Increased Risk of Death, in the Hospital and Outside the Intensive Care Unit, for Patients With Cirrhosis After Cardiac Arrest

Objective The objective of this study is to evaluate the effect of noncephalic presentation on neonatal outcomes in preterm delivery. Study Design In this study a secondary analysis of the BEAM trial was performed. It included women with singleton, liveborn, and nonanomalous fetuses. Neonatal outcomes were compared in noncephalic versus cephalic presentation. Adjusted odds ratios and 95% confidence intervals were calculated for each outcome with logistic regression while controlling for possible confounders. A stratified analysis by mode of delivery was also performed in this study. Results A total of 458 noncephalic deliveries were compared with 1,485 cephalic deliveries. In multivariate analysis, noncephalic presentation was associated with increased risk of death in the neonatal intensive care unit (NICU) or death at <15 months corrected gestational age (cGA), and a decreased risk of IVH. The risk of death persisted in stratified analysis, with increased risk of death at <15 months cGA in noncephalic neonates born via cesarean delivery. In the vaginal delivery group, there was an increased risk of death at <15 months cGA and NICU death. Conclusion After controlling for possible confounders, neonates who are noncephalic at delivery have higher risk for death <15 months cGA and death in the NICU while their risk of IVH is reduced. The risk of death persisted in stratified analyses by mode of delivery.

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Joint Modeling of Repeated Measurements of Different Biomarkers Predicts Mortality in COVID-19 Patients in the Intensive Care Unit.

10.21203/rs.3.rs-944704/v1 ◽

2021 ◽

Author(s):

Kirby Tong-Minh ◽

Yuri van der Does ◽

Joost van Rosmalen ◽

Christian Ramakers ◽

Diederik Gommers ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Survival Data ◽

Single Point ◽

Joint Modeling ◽

Repeated Measurements ◽

Joint Models ◽

Icu Admission ◽

Risk Of Death ◽

Increased Risk

Abstract BackgroundPredicting disease severity is important for treatment decisions in patients with COVID-19 in the intensive care unit (ICU). Different biomarkers have been investigated in COVID-19 as predictor of mortality, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and soluble urokinase-type plasminogen activator receptor (suPAR). Using repeated measurements in a prediction model may result in a more accurate risk prediction than the use of single point measurements. The goal of this study is to investigate the predictive value of trends in repeated measurements of CRP, PCT, IL-6 and suPAR on mortality in patients admitted to the ICU with COVID-19. MethodsThis was a retrospective single center cohort study. Patients were included if they tested positive on SARS-CoV-2 by PCR test and if IL-6, PCT, suPAR was measured during any of the ICU admission days. There were no exclusion criteria for this study. We used joint models to predict ICU-mortality. This analysis was done using the framework of joint models for longitudinal and survival data. The reported hazard ratios express the relative change in the risk of death resulting from a doubling or 20% increase of the biomarker’s value in a day compared to no change in the same period. ResultsA total of 107 patients were included, of which 26 died during ICU admission. Adjusted for sex and age, a doubling in the next day in either levels of PCT, IL-6 and suPAR was significantly predictive of in-hospital mortality with and an HR of 1.523 (1.012 – 6.540), 75.25 (1.116 – 6247) and 24.45 (1.696 – 1057) respectively. With a 20% increase in biomarker value in a subsequent day, the HR of PCT, IL-6 and suPAR were 1.117 (1.03 – 1.639), 3.116 (1.029 – 9.963) and 2.319 (1.149 – 6.243) respectively.ConclusionJoint models for the analysis of repeated measurements of PCT, suPAR and IL-6 are a useful method for predicting mortality in COVID-19 patients in the ICU. Patients with an increasing trend of biomarker levels in consecutive days are at increased risk for mortality.

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Subphenotypes of Cardiac Arrest Patients Admitted to Intensive Care Unit: a latent profile analysis of a large critical care database

Scientific Reports ◽

10.1038/s41598-019-50178-0 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Zhongheng Zhang ◽

Min Yao ◽

Kwok M. Ho ◽

Yucai Hong

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Laboratory Data ◽

Elevated Serum ◽

Multiple Organ ◽

Risk Of Death ◽

Latent Profile

Abstract Cardiac arrest (CA) may occur due to a variety of causes with heterogeneity in their clinical presentation and outcomes. This study aimed to identify clinical patterns or subphenotypes of CA patients admitted to the intensive care unit (ICU). The clinical and laboratory data of CA patients in a large electronic healthcare database were analyzed by latent profile analysis (LPA) to identify whether subphenotypes existed. Multivariable Logistic regression was used to assess whether mortality outcome was different between subphenotypes. A total of 1,352 CA patients fulfilled the eligibility criteria were included. The LPA identified three distinct subphenotypes: Profile 1 (13%) was characterized by evidence of significant neurological injury (low GCS). Profile 2 (15%) was characterized by multiple organ dysfunction with evidence of coagulopathy (prolonged aPTT and INR, decreased platelet count), hepatic injury (high bilirubin), circulatory shock (low mean blood pressure and elevated serum lactate); Profile 3 was the largest proportion (72%) of all CA patients without substantial derangement in major organ function. Profile 2 was associated with a significantly higher risk of death (OR: 2.09; 95% CI: 1.30 to 3.38) whilst the mortality rates of Profiles 3 was not significantly different from Profile 1 in multivariable model. LPA using routinely collected clinical data could identify three distinct subphenotypes of CA; those with multiple organ failure were associated with a significantly higher risk of mortality than other subphenotypes. LPA profiling may help researchers to identify the most appropriate subphenotypes of CA patients for testing effectiveness of a new intervention in a clinical trial.

