Goldilocks, the Three Bears and Intensive Care Unit Utilization: Delivering Enough Intensive Care But Not Too Much. A Narrative Review

AbstractProfessional societies have developed recommendations for patient triage protocols, but wide variations in triage patterns for many acute conditions exist among hospitals in the United States. Differences in hospitals’ triage patterns can be attributed to factors such as physician behavior, hospital policy and real-time conditions such as intensive care unit capacity. The patient safety concern is that patients evaluated for admission to the intensive care unit during times of high intensive care unit capacity may have adverse outcomes related to delays in care. Because standardization of a national triage policy is not feasible due to differing resources available at each hospital, local guidelines should prevail that take into account hospitals’ local resources. The goal would be to better match intensive care unit bed supply with demand.

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Intensive Care Unit Capacity Measure

PsycTESTS Dataset ◽

10.1037/t75233-000 ◽

2018 ◽

Author(s):

Dawn Opgenorth ◽

Henry T. Stelfox ◽

Elaine Gilfoyle ◽

R. T. Noel Gibney ◽

Michael Meier ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Unit Capacity ◽

Capacity Measure

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Hyperoxia is associated with adverse outcomes in the cardiac intensive care unit: insights from the Medical Information Mart for Intensive Care (MIMI-III) database

European Heart Journal ◽

10.1093/ehjci/ehaa946.1837 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A.Y Lui ◽

L Garber ◽

M Vincent ◽

L Celi ◽

J Masip ◽

...

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Hospital Mortality ◽

Adverse Outcomes ◽

Rank Test ◽

Positive Pressure ◽

Cardiac Intensive Care Unit ◽

Multivariable Logistic Regression ◽

Cardiac Intensive Care

Abstract Background Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU). Methods Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 >120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP. Results Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002). Conclusions In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted. Funding Acknowledgement Type of funding source: None

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Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽

10.1515/dx-2020-0099 ◽

2020 ◽

Vol 7 (4) ◽

pp. 381-383

Author(s):

Steven Liu ◽

Cara Sweeney ◽

Nalinee Srisarajivakul-Klein ◽

Amanda Klinger ◽

Irina Dimitrova ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

New York ◽

New York City ◽

Intensive Care ◽

Initial Phase ◽

The United States ◽

Lessons Learned ◽

Hypoxemic Respiratory Failure ◽

Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

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Healthcare-Associated Infections among Patients in a Large Burn Intensive Care Unit: Incidence and Pathogens, 2008–2012

Infection Control and Hospital Epidemiology ◽

10.1086/678067 ◽

2014 ◽

Vol 35 (10) ◽

pp. 1304-1306 ◽

Cited By ~ 16

Author(s):

David J. Weber ◽

David van Duin ◽

Lauren M. DiBiase ◽

Charles Scott Hultman ◽

Samuel W. Jones ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

The United States ◽

Burn Injuries ◽

Morbidity And Mortality ◽

Common Source ◽

Healthcare Associated Infections ◽

Burn Patients ◽

Healthcare Associated

Burn injuries are a common source of morbidity and mortality in the United States, with an estimated 450,000 burn injuries requiring medical treatment, 40,000 requiring hospitalization, and 3,400 deaths from burns annually in the United States. Patients with severe burns are at high risk for local and systemic infections. Furthermore, burn patients are immunosuppressed, as thermal injury results in less phagocytic activity and lymphokine production by macrophages. In recent years, multidrug-resistant (MDR) pathogens have become major contributors to morbidity and mortality in burn patients.Since only limited data are available on the incidence of both device- and nondevice-associated healthcare-associated infections (HAIs) in burn patients, we undertook this retrospective cohort analysis of patients admitted to our burn intensive care unit (ICU) from 2008 to 2012.

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Malnutrition on admission to the paediatric cardiac intensive care unit increases the risk of mortality and adverse outcomes following paediatric congenital heart surgery: A prospective cohort study

Australian Critical Care ◽

10.1016/j.aucc.2021.07.004 ◽

2021 ◽

Author(s):

Sibel Yilmaz Ferhatoglu ◽

Okan Yurdakok ◽

Nurgul Yurtseven

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Adverse Outcomes ◽

Cardiac Intensive Care Unit ◽

Risk Of Mortality ◽

Cardiac Intensive Care

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Advances in the Management of Sepsis and the Understanding of Key Immunologic Defects

Anesthesiology ◽

10.1097/aln.0b013e31823422e8 ◽

2011 ◽

Vol 115 (6) ◽

pp. 1349-1362 ◽

Cited By ~ 27

Author(s):

Lee P. Skrupky ◽

Paul W. Kerby ◽

Richard S. Hotchkiss

Keyword(s):

United States ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Operating Room ◽

The United States ◽

Difficult Problem ◽

Treatment Algorithms ◽

New Treatment ◽

Overall Mortality

Anesthesiologists are increasingly confronting the difficult problem of caring for patients with sepsis in the operating room and in the intensive care unit. Sepsis occurs in more than 750,000 patients in the United States annually and is responsible for more than 210,000 deaths. Approximately 40% of all intensive care unit patients have sepsis on admission to the intensive care unit or experience sepsis during their stay in the intensive care unit. There have been significant advances in the understanding of the pathophysiology of the disorder and its treatment. Although deaths attributable to sepsis remain stubbornly high, new treatment algorithms have led to a reduction in overall mortality. Thus, it is important for anesthesiologists and critical care practitioners to be aware of these new therapeutic regimens. The goal of this review is to include practical points on important advances in the treatment of sepsis and provide a vision of future immunotherapeutic approaches.

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