Treatment with oseltamivir decreases the length of hospital stay in critically ill children with influenza

Introduction: Magnesium deficiency, a common finding in critically ill patients, is associated with increased need for respiratory support, increased duration of ICU stay and mortality. The primary objective of our study is to assess the prevalence of hypomagnesaemia in critically ill children (requiring inotropic support, respiratory support, and fluid resuscitation) on admission in the Paediatric Intensive Care Unit (PICU). The secondary objective is to evaluate its relationship with the length of hospital stay and mortality. Methods: This prospective observational study was conducted in the PICU of a tertiary care hospital. In this study, serum magnesium levels at admission were measured along with other laboratory tests, after informed consent. Serum magnesium levels were assayed in our laboratory. The normal range of serum magnesium in our lab is 1.7-2.7 mg/dl. During admission in PICU, there was follow-up for ionotrope administration, need for mechanical ventilation, APACHE II score, PICU length of stay and mortality. Results: In this study, 350 critically ill children requiring hemodynamic / respiratory support were chosen. However, 83 children were excluded from study as they were discharged against medical advice. The prevalence of hypomagnesemia in this study was 43.4%. There was no significant association between hypomagnesemia, duration of hospital stay and mortality. Conclusion: Hypomagnesaemia is a common finding in critically ill paediatric patients, however there is no significant association noted in regards to length of hospital stay, duration of mechanical ventilation, inotropic support and mortality.

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Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

Current Diabetes Reviews ◽

10.2174/1573399814666180119142254 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-140 ◽

Cited By ~ 1

Author(s):

Ghada El Khoury ◽

Hanine Mansour ◽

Wissam K. Kabbara ◽

Nibal Chamoun ◽

Nadim Atallah ◽

...

Keyword(s):

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Center ◽

Descriptive Analysis ◽

Tertiary Care ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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In-line filtration of intravenous infusion may reduce organ dysfunction of adult critical patients

Critical Care ◽

10.1186/s13054-019-2618-z ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

Elke Schmitt ◽

Patrick Meybohm ◽

Eva Herrmann ◽

Karin Ammersbach ◽

Raphaela Endres ◽

...

Keyword(s):

Hospital Stay ◽

Critically Ill ◽

Organ Dysfunction ◽

Kidney Injury ◽

Adult Patients ◽

Brain Inflammation ◽

Critically Ill Children ◽

Respiratory Dysfunction ◽

Time Period ◽

Fine Filter

Abstract Background The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. So far, only significant improved outcome in critically ill children and new-borns was demonstrated when using in-line filters, but for adult patients, evidence is still missing. Methods This single-centre, retrospective controlled cohort study assessed the effect of in-line filtration of intravenous fluids with finer 0.2 or 1.2 μm vs 5.0 μm filters in critically ill adult patients. From a total of n = 3215 adult patients, n = 3012 patients were selected by propensity score matching (adjusting for sex, age, and surgery group) and assigned to either a fine filter cohort (with 0.2/1.2 μm filters, n = 1506, time period from February 2013 to January 2014) or a control filter cohort (with 5.0 μm filters, n = 1506, time period from April 2014 to March 2015). The cohorts were compared regarding the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay. Results Comparing fine filter vs control filter cohort, respiratory dysfunction (Horowitz index 206 (119–290) vs 191 (104.75–280); P = 0.04), pneumonia (11.4% vs 14.4%; P = 0.02), sepsis (9.6% vs 12.2%; P = 0.03), interleukin-6 (471.5 (258.8–1062.8) ng/l vs 540.5 (284.5–1147.5) ng/l; P = 0.01), and length of ICU (1.2 (0.6–4.9) vs 1.7 (0.8–6.9) days; P < 0.01) and hospital stay (14.0 (9.2–22.2) vs 14.8 (10.0–26.8) days; P = 0.01) were reduced. Rate of severe vasoplegia (21.0% vs 19.6%; P > 0.20) and acute kidney injury (11.8% vs 13.7%; P = 0.11) was not significantly different between the cohorts. Conclusions In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients. Trial registration The study was registered at ClinicalTrials.gov (number: NCT02281604).

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Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

Journal of Intensive Care ◽

10.1186/s40560-020-00487-8 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Priyam Batra ◽

Kapil Dev Soni ◽

Purva Mathur

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Icu Stay ◽

Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

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Impact of Glycemic Variability and Hypoglycemia on the Mortality and Length of Hospital Stay among Elderly Patients in Brazil

Current Diabetes Reviews ◽

10.2174/1573399815999190619141622 ◽

2020 ◽

Vol 16 (2) ◽

pp. 171-180 ◽

Cited By ~ 1

Author(s):

Danielle Bruginski ◽

Dalton Bertolin Précoma ◽

Ary Sabbag ◽

Marcia Olandowski

Keyword(s):

Blood Glucose ◽

Elderly Patients ◽

Hospital Stay ◽

Critically Ill ◽

Glucose Level ◽

Length Of Hospital Stay ◽

Glycemic Variability ◽

Ease Of Use ◽

Hospitalized Elderly ◽

Enteral Diet

Background: Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice. Objective: This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients. Methods: The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses. Results: Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality. Conclusion: Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.

