scholarly journals Prevalence and prognosis impact of frailty among older adults in cardiac intensive care units

CJC Open ◽  
2021 ◽  
Author(s):  
Kim Volle ◽  
Clément Delmas ◽  
Jean Ferrières ◽  
Olivier Toulza ◽  
Stephanie Blanco ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Cardiac Intensive Care

Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Caroline Ong ◽  
Albert Lui ◽  
John A Dodson ◽  
Jordan B Strom ◽  
Carlos Alviar
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Older Age ◽  
Icu Mortality ◽  
Differential Outcomes ◽  
Medical Intensive Care ◽  
Cardiac Intensive Care

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

scholarly journals Redesigned Geriatric Emergency Care May Have Helped Reduce Admissions Of Older Adults To Intensive Care Units

2015 ◽  
Vol 34 (5) ◽  
pp. 788-795 ◽  
Author(s):  
Corita Grudzen ◽  
Lynne D. Richardson ◽  
Kevin M. Baumlin ◽  
Gary Winkel ◽  
Carine Davila ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Emergency Care

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

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
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.

scholarly journals Are morbidity and mortality case review practices in Scottish intensive care units aligned to national standards?

2017 ◽  
Vol 19 (3) ◽  
pp. 264-268
Author(s):  
Mohammed(Mo) Faik Al-Haddad ◽  
Andrew Cadamy ◽  
Euan Black ◽  
Kate Slade
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
National Standards ◽  
Morbidity And Mortality ◽  
Case Review ◽  
Allied Health Professionals ◽  
Telephone Interviews ◽  
Significant Events ◽  
Mortality Case ◽  
Cardiac Intensive Care

Introduction Both Scottish and UK standards guidelines recommend that intensive care units should hold regular, structured, multidisciplinary morbidity and mortality meetings. The aim of this survey was to ascertain the nature of current practice with regards to morbidity and mortality case reviews and meetings in all intensive care units in Scotland. Methods Semi-structured telephone interviews were conducted with a consultant from all Scottish intensive care units. A list of intensive care units in Scotland was obtained from the Scottish Intensive Care Society Audit Group annual report. Results All 24 intensive care units (100%) in Scotland were surveyed. The interviews took an average of 20 min. The three cardiac intensive care units were excluded from analysis. All other intensive care units had morbidity and mortality meetings and 18 units had a morbidity and mortality clinical lead. Nineteen intensive care units held joint morbidity and mortality meetings, eight of which were regular. In all intensive care units, meetings were attended by consultants and trainees. In 14 intensive care units, meetings were attended by nurses, seven by allied health professionals, 1 by a manager and 11 by other professionals. All mortality cases in intensive care unit were discussed in 19 intensive care units, in the other two intensive care units, 10–20% of mortality cases were discussed. Conclusion There is a wide variation in the processes of reviewing mortality cases and significant events in intensive care units across Scotland, and in the way morbidity and mortality meetings are organised and held. Based on this survey, there is scope for improving the consistency of approach to morbidity and mortality case reviews and meetings in order to improve education and facilitate shared learning.

Prognosis of Severe Nosocomial Sepsis in 33 Older Adults Not Eligible for Intensive Care Units

2012 ◽  
Vol 60 (1) ◽  
pp. 179-180
Author(s):  
Jérôme Bédoucha ◽  
Véronique Mangin d'Ouince ◽  
Farouk Mahious ◽  
Anne-Marie Hallet-Lezy ◽  
Dragoslav Miric
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nosocomial Sepsis

Abstract 285: Resuscitation Practices of Cardiac Arrest in Children with Cardiac Disease in Cardiac Intensive Care Units Compared to Pediatric Intensive Care Units

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Tanya Perry ◽  
Tia T Raymond ◽  
Joanna Fishbein ◽  
Michael G Gaies ◽  
Todd Sweberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Univariate Analysis ◽  
Pediatric Intensive Care ◽  
Heart Association ◽  
Pediatric Intensive Care Units ◽  
Achievement Measures ◽  
Cardiac Intensive Care

Introduction: Hospitalized children with critical cardiac disease experience cardiac arrest more than any other disease type. Varying models are devoted to caring for this population, including pediatric intensive care units (PICU) and dedicated cardiac intensive care units (CICU). The process of CPR delivery has not been evaluated in CICUs in comparison to PICUs. Hypothesis: There will be no difference in cardiac arrest resuscitation practices between unit types. Methods: We analyzed patients <18 years from the American Heart Association Get with the Guidelines-Resuscitation database (GWTG-R) with an illness category of medical or surgical cardiac disease who received CPR in a CICU or PICU from 2014 to 2018. Events were assessed for compliance with GWTG-R achievement measures of time to first chest compressions ≤ 1 minute, time to IV/IO epinephrine ≤ 5 minutes, time to first shock ≤ 2 minutes for VF/pulseless VT first documented rhythm, and confirmation of endotracheal tube (ETT) placement in trachea. Results: CPR practices were evaluated on 866 patients, 687 CICU and 179 PICU (55% male and 65% neonatal). Surgical cardiac disease was present in 56%. Cardiac malformations were present in 81% (45% cyanotic 29% acyanotic). Pulseless arrest was the initial event in 41% with a shockable rhythm in 14%. Return of spontaneous circulation occurred in 86% and survival to hospital discharge in 58%. Univariate analysis comparing resuscitation practice is shown in Table 1. ECPR use was the only variable noted to be significantly different between units (CICU 22% vs PICU 6%, P<0.01). On multivariate analysis, there were no differences in GWTG-R achievement measures between ICU types for ETT placement confirmation, time to IV/IO epinephrine dose, time to first chest compression to first shock (P>0.05). Conclusion: Despite differences in infrastructure, process, and provider expertise, there were no differences in cardiac arrest resuscitation practice between CICUs and PICUs.

Epidemiology and Patterns of Care in Modern Cardiac Intensive Care Units

2021 ◽  
pp. 1-18
Author(s):  
Gianni Casella ◽  
Laura Sofia Cardelli ◽  
Rodolfo Francesco Massafra
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Patterns Of Care ◽  
Cardiac Intensive Care

scholarly journals Epidemiology of Shock in Contemporary Cardiac Intensive Care Units

2019 ◽  
Vol 12 (3) ◽  
Author(s):  
David D. Berg ◽  
Erin A. Bohula ◽  
Sean van Diepen ◽  
Jason N. Katz ◽  
Carlos L. Alviar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Cardiac Intensive Care

scholarly journals Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

2019 ◽  
Vol 53 ◽  
Author(s):  
Renata Eloah de Lucena Ferretti-Rebustini ◽  
Nilmar da Silva Bispo ◽  
Winnie da Silva Alves ◽  
Thiago Negreiro Dias ◽  
Cristiane Moretto Santoro ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Group Method ◽  
Predictive Capacity ◽  
Organic Dysfunction ◽  
Intensity Of Care ◽  
Correlation Tests ◽  
The City

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults.

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