scholarly journals Clinical characteristics and factors associated with in hospital mortality of convulsive status epilepticus in adult patients admitted to neurointensive care unit

2014 ◽  
Vol 01 (01) ◽  
pp. 016-020
Author(s):  
Sudhindra Vooturi ◽  
Sita Jayalakshmi ◽  
Sambit Sahu ◽  
Surath Mohandas
Keyword(s):  
Mechanical Ventilation ◽  
Status Epilepticus ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Adult Patients ◽  
Neurointensive Care ◽  
Categorical Variables ◽  
Neurointensive Care Unit ◽  
Factors Associated ◽  
Risk Of Mortality

Abstract Background Status epilepticus (SE) is a common neurological emergency; convulsive SE has a distribution with peaks in children and elderly than adult population. Aim To determine the clinical characteristics and factors associated with in hospital mortality in adult patients admitted to the neurointensive care unit (NICU). Methods A retrospective analysis of the clinical characteristics and outcome of adult patients (aged 18 years and above, below 60 years) with CSE admitted into the NICU was performed. The outcome was classified as alive or death in NICU. The differences between the alive and dead patients for data collected were analyzed using t tests and chi-square test for continuous and categorical variables respectively. Spearman correlations were used to analyze association between the variables, where r > 0.3 and p < 0.05 were considered significant. Results A total of 105 adult patients formed the inclusion criteria and were included for data analysis. Forty two out of the 105 patients were women. Sixty one (58%) of the 105 patients had acute symptomatic etiology while 17.1% patients were known epileptics; acute symptomatic etiology increased risk of mortality 5.28 times (95% confidence interval (CI): 1.44–19.35) (p = <0.01). Thirty eight (36.1%) patients progressed to refractory SE. The mortality in the entire cohort was 19%. Complications of prolonged mechanical ventilation and refractory status epilepticus showed strong and significant association with mortality (r > 0.300; p < 0.0001). Mortality was significantly higher in patients with acute symptomatic etiology and than other etiologies (85.0% vs 54.1%; p = 0.011). Conclusion Acute symptomatic etiology was the most common cause of SE in adults. While requirement for mechanical ventilation and refractory SE were the major factors associated with mortality, acute symptomatic etiology increased the risk of mortality in adult patients with SE.

Risk Factors for the Development of Nosocomial Pneumonia and Its Clinical Impact in Cardiac Surgery

2021 ◽  
Author(s):  
Ferdinand Jr Rivera Gerod ◽  
Edgar Ongjoco ◽  
Rod Castro ◽  
Armin Masbang ◽  
Elmer Casley Repotente ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Nosocomial Pneumonia ◽  
Clinical Impact ◽  
Adult Patients ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Prolonged Icu Stay

Abstract BackgroundThe development of nosocomial pneumonia after cardiac surgery is a significant post-operative complication that may lead to increased morbidity, mortality, and hospital cost. We aimed to identify risk factors associated with it and to determine its clinical impact in terms of in-hospital mortality and morbidity.MethodsThis is a retrospective cohort study conducted among all adult patients who underwent cardiac surgery from 2014-2019 in St. Luke’s Medical Center, Quezon City, Philippines. Baseline characteristics and possible risk factors for pneumonia were retrieved from medical records. Nosocomial pneumonia was based on the Centers for Disease Control and Prevention criteria. Clinical outcomes include in-hospital mortality and morbidity. Odds ratios from logistic regression was computed to determine risk factors associated with pneumonia using STATA 15.0.ResultsOut of 373 patients included in this study, 104 (28%) patients acquired pneumonia. Most surgeries were coronary artery bypass graft (CABG) (71.58%), followed by valve repair/replacement (29.76%). Neither age, sex, BMI, diabetes, LV dysfunction, renal dysfunction, COPD/asthma, urgency of surgery, surgical time, nor smoking showed association in the development of pneumonia. However, preoperative stay of >2 days was associated with 92.3% (95%CI 18–213%) increased odds of having pneumonia (p=.009). Also, every additional hour on mechanical ventilation conferred 0.8% (95%CI, 0.3–1%) greater odds of acquiring pneumonia (p=.003).Patients who developed pneumonia had 3.9 times odds of mortality (95%CI 1.51–9.89, p=.005), 3.8 times odds of prolonged hospitalization (95%CI 1.81–7.90,p<.001), 6.4 times odds of prolonged ICU stay (95%CI 3.59–11.35,p<.001), and 9.5 times odds of postoperative reintubation (95%CI 3.01–29.76,p<.001). ConclusionAmong adult patients undergoing cardiac surgeries, prolonged preoperative hospital stay and prolonged mechanical ventilation were both associated with an increased risk for nosocomial pneumonia. Those who developed pneumonia had worse outcomes with significantly increased in-hospital mortality, prolonged hospitalization, prolonged ICU stay, and increased postoperative re-intubation. Clinicians should therefore minimize delays in surgery to avoid unnecessary exposure to pathogenic organisms. Also, timely liberation from mechanical ventilation after surgery should be encouraged.

