scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

The Impact of Continuous Infusion Compared to Intravenous Bolus Administration of Pantoprazole on Length of Intensive Care Unit Stay in Critically Ill Patients

2021 ◽  
pp. 089719002110360
Author(s):  
Katelynn Callaway ◽  
Mrinmayee Lakkad ◽  
Jacob T Painter ◽  
Lindsey Dayer ◽  
Allison K Oswalt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Continuous Infusion ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intravenous Bolus ◽  
Gi Bleeding ◽  
Icu Length Of Stay

Purpose: To determine if intravenous (IV) bolus pantoprazole increases intensive care unit (ICU) length of stay compared to IV infusion pantoprazole for treatment of gastrointestinal (GI) bleeding in critically ill patients. Methods: This retrospective cohort study included adult patients admitted to the ICU with GI bleeds. Patients treated with IV pantoprazole from January 1, 2017 to December 31, 2017 were analyzed in the continuous infusion group, and patients treated from March 1, 2018 to February 28, 2019 were analyzed in the bolus only group. Patients with pregnancy, variceal bleeds, or lower GI bleeds were excluded. Intensive care unit length of stay was compared between the two cohorts using the Mann Whitney U test. Adjusted analysis was conducted using the generalized linear model with gamma log link to estimate the effect of type of infusion on ICU length of stay. Results: A total of 145 patients were included in the analysis, with 72 patients in the continuous infusion group and 73 patients in the bolus only group. The median ICU length of stay was 70.5 hours for continuous infusion and 64 hours for bolus only pantoprazole ( P-value = .577). In the adjusted analysis, there was no difference in ICU length of stay between the continuous infusion and bolus only groups (RR, 1.06; 95% CI, .76–1.47). Conclusion: Intensive care unit length of stay was not prolonged with the use of IV bolus only compared to continuous infusion pantoprazole. Intravenous bolus only pantoprazole may be used in critically ill patients for treatment of upper GI bleeding.

scholarly journals Vascular access: the impact of ultrasonography

2016 ◽  
Vol 14 (4) ◽  
pp. 561-566 ◽  
Author(s):  
Carlos Eduardo Saldanha de Almeida ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Albert Einstein ◽  
Sao Paulo ◽  
Future Studies ◽  
The Impact ◽  
Puncture Technique

ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.

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

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.

Short- and Long-term Outcomes of Critically Ill Patients With Cancer and Prolonged ICU Length of Stay

CHEST Journal ◽  
2008 ◽  
Vol 134 (3) ◽  
pp. 520-526 ◽  
Author(s):  
Márcio Soares ◽  
Jorge I.F. Salluh ◽  
Viviane B.L. Torres ◽  
Juliana V.R. Leal ◽  
Nelson Spector
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Long Term Outcomes ◽  
Patients With Cancer ◽  
Icu Length Of Stay ◽  
Short And Long Term

scholarly journals Appropriateness of Heparin-Induced Thrombocytopenia (HIT) Testing and the Reliability of 4-Ts Scoring in Critically Ill Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4988-4988
Author(s):  
Phyo Thazin Myint ◽  
Amani Erra ◽  
Taha Alrifai ◽  
Salman Syed ◽  
Bibek Singh Pannu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
False Positive ◽  
High Probability ◽  
Icu Patients ◽  
Heparin Induced Thrombocytopenia ◽  
Common Cause ◽  
Icu Length Of Stay ◽  
Low Probability

