Prevalence of obesity and the effect on length of mechanical ventilation and length of stay in intensive care patients: A single site observational study

Abstract Background As the coronavirus disease (COVID-19) pandemic spread worldwide in 2020, the number of patients requiring intensive care and invasive mechanical ventilation (IMV) has increased rapidly. Tracheostomy has several advantages over oral intubation in critically ill patients, including the facilitation of prolonged mechanical ventilation. However, the optimal timing of the procedure remains unclear. During the pandemic, early recommendations suggested that tracheostomy should be postponed, as the potential benefits were not certain to exceed the risk of viral transmission to healthcare workers. The aim of this study was to assess the utility of tracheostomy in patients with COVID-19-related acute respiratory distress syndrome, in terms of patient and clinical characteristics, outcomes, and complications, by comparing between early and late tracheostomy. Methods A multicentre, retrospective observational study was conducted in Jönköping County, Sweden. Between 14 March 2020 and 13 March 2021, 117 patients were included in the study. All patients > 18 years of age with confirmed COVID-19 who underwent tracheostomy were divided into two groups based on the timing of the procedure (< / > 7 days). Outcomes including the time on IMV, intensive care unit (ICU) length of stay, and mortality 30 days after ICU admission, as well as complications due to tracheostomy were compared between the groups. Results Early tracheostomy (< 7 days, n = 56) was associated with a shorter duration of mechanical ventilation (7 [Inter Quartile Range, IQR 12], p = 0.001) as well as a shorter ICU stay (8 [IQR 14], p = 0.001). The mortality rates were equal between the groups. The most frequent complication of tracheostomy was minor bleeding. With the exception of a higher rate of obesity in the group receiving late tracheostomy, the patient characteristics were similar between the groups. Conclusions This study showed that early tracheostomy was safe and associated with a shorter time on IMV as well as a shorter ICU length of stay, implicating possible clinical benefits in critically ill COVID-19 patients. However, it is necessary to verify these findings in a randomised controlled trial.Trial Registration: Not required

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The Impact of Alcohol-Related Admissions on Resource Use in Critically Ill Patients from 2009 to 2015: An Observational Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x1804600109 ◽

2018 ◽

Vol 46 (1) ◽

pp. 58-66 ◽

Cited By ~ 2

Author(s):

P. J. Secombe ◽

P. C. Stewart

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Observational Study ◽

Resource Use ◽

Alcohol Misuse ◽

National Level ◽

Hospital Length Of Stay ◽

Central Australia ◽

The Impact

Excessive alcohol use is associated with increased health care utilisation and increased mortality. This observational study sought to identify the proportion of patients admitted with a critical illness in which alcohol misuse contributed, and to examine the resource use for this group. We performed an observational retrospective database review of all admissions to the Alice Springs Hospital intensive care unit (ICU) between 1 January 2009 and 31 December 2015. The Alice Springs Hospital ICU is a ten-bed unit located in Central Australia, with approximately 600 admissions annually. The per capita consumption of alcohol in Central Australia is approximately 1.5 times the national average. The primary aim was to determine the proportion of admissions to intensive care in which alcohol misuse was identified as a contributing cause. Secondary aims examined resource utilisation including ICU and hospital length of stay, need for and duration of mechanical ventilation, and ICU re-admission. There were 3,768 admissions involving 2,670 individual patients. Of these admissions 947 (25%) were associated with alcohol misuse. Admissions associated with alcohol were significantly more likely to require mechanical ventilation (30% versus 20%, P <0.01), and had a significantly longer ICU length of stay (2.1 versus 1.9 days, P <0.05). The proportion of admissions in which alcohol misuse was implicated is amongst the highest in the published literature. The results of this study should drive further policy change directed at harm minimisation, and warrant more detailed epidemiological work at both a local and national level.

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Volume based feeding versus rate based feeding in the critically ill: A UK study

Journal of the Intensive Care Society ◽

10.1177/1751143719847321 ◽

2019 ◽

Vol 20 (4) ◽

pp. 299-308

Author(s):

Mina Bharal ◽

Sally Morgan ◽

Tariq Husain ◽

Katerina Hilari ◽

Charlie Morawiec ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Glycaemic Control ◽

