scholarly journals The Acutely Failing Heart Plus Failing Brain Equals Double Trouble: Clinical Significance of Intensive Care Unit Delirium in Patients With Heart Failure

2020 ◽  
Vol 36 (10) ◽  
pp. 1580-1582
Author(s):  
D. Scott Kehler ◽  
Rakesh C. Arora
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Significance ◽  
Failing Heart ◽  
Patients With Heart Failure ◽  
Intensive Care Unit Delirium

scholarly journals Clinical characteristics and outcomes of patients with heart failure admitted to the intensive care unit with coronavirus disease 2019 (COVID19): a multicenter cohort study

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
H Badreldin ◽  
DR Hafidh ◽  
DR Bin Saleh ◽  
DR Al Sulaiman ◽  
DR Al Juhani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Characteristics ◽  
P Value ◽  
Heart Failure Patients ◽  
Icu Admission ◽  
Patients With Heart Failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with heart failure in the setting of COVID-19 requiring admission to the intensive care unit may present a set of unique challenges. There is limited data to describe the clinical characteristics and outcomes in this subset of the patient population. Purpose The study"s purpose was to extensively describe the characteristics and outcomes of heart failure patients admitted to the intensive care unit with COVID-19 compared to non-heart failure patients . Methods We conducted a multicenter, prospective analysis for all adult critically ill patients with heart failure admitted to intensive care units (ICUs) between March 1 to August 31, 2020, with an objectively confirmed diagnosis of COVID-19. Results A total of 723 critically ill patients with COVID-19 had been admitted in ICUs, 59 patients with heart failure, and 664 patients with no heart failure before ICU admission. Heart failure patients had significantly more comorbid conditions such as diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and acute coronary syndrome. Higher baseline severity scores (APACHE II & SOFA score) and nutritional risk (NUTRIC Score) were observed in heart failure patients. Also, heart failure patients had more acute kidney injury during ICU admission and required more mechanical ventilation within 24 hours of ICU admission. Patients with heart failure had a similar incidence of thrombosis compared to patients with no heart failure. Critically ill patients with COVID-19 and heart failure had similar ICU length of stay (LOS), mechanical ventilation duration, and hospital LOS compared to patients with no heart failure. During ICU stay, patients with heart failure had more in-hospital and ICU deaths in comparison to the non-heart failure group (64.3% vs. 44.6%, P-value <0.01) and (54.5% vs. 39%, P-value = 0.02) respectively. Conclusion In this observational study evaluating the clinical characteristics and outcomes of critically ill COVID-19 patients with heart failure, patients with COVID-19 and heart failure had similar ICU LOS, duration of MV and hospital LOS, thrombosis rate compared to patients with no heart failure. However, during ICU stay, patients with heart failure had more in-hospital and ICU deaths than the non-heart failure group.

Safety and Patients’ Response to Ambulation With a Pulmonary Artery Catheter in the Cardiac Intensive Care Unit

2019 ◽  
Vol 28 (2) ◽  
pp. 101-108
Author(s):  
Elisa Mattioli ◽  
Bienvenido Tabuzo ◽  
Prasama Sangkachand ◽  
Janet Parkosewich ◽  
Liberty Reyes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Well Being ◽  
Cardiac Intensive Care Unit ◽  
Catheter Position ◽  
Patients With Heart Failure ◽  
Cardiac Intensive Care

Background Early mobilization of patients in the intensive care unit can be beneficial, but evidence is insufficient to indicate whether allowing patients with an indwelling pulmonary artery catheter to walk is safe. Objective To describe the physiological and emotional responses to ambulation in patients with heart failure and a pulmonary artery catheter. Methods This prospective, descriptive study included 19 patients with heart failure monitored with a pulmonary artery catheter in a cardiac intensive care unit. Each patient, accompanied by a nurse, walked with continuous observation of heart rate and rhythm and pulmonary artery tracing on a transport monitor. Pulmonary artery catheter position and waveform, arrhythmias, and perceived levels of exertion and fatigue were recorded before and after each walk. The distance ambulated was documented. One to 3 times per week, nurses administered a questionnaire addressing patients’ sense of well-being. Results The 19 patients had 303 walks (range, 1–68; median, 7). During 7 patient walks (2.4%), catheter migration of 1 to 5 cm occurred, but no arrhythmias or waveform changes were observed. Changes in exertion and fatigue were significant (P < .001, paired t test), but levels of both were minimal after walking. Patients expressed physical and emotional benefits of walking. Conclusions This study provides preliminary evidence that for hemodynamically stable patients with heart failure, ambulating with a pulmonary artery catheter is safe and enhances their sense of well-being. The presence of an indwelling pulmonary artery catheter should not preclude walking.

scholarly journals Incremental costs of high intensive care utilisation in patients hospitalised with heart failure

2019 ◽  
Vol 8 (7) ◽  
pp. 660-666 ◽  
Author(s):  
Sean van Diepen ◽  
Dat T Tran ◽  
Justin A Ezekowitz ◽  
Gregory Schnell ◽  
Brandon M Wiley ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Hospital Costs ◽  
Cost Savings ◽  
Intensive Care Unit Care ◽  
Inhospital Mortality ◽  
Potential Cost ◽  
Patients With Heart Failure

Aims: Registries have reported large inter-hospital differences in intensive care unit admission rates for patients with acute heart failure, but little is known about the potential economic impact of over-admission of low-risk patients with heart failure to higher cost intensive care units. We described the variability in intensive care unit admission practices, the provision of critical care therapies, and estimated the potential national cost savings if all hospitals adopted low intensive care unit admission practices for patients admitted with heart failure. Methods: Using a national population health dataset, we identified 349,693 heart failure admission hospitalisations with a primary diagnosis of heart failure between 2007 and 2016. Hospitals were categorised as low (first quartile), medium (second and third quartile) and high (fourth quartiles) intensive care unit utilisation. Results: The mean intensive care unit admission rate was 16.4% (inter-hospital range 0.3–51%) including 5.4% in low, 14.5% in medium and 30% in high utilisation hospitals. Intensive care unit therapies in low, medium and high intensive care unit utilisation hospitals were 54.5%, 45.1% and 24.1% ( P<0.001), respectively and the inhospital mortality rate was not significantly different. The proportion of hospital costs incurred by intensive care unit care was 7.8% in low, 19.8% in medium and 28.2% in high ( P<0.001) admission hospitals. The potential cost savings of altering intensive care unit utilisation practices for patients with heart failure was CAN$234.8m over the study period. Conclusions: In a national cohort of patients hospitalised with heart failure, we observed that low intensive care unit utilisation centres had lower hospital costs with no differences in mortality rates. The development of standardised admission criteria for high-cost and high acuity intensive care unit beds could reduce costs to the healthcare system.

▾ Enoximone and ▾ milrinone – inotropic vasodilators for severe heart failure

1991 ◽  
Vol 29 (10) ◽  
pp. 39-40
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Severe Heart Failure ◽  
Phosphodiesterase Inhibitors ◽  
First Line ◽  
Short Term ◽  
Failing Heart ◽  
Patients With Heart Failure

Enoximone (Perfan – Merrell) and milrinone (Primacor – Sterling-Winthrop) are phosphodiesterase inhibitors marketed for short-term intravenous use in patients with heart failure on intensive care units. The manufacturers claim that enoximone is ‘a first-line inotrope for the failing heart’ while milrinone is advocated for ‘resistant heart failure’. Are these drugs useful additions to existing treatments?

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