine the association between serum albumin concentration and mortality risk in critically ill patients. We retrospectively studied 1003 patients admitted to our Intensive Care Unit (ICU) over an 18-month period. Serial albumin measurements over 72 hours were compared between survivors and non-survivors, and medical and surgical patients were also compared. Our results showed that serum albumin decreased after ICU admission, most rapidly in the first 24 hours, in both survivors and non-survivors. Serum albumin was lower in non-survivors than in survivors, but albumin concentrations poorly differentiated the two groups. Medical patients had higher admission albumin levels than surgical patients, but both subgroups showed a similar albumin profile over 72 hours. We evaluated the prognostic value of serum albumin using receiver operator characteristic (ROC) curves. We constructed ROC curves for APACHE II score, admission albumin, albumin at 24 and 48 hours. We also combined APACHE II with albumin values and constructed the corresponding ROC curves. Our data showed that serum albumin had low sensitivity and specificity for predicting hospital mortality. Combining APACHE II score with serum albumin concentrations did not improve the accuracy of outcome prediction over that of APACHE II alone.

scholarly journals Immunonutrition in surgical and critically ill patients

2007 ◽  
Vol 98 (S1) ◽  
pp. S133-S139 ◽  
Author(s):  
Philip C. Calder
Keyword(s):  
Fatty Acids ◽  
Immune Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Experimental Studies ◽  
Good Evidence ◽  
Antioxidant Vitamins ◽  
Surgical Patients ◽  
Susceptibility To Infection ◽  
Long Chain

Surgery, trauma, burns and injury induce an inflammatory response that can become excessive and damaging in some patients. This hyperinflammation can be followed by an immunosuppressed state which increases susceptibility to infection. The resulting septic syndromes are associated with significant morbidity and mortality. A range of nutrients are able to modulate inflammation (and the associated oxidative stress) and to maintain or improve immune function. These include several amino acids, antioxidant vitamins and minerals, long-chain n-3 fatty acids and nucleotides. Experimental studies support a role for each of these nutrients in surgical, injured or critically ill patients. There is good evidence that glutamine influences immune function in such patients and that this is associated with clinical improvement. Evidence is also mounting for the use of long-chain n-3 fatty acids in surgical and septic patients, but more evidence of clinical efficacy is required. Mixtures of antioxidant vitamins and minerals are also clinically effective, especially if they include selenium. Their action appears not to involve improved immune function, although an anti-inflammatory mode of action has not been ruled out. Enteral immunonutrient mixtures, usually including arginine, nucleotides and long-chain n-3 fatty acids, have been used widely in surgical and critically ill patients. Evidence of efficacy is good in surgical patients. However whether these same mixtures are beneficial, or should even be used, in critically ill patients remains controversial, since some studies show increased mortality with such mixtures. There is a view that this is due to a high arginine content driving nitric oxide production.

scholarly journals Liver function, quantified by the LiMAx test, as a predictor for the clinical outcome of critically ill patients treated with linezolid

2021 ◽  
pp. 1-13
Author(s):  
Rawan Alraish ◽  
Sebastian G. Wicha ◽  
Otto R. Frey ◽  
Anka C. Roehr ◽  
Johann Pratschke ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Function ◽  
Clinical Outcome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Predictor ◽  
Surgical Patients ◽  
Clinical Failure ◽  
Linezolid Therapy ◽  
Critically Ill Surgical Patients

BACKGROUND: Critically ill patients commonly suffer from infections that require antimicrobial therapy. In previous studies, liver dysfunction was shown to have an essential impact on the dose selection in these patients. This pilot study aims to assess the influence of liver dysfunction, measured by the novel LiMAx test, on clinical outcomes in critically ill patients treated with linezolid. METHODS: Twenty-nine critically ill patients were included and treated with linezolid. Indications for linezolid therapy were secondary or tertiary peritonitis (46.7%), bloodstream infection (6.7%) and 46.7% were other infections with gram-positive bacteria. Linezolid Cmin, maximal liver function capacity (LiMAx test) and plasma samples were collected while linezolid therapy was in a steady-state condition. Furthermore, potential factors for the clinical outcome were investigated using logistic regression analysis. Clinical cure was defined as the resolution or significant improvement of clinical symptoms without using additional antibiotic therapy or intervention. RESULTS: Cured patients presented lower median linezolid Cmin yet a significantly higher mean LiMAx-value compared to the clinical failure group (1.9 mg/L vs. 5.1 mg/L) (349 μg/kg/h vs. 131 μg/kg/h). In the logistic regression model, LiMAx < 178 μg/kg/h was the only independent predictor of clinical failure with a sensitivity of 77% and specificity of 93%. CONCLUSIONS: The LiMAx test predicts clinical failure more precisely than linezolid trough levels in critically ill surgical patients. Therefore liver failure may have a stronger impact on the outcome of critically ill surgical patients than low linezolid Cmin. While linezolid Cmin failed to predict patient’s outcome, LiMAx results were the only independent predictor of clinical failure.

Minimizing diagnostic blood loss in critically ill patients

1992 ◽  
Vol 1 (1) ◽  
pp. 85-90 ◽  
Author(s):  
E Gleason ◽  
S Grossman ◽  
C Campbell
Keyword(s):  
Blood Loss ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Diagnostic Procedures ◽  
Open Group ◽  
Surgical Patients ◽  
Comparison Study ◽  
Initial Sample ◽  
Open Method ◽  
Critically Ill Surgical Patients

BACKGROUND: Blood loss from diagnostic procedures in critically ill patients needs to be minimized. Traditionally, when drawing blood from arterial lines, the initial sample used to clear the line has been discarded (open method). Use of a temporary reservoir enables this discard sample to be returned to the patient (closed method). METHODS: Critically ill surgical patients were prospectively randomized to the open or closed method of drawing blood from arterial lines. Blood loss to diagnostic sampling was measured in both groups. RESULTS: A comparison study (n = 1657) of these two methods revealed that blood loss to the patient was significantly decreased (P &lt;&lt; .01) using the closed method. Mean blood loss per patient per day was 69 mL in the open group (n = 873) vs 35 mL in the closed group (n = 784). CONCLUSIONS: Use of the closed method when drawing blood from arterial lines results in a significant decrease in blood lost to diagnostic procedures.