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Evaluation of Nurses’ Workload in the Intensive Care Unit, Neonatal Intensive Care Unit and Coronary Care Unit: An Analytical Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44824.14181 ◽

2020 ◽

Author(s):

Maryam Azadi ◽

Jalil Azimian ◽

Maryam Mafi ◽

Farnoosh Rashvand

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Analytical Study ◽

Pearson Correlation ◽

Risk Of Death ◽

Increased Risk ◽

The Mean ◽

Coronary Care

Introduction: The workload on nurses can have adverse effects on the patient, nurse and healthcare system such as reduced quality of care, increased risk of nursing errors, reduced patient satisfaction, increased nurse anxiety, increased nursing job stress, increased risk of infection, increase in the length of hospital stay and increased risk of death. Aim: The present study was designed and conducted to compare nurses’ workload in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NICU), and Coronary Care Units (CCU). Materials and Methods: The present study is a cross sectional analytical study that was conducted in the ICU, NICU and CCU of educational hospitals affiliated to Qazvin University of Medical Sciences. The convenience sampling method was used. A nursing activity score was used to assess nurses’ workload. The total score in this instrument is between zero and 178. Data were analysed using SPSS 16. Pearson correlation coefficient, chi-square, independent t-test, one-way analysis of variance was used. Results: The mean score of the total workload in nurses was 104.19±25.18. Regarding the primary purpose of the study, the results of the present study showed that the mean score of nurses’ workload was significantly higher in nurses working in the NICU than nurses working in the ICU and CCU (p<0.05). Among the demographic variables, only the marital status was significantly associated with nurses’ workload, that married nurses experienced more workload in some shifts (p<0.05). Conclusion: Nurses working in NICUs experienced a higher level of workload compared to the nurses in ICU and CCU. Due to the high workload of nurses in the NICU and the complications that this can cause for neonatal patients and nurses, it is necessary to pay more attention to the distribution of nurses in these wards.

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COVID-19 Hospitalizations, ICU Admissions and Deaths Associated with the New Variants of Concern

10.47326/ocsat.2021.02.18.1.0 ◽

2021 ◽

Author(s):

Ashleigh R. Tuite ◽

David N. Fisman ◽

Ayodele Odutayo ◽

Pavlos Bobos ◽

Vanessa Allen ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Healthcare System ◽

Substantial Impact ◽

Daily Number ◽

Icu Admission ◽

Risk Of Death ◽

Increased Risk ◽

Second Wave

New variants of concern (VOCs) now account for 67% of all Ontario SARS-CoV-2 infections. Compared with early variants of SARS-CoV-2, VOCs are associated with a 63% increased risk of hospitalization, a 103% increased risk of intensive care unit (ICU) admission and a 56% increased risk of death due to COVID-19. VOCs are having a substantial impact on Ontario’s healthcare system. On March 28, 2021, the daily number of new SARS-CoV-2 infections in Ontario reached the daily number of cases observed near the height of the second wave, at the start of the province-wide lockdown, on December 26, 2020. The number of people hospitalized with COVID-19 is now 21% higher than at the start of the province-wide lockdown, while ICU occupancy is 28% higher (Figure 1). The percentage of COVID-19 patients in ICUs who are younger than 60 years is about 50% higher now than it was prior to the start of the province-wide lockdown. Because the increased risk of COVID-19 hospitalization, ICU admission and death with VOCs is most pronounced 14 to 28 days after diagnosis, there will be significant delays until the full burden to the health care system becomes apparent.

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Surviving cardiac arrest: What happens after admission to the intensive care unit?

Revista Portuguesa de Cardiologia ◽

10.1016/j.repc.2020.07.020 ◽

2021 ◽

Author(s):

Raquel Menezes Fernandes ◽

Daniel Nuñez ◽

Nuno Marques ◽

Cláudia Camila Dias ◽

Cristina Granja

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care

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Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic

Proceedings of Singapore Healthcare ◽

10.1177/2010105821991170 ◽

2021 ◽

pp. 201010582199117

Author(s):

Leonard Wei Wen Loh ◽

Yingke He ◽

Hairil Rizal Abdullah ◽

Kai Lee Ng ◽

Un Sam Mok

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Severe Illness ◽

Continuing Care ◽

Short Report ◽

Obstetric Anaesthesia ◽

Increased Risk ◽

Process And Outcome ◽

Risk Of Exposure ◽

Anaesthesia Care

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.

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P-73 Arrhythmias and cardiac arrest in prehospital fibrinolysis in acute myocardial infarction. Resuscitation in mobile intensive care unit physician staffed

Resuscitation ◽

10.1016/0300-9572(96)83935-9 ◽

1996 ◽

Vol 31 (3) ◽

pp. S39 ◽

Cited By ~ 1

Author(s):

A Pacheco ◽

J Ortega ◽

F Hermoso ◽

C Murtel

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Intensive Care Unit Physician ◽

Mobile Intensive Care Unit

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Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

Cardiology in the Young ◽

10.1017/s1047951107001229 ◽

2007 ◽

Vol 17 (S4) ◽

pp. 116-126 ◽

Cited By ~ 26

Author(s):

Stacie B. Peddy ◽

Mary Fran Hazinski ◽

Peter C. Laussen ◽

Ravi R. Thiagarajan ◽

George M. Hoffman ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Cardiopulmonary Resuscitation ◽

Intensive Care Units ◽

Cardiac Disease ◽

Paediatric Intensive Care ◽

Cardiac Intensive Care Unit ◽

Cardiac Intensive Care ◽

Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

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