scholarly journals Status Epilepticus among Older Adults in the United States

Geriatrics ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 45 ◽  
Author(s):  
Priya Mendiratta ◽  
Neeraj Dayama ◽  
Jeanne Y Wei ◽  
Pallavi Prodhan ◽  
Parthak Prodhan
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Ischemic Stroke ◽  
Status Epilepticus ◽  
Age Group ◽  
Brain Hemorrhage ◽  
Factors Associated ◽  
Hospitalized Elderly ◽  
Risk Of Mortality ◽  
Overall Mortality

Objective: This study aimed to identify temporal time trends and risk factors associated with mortality for hospitalized older adults with status epilepticus (SE). Design: A retrospective study was performed. Setting: Hospitalized patients were identified utilizing an administrative database—The Nationwide Inpatient Sample database from 1998 through September 2015. Patients: Patients were older adults 65 years and older with SE. Interventions: No interventions were undertaken. Measurements and Main Results: Demographic, temporal trends, clinical characteristics, and outcome data were abstracted. The results indicated that hospitalized elderly Americans with SE increased over the 11-year study period. Univariate and multivariate analyses were performed to evaluate risk factors associated with mortality in the study cohort. From the weighted sample, 130,109 subjects were included. Overall mortality was 19%. For age subgroups, the mortality was highest for the >85 years age group (24.1%) compared to the 65–75 years (19%) and 75–85 years (23%) age groups. Among investigated etiologies, the three most common causes of SE were acute ischemic stroke (11.2% of total) followed by non-traumatic brain hemorrhage (5.4%) and malignant brain lesions (4.9%). The highest mortality by etiology was noted for acute traumatic brain injury (TBI) (31.5%), non-traumatic brain hemorrhage (31%), and acute ischemic stroke (AIS) (30.1%). Multivariate analysis indicated that non-survivors when compared to survivors were more like to have the following characteristics: older age group, acute TBI, brain neoplasms, non-traumatic brain hemorrhage, AIS and central nervous system (CNS) infections, and utilization of mechanical ventilation. Associated conditions significantly increasing risk of mortality were sodium imbalance, cardiac arrest, anoxic brain injury, pneumonia, and sepsis. Comorbidities associated with increased risk of mortality included valvular heart disease, renal failure, liver disease, and neoplasms. Conclusions: The number of hospitalized elderly Americans with SE increased over the 11-year study period. Overall mortality was 19%, with even higher mortality among various patient subsets. Several demographic and co-morbid factors are associated with increased mortality in this age group.

Outcome of Acute Hypoxaemic Respiratory Failure. Insights from the Lung Safe Study

2020 ◽  
pp. 2003317
Author(s):  
Tài Pham ◽  
Antonio Pesenti ◽  
Giacomo Bellani ◽  
Gordon Rubenfeld ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Pulmonary Involvement ◽  
Positive End Expiratory Pressure ◽  
Factors Associated ◽  
Risk Of Death ◽  
Increased Risk ◽  
Current Incidence

BackgroundThe current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in intensive care unit are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS).MethodsAn international, multicentre, prospective cohort study of patients presenting with hypoxemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with PaO2/FiO2 ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure (PEEP) of at least 5 cm H2O. ICU prevalence, causes of hypoxemia, hospital survival, factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared.Findings12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (8.2%, CHF). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1%versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality but similar adjusted mortality than ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only 2 quadrants involved.InterpretationMore than one third of the patients receiving mechanical ventilation have hypoxaemia and new infiltrates with an hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.

scholarly journals Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

2018 ◽  
Vol 44 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Laura Fuchs Bahlis ◽  
Luciano Passamani Diogo ◽  
Ricardo de Souza Kuchenbecker ◽  
Sandra Costa Fuchs
Keyword(s):  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Public Hospital ◽  
Community Acquired Pneumonia ◽  
Factors Associated ◽  
Icu Admission ◽  
Patient Profile

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.

scholarly journals Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission

2014 ◽  
Vol 40 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Denise Rossato Silva ◽  
Larissa Pozzebon da Silva ◽  
Paulo de Tarso Roth Dalcin
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Admission Rate ◽  
Hospitalized Patients ◽  
Tuberculosis Treatment ◽  
Medical Attention ◽  
Considerable Proportion ◽  
Sputum Smear ◽  
Icu Admission

Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment.

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