Abstract Introduction: Thrombocytopenia is a common occurrence in critically ill patients and results in an array of diagnostic workup. Heparin induced thrombocytopenia (HIT) is one of the most frequently ordered tests in this scenario, although it is a less common cause (0.02-0.5%) The over testing and treatment of HIT in Intensive Care Unit (ICU) can lead to a change in medications, and result in side effects, increased ICU length of stay and increased costs. Current guidelines recommend 4-Ts criteria to evaluate the clinical HIT probability in general population, but it may also be used in Intensive Care Unit (ICU) patients. Here, we want to analyze the the usage of 4Ts score in a community hospital and to understand its correlation with HIT testing to see if HIT testing could have been avoided. Methods: We performed a retrospective chart review of adult patients who underwent testing for Heparin Induced Thrombocytopenia anti-platelet factor 4 antibody (anti- PF4 Ab) in ICU at our institution from 03/01/2012 to 02/01/2018. The primary outcomes were set to identify (1) the extent of inappropriate of HIT testing and its consequences in patients with low 4Ts scores, and (2) if 4Ts score as a potential predictor of length of stay and mortality in ICU. As a secondary outcome, we assessed if Body Mass Index (BMI) and Recent Surgery are related to false positive anti-PF4 Ab test. Kruskal-Wallis test and Fisher Exact test were used. Results: A total of 66 patients were identified. The mean age was 64 yr and the male-female ratio was similar. 40 patients had recent surgery in the past 3 months. The cause of thrombocytopenia other than HIT was possible or definite in 62 patients with sepsis being the most common cause (56.45%). 30 patients had low probability 4-Ts scores, 28 had intermediate and 7 had high probability. HIT was confirmed (Serotonin Release Assay-SRA positive) in 0%, 7.14% and 12.5% of patients with low, intermediate and high probability 4Ts scores, respectively. In the patients with low probability 4Ts and anti-PF4 Ab testing, heparin was held in 24 (80%) and the anti-coagulation was switched (to either fondaparinux or argatroban) in 10 (33.33%). In those patients with anticoagulation switch, 3 had minor bleeding. There was no difference in the ICU length of stay (p=0.1712) and mortality (p=0.149) between patients with low, intermediate and high probability 4Ts scores. Patients with BMI ≥40 kg/m2 had twice the percentage of false positive anti-PF4 Ab testing compared with the rest, but the results were not significant (p=0.285). Recent surgery was not related to the false positive anti-PF4 Ab testing (p=1). Conclusion: As no patient with low-probability 4Ts score had confirmed HIT, low 4Ts may be a good estimator of the unlikeliness of HIT even in critically ill patients. We found discrepancy in the recommendations and usage of Anti-PF4 Ab testing in our institution. This has resulted in switching of heparin to other, more expensive anti-coagulations. This may very well be the situation in many other similar institutions. This could partly be due to lack of awareness of HIT testing guidelines in the critical care setting. We recommend the use of 4Ts scoring and more sensible testing and treatment of HIT in ICU patients. Although we could not demonstrate the statistical association between morbid obesity and false positive anti-PF4 Ab, our study might have been underpowered by low subgroup population of such patients. We propose further studies about HIT testing and treatment to include morbidly obese patients as a separate sub-group. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3302
Author(s):  
Michał Czapla ◽  
Raúl Juárez-Vela ◽  
Vicente Gea-Caballero ◽  
Stanisław Zieliński ◽  
Marzena Zielińska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Nutritional Risk ◽  
Risk Of Death ◽  
The Impact

Background: Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0–29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). Conclusions: Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient’s age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.

Evaluation of the Impact of Prior-to-Admission Sleep Aid Prescribing Practices on Sleep and Delirium in the Intensive Care Unit

2021 ◽  
pp. 106002802110426
Author(s):  
Melissa Chudow ◽  
Vittorio Paradiso ◽  
Nicole Silva ◽  
Jillian Collette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Icu Admission ◽  
Icu Length Of Stay ◽  
The Impact ◽  
Time Point ◽  
Similar Incidence

Background: Sleep disruptions in the intensive care unit (ICU) may lead to complications such as delirium. There is limited evidence addressing how sleep aid use before and during ICU admission affects outcomes. Objective: The purpose of this study is to evaluate the impact of prior-to-admission sleep aid prescribing practices in the ICU on delirium and sleep outcomes. Methods: A retrospective review was conducted of adult patients admitted to any ICU from January to June 2018 receiving a sleep aid prior to admission. Patients were categorized based on sleep aid continuation, discontinuation, or alteration during the ICU admission. The primary end point was the incidence of delirium. Secondary end points included the incidence of sleep-wake cycle disturbances, delirium scores, and ICU length of stay. Results: A total of 291 patients were included with 109 in the continued group, 121 in the discontinued group, and 61 in the altered group. There was a similar incidence of delirium at 24 hours ( P = 0.71), 48 hours ( P = 0.60), 72 hours ( P = 0.25), and 5 days ( P = 0.48) after ICU admission. There was also no statistical difference in sleep-wake cycle disturbances or delirium scores at any time point. ICU length of stay was similar between the groups. Conclusion and Relevance: The incidence of delirium and sleep-wake cycle disturbances was not affected by differences in prior-to-admission sleep aid prescribing patterns during ICU admission.

scholarly journals Intensive care unit admission protocol controlled by intensivists can reduce transfer delays from the emergency department in critically ill patients

2018 ◽  
Vol 26 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Ji Eun Kim ◽  
Seul Lee ◽  
Jinwoo Jeong ◽  
Dong Hyun Lee ◽  
Jin-Heon Jeong
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Before And After

Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher in-hospital mortality and increased hospital length of stay. Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients. Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention. Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3–1665.3) min to 392.0 (279.3–686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0–11.8) days to 5.0 (3.0–10.0) days (p = 0.015). Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

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