Arginine Immunonutrition in Critically Ill Patients: A Clinical Dilemma

2004 ◽  
Vol 13 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Joyce K. Stechmiller ◽  
Beverly Childress ◽  
Tricia Porter
Keyword(s):  
Immune System ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Nutritional Deficiencies ◽  
Review Of The Literature ◽  
Clinical Dilemma ◽  
Enteral Formula ◽  
Meta Analyses

Commercial enteral nutritional formulas for enhancement of the immune system are widely used in critical care. Immunonutrition with arginine can enhance inflammatory and immunologic responses in animal models and in humans. Although clinical improvements in surgical patients have been reported, benefits in critically ill patients with systemic inflammatory response syndrome, sepsis, or organ failure are less clear. Recent meta-analyses on the use of immunonutrition with arginine in critically ill and surgical patients revealed methodological weaknesses in most published studies. Specifically, a meta-analysis indicated that critically ill patients with preexisting severe sepsis may have an increased mortality rate when fed an immunonutritional enteral formula that contains arginine. These findings brought about confusion and controversy over the use of immunonutritional formulas in subsets of critically ill patients. A review of the literature on the function of arginine, its effect on the immune system, its roles in immunonutrition and in the clinical outcomes of critically ill patients, and the implications for nursing practice indicated that the benefits of immunonutrition with arginine in critically ill patients are unproven and warrant further study. Until more information is available, nutritional support should focus primarily on preventing nutritional deficiencies rather than on immunomodulation.

Systemic pharmacokinetics and safety of high doses of nebulized colistimethate sodium in critically ill patients with hospital-acquired and ventilator-associated pneumonia

2019 ◽  
Vol 74 (11) ◽  
pp. 3268-3273 ◽  
Author(s):  
Adela Benítez-Cano ◽  
Marta de Antonio-Cuscó ◽  
Sonia Luque ◽  
Luisa Sorlí ◽  
Jesús Carazo ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Case Series ◽  
Surgical Patients ◽  
Ventilator Associated Pneumonia ◽  
Colistimethate Sodium ◽  
High Doses ◽  
Hospital Acquired ◽  
Critically Ill Surgical Patients

Abstract Objectives To assess the pharmacokinetics of formed colistin in plasma and the safety of two different high doses of colistimethate sodium administered via nebulization in critically ill surgical patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Patients and methods Formed colistin plasma concentrations were measured in critically ill surgical patients with pneumonia treated with two different doses of nebulized colistimethate sodium (3 MIU/8 h versus 5 MIU/8 h). Adverse events possibly related to nebulized colistimethate sodium were recorded. Results Twenty-seven patients (15 in the 3 MIU/8 h group and 12 in the 5 MIU/8 h group) were included. Colistin plasma concentrations were unquantifiable (<0.1 mg/L) in eight (53.3%) patients in the 3 MIU/8 h group and in seven patients (58.3%) in the 5 MIU/8 h group. Median (IQR) quantifiable colistin plasma concentrations before nebulization and at 1, 4 and 8 h were 0.17 (0.12–0.33), 0.20 (0.11–0.24), 0.17 (0.12–0.23) and 0.17 (0.11–0.32) mg/L, respectively, in the 3 MIU/8 h group and 0.20 (0.11–0.35), 0.24 (0.12–0.44), 0.24 (0.10–0.49) and 0.23 (0.11–0.44) mg/L, respectively, in the 5 MIU/8 h group, with no differences between the two groups at any time. Renal impairment during nebulized treatment was observed in three patients in each group, but was unlikely to be related to colistimethate sodium treatment. Nebulized colistimethate sodium therapy was well tolerated and no bronchospasms or neurotoxicity events were observed. Conclusions In this limited observational case series of critically ill patients with HAP or VAP treated with high doses of nebulized colistimethate sodium, systemic exposure was minimal and the treatment was well tolerated.

scholarly journals The Impact of Routine Cardiology Consultation on Critically Ill Patients with Elevated Troponin Levels

2020 ◽  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Elevated Troponin ◽  
Specific Context ◽  
Coronary Syndrome ◽  
The Impact ◽  
Critical Care Patients

Cardiac troponin (cTn) is used to diagnose acute coronary syndrome (ACS). However, cTn can also be elevated in critically ill patients secondary to demand ischaemia or myocardial injury. In a meta-analysis of 20 different studies involving critically ill patients, cTn was found to be elevated in 43% of patients.1 Prior studies have evaluated the significance of cTn as a prognostic factor and mortality predictor in different clinical entities in intensive care units (ICU).2,3 However, the data on the impact of cardiology consultation on the outcomes in this specific context of critical care patients are limited. While prior studies have addressed such an impact on the outcomes among different groups of surgical patients,4,5 to the authors’ knowledge, no prior studies have examined that impact on critically ill patients with elevated cTn. This study aimed to investigate the impact of cardiology consultation on critically ill patients in the medical ICU with elevated cTn and no signs of ACS.

Sign in / Sign up

Export Citation Format

Share Document