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The effect of short term peripheral parenteral nutrition on treatment outcomes and mortality in critically ill pediatric canine patients

Irish Veterinary Journal ◽

10.1186/s13620-021-00194-2 ◽

2021 ◽

Vol 74 (1) ◽

Author(s):

Cesar Augusto Flores Dueñas ◽

Soila Maribel Gaxiola Camacho ◽

Martin Francisco Montaño Gómez ◽

Rafael Villa Angulo ◽

Idalia Enríquez Verdugo ◽

...

Keyword(s):

Weight Loss ◽

Adverse Effects ◽

Parenteral Nutrition ◽

Hospital Stay ◽

Critically Ill ◽

Energy Requirement ◽

Length Of Hospital Stay ◽

Short Term ◽

Clinical Complications ◽

Significant Difference

Abstract Background Peripheral parenteral nutrition (PPN) is increasingly considered as an alternative to central parenteral nutrition (CPN) given the higher cost and more frequent clinical complications associated with the latter. However, the assessment of potential risks and benefits of PPN in critically ill pediatric canine patients has not been extensively performed. In this study, we aimed to explore the effect of short-term, hypocaloric PPN on weight loss, length of hospital stay, the incidence of complications, adverse effects, and mortality in critically ill pediatric canine patients. Results Between August 2015 and August 2018, a total of 59 critically ill pediatric canine patients aged from 1 to 6 months admitted at the Veterinary Sciences Research Institute of the Autonomous University of Baja California were included in this non-randomized clinical trial. Canine pediatric patients were initially allocated to 3 groups: 11 in group 1 receiving parenteral nutrition (PN) supplementation equivalent to 40% of the resting energy requirement (RER), 12 in group 2 receiving supplementation of 50% of the RER, and 36 in group 3 receiving no PN supplementation. After establishing that there was no significant difference between 40 and 50% of PN supplementation, these groups were not separated for downstream analysis. Similar lengths of hospital stays were noted among study subjects who received PN supplementation and those who did not (4.3 ± 1.5 vs. 5.0 ± 1.5, days, p = 0.097). No metabolic-, sepsis- or phlebitis-related complications were observed in any animal in the PPN supplemented group. Higher mortality (19.4% vs. 0%, p = 0.036), and a greater percentage of weight loss (9.24% vs. 0%, p < 0.001) were observed in patients who received no supplementation. Conclusion Even though short-term, hypocaloric PPN did not reduce the length of hospital stay, it was associated with lower mortality and resulted in mitigation of weight loss. In contrast to previous studies evaluating central and peripheral parenteral nutrition protocols, we observed a lower frequency of metabolic, septic, and phlebitis complications using a 40–50% parenteral nutrition treatment. The parenteral nutrition therapeutic intervention used in our study may reduce PN-related adverse effects and promote a favorable disease outcome in critically ill canine patients. Larger studies will be needed to confirm these observations.

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Influence of nutritional status on clinical outcomes in critically ill children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180536 ◽

2018 ◽

Vol 5 (2) ◽

pp. 462 ◽

Cited By ~ 1

Author(s):

Chaitra K. M. ◽

Bhavya G. ◽

Harish S. ◽

Shruthi Patel ◽

Syeda Kausar Anjum

Keyword(s):

Nutritional Status ◽

Hospital Stay ◽

Critically Ill ◽

Tertiary Care ◽

Metabolic Stress ◽

Normal Weight ◽

Critically Ill Children ◽

Obese Children ◽

Significant Difference ◽

Prolonged Hospital

Background: Critically-ill children have a state of metabolic stress. The nutritional needs of these patients can be increased. Their nutritional status at admission and its possible deterioration during hospitalization can be a predictor of worse outcome. The objective of this study was to study the influence of nutritional status on outcomes like mortality, duration of mechanical ventilation and duration PICU stay and hospital stay, in critically ill children.Methods: This was a prospective comparative study conducted on 60 critically ill children aged 1 month to 18 years admitted to PICU of tertiary care, teaching hospital, Bangalore, Karnataka over a study period of 12 months. Patients were divided into 4 categories based on Body mass index (BMI) as per WHO growth charts into: underweight, normal, overweight and obese and outcomes was analysed.Results: In the present study 60 children were studied. Subjects were classified as underweight (23.33%), normal weight (45%), overweight/obese (31.67%) based on BMI Z-score at admission. The odds of prolonged hospital stay were higher in underweight and overweight/obese children (OR-2.85, p-0.12 and OR-3.92, p-0.03 respectively). Underweight and overweight/ obese children had higher odds for prolonged PICU stay. (OR-6, p-0.02 and OR-2.13, p-0.36 respectively). Underweight children required prolonged ventilator support (OR-2, p-0.03). There was no significant difference among the group.Conclusions: There is a high prevalence of malnourishment in critically ill children compared to general population and they are prone for poor outcome. Malnourished children must be identified at admission and optimal therapies, nutritional strategies aimed at preventing further nutritional deterioration should be made.

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