Length Of Stay ◽

Clinical Outcomes ◽

Protein Delivery ◽

Surgical Intensive Care Unit ◽

Gastrointestinal Tolerance ◽

Intensive Care Patients

Background Underfeeding in intensive care patients on enteral nutrition is commonplace and multifactorial. This can be exacerbated by interruptions caused by routine fasting for procedures and investigations. Our study aims to demonstrate that a volume based feeding protocol can overcome the barriers of underfeeding and safely increase energy and protein delivery in UK intensive care patients, potentially improving clinical outcomes. Methods In this single centre cohort study, data were collected from adult mechanically ventilated patients. We compared the standard care of rate based feeding, from an International Nutrition Survey (2014/15) to the new intervention of volume based feeding, in a mixed medical and surgical intensive care unit. The primary outcomes were the proportion of energy and protein daily targets delivered. Secondary outcomes compared the effects on gastrointestinal tolerance, glycaemic control, mortality, mechanical ventilation days, length of stay in intensive care unit and hospital. Results From a total of 82 patients (rate based feeding = 27, volume based feeding = 55), volume based feeding patients received significantly more prescribed energy (52% versus 81%; p < 0.001) and protein (40% versus 74%; p < 0.001). There was no significant difference in gastrointestinal symptoms such as gastric residual volumes (p = 0.62), glycaemic control (p = 0.94) or insulin usage (p = 0.75). Although there was an improvement in energy and protein delivery, there were no differences in mechanical ventilation days (p = 0.12), mortality (p = 0.06), length of stay in intensive care unit (p = 0.93) and hospital (p = 0.72) between the groups. Conclusion Compared to rate based feeding, volume based feeding significantly improved energy and protein provision with no adverse effects on glycaemic control or gastrointestinal tolerance, clinical outcomes were not affected.

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Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients

Critical Care Nurse ◽

10.4037/ccn2016520 ◽

2016 ◽

Vol 36 (5) ◽

pp. e1-e7 ◽

Cited By ~ 15

Author(s):

Maria Parisi ◽

Vasiliki Gerovasili ◽

Stavros Dimopoulos ◽

Efstathia Kampisiouli ◽

Christina Goga ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Ventilator Associated Pneumonia ◽

Staff Education ◽

Hospital Acquired Infections ◽

Intensive Care Patients ◽

Greek Hospital ◽

Hospital Acquired

BackgroundVentilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate.ObjectivesTo evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence.MethodsA 24-month-long before/after study was conducted, divided into baseline, intervention, and postintervention periods. VAP incidence and rate, the microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit were recorded and compared between the periods.ResultsOf 1097 patients evaluated, 362 met the inclusion criteria. The baseline VAP rate was 21.6 per 1000 ventilator days. During the postintervention period, it decreased to 11.6 per 1000 ventilator days (P = .01). Length of stay in the intensive care unit decreased from 36 to 27 days (P = .04), and duration of mechanical ventilation decreased from 26 to 21 days (P = .06).ConclusionsVAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit.

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Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters

Annals of Intensive Care ◽

10.1186/s13613-019-0599-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Youenn Jouan ◽

Leslie Grammatico-Guillon ◽

Noémie Teixera ◽

Claire Hassen-Khodja ◽

Christophe Gaborit ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Length Of Stay ◽

Population Based ◽

Hospital Length Of Stay ◽

Healthcare Use ◽

Icu Admission ◽

Icu Discharge

Abstract Background The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories. Results Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU. Conclusion For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.

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The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Critical Care ◽

10.1186/s13054-020-03447-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

L. J. Delaney ◽

E. Litton ◽

K. L. Melehan ◽

H.-C. C. Huang ◽

V. Lopez ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Total Sleep Time ◽

Sleep Time ◽

Moderate Level ◽

Sleep Monitoring ◽

Clinical Trial Registration ◽

Wake Time ◽

Intensive Care Patients

Abstract Background Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

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A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients With COVID-19

Journal of Intensive Care Medicine ◽

10.1177/0885066621994057 ◽

2021 ◽

pp. 088506662199405

Author(s):

Justine J. Ko ◽

Clay Wu ◽

Neha Mehta ◽

Noah Wald-Dickler ◽

Wei Yang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Los Angeles ◽

Usual Care ◽

Low Income ◽

Corticosteroid Treatment ◽

Intensive Care Patients ◽

Institutional Review ◽

Mortality Effect ◽

All Cause Mortality

Objectives: This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring intensive care. Design: This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit (ICU) admission. Patients admitted and requiring oxygen supplementation were treated with no steroids, methylprednisolone, or dexamethasone. Setting: This study takes place in the ICU’s at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles. Patients: All eligible patients admitted to the ICU for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study. Interventions: A total of 262 patients were grouped as receiving usual care (n = 75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n = 104), or dexamethasone dosed at least at 6 mg for ≥7 days (n = 83). Measurements and Main Results: All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient. In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days ( P < 0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, P = 0.0385). Conclusions: In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.

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