PP023-SUN LOWER SKELETAL MUSCLE INDEX BY CT SCAN IS A STRONG AND INDEPENDENT OF BMI RISK FACTOR FOR MORTALITY IN MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS

Abstract Background: The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. Objective: To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality.Methods: We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed effects mode. Results: Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 38% (95% CI:36%-39%). Critically ill patients with sarcopenia in intensive care unit have an increased risk of mortality, compared to critically ill patients without sarcopenia (HR=2.22, 95%CI: 1.79-2.75; P<0.001; I2=0.0%). In addition, a subgroup analysis found a significant difference in the association between sarcopenia and mortality when using total psoas muscle area (TPA), skeletal muscle index (SMI), and skeletal muscle area (SMA) to define sarcopenia (HR=2.96,95%CI:1.72-5.11,P<0.001; HR = 2.11,95%CI:1.59-2.80,P<0.01; HR=2.11, 95%CI:1.33-3.33,P=0.001, respectively), whereas the results were not significant when measuring the masseter muscle to define sarcopenia (HR=2.00, 95%CI:0.82-4.90,P=0.129).Conclusion: Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments, offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

Download Full-text

Faculty Opinions recommendation of Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1160807.628059 ◽

2009 ◽

Author(s):

Babak Sarani

Keyword(s):

Randomised Controlled Trial ◽

Occupational Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Mechanically Ventilated ◽

Randomised Controlled

Download Full-text

Faculty Opinions recommendation of Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717965140.793465923 ◽

2012 ◽

Author(s):

Michael O'Connor

Keyword(s):

Randomized Controlled Trial ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Mechanically Ventilated ◽

Randomized Controlled ◽

Sedation Protocol ◽

Daily Sedation Interruption

Download Full-text

Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

Download Full-text

Selection strategy for sedation depth in critically ill patients on mechanical ventilation

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01452-7 ◽

2021 ◽

Vol 21 (S2) ◽

Author(s):

Longxiang Su ◽

Chun Liu ◽

Fengxiang Chang ◽

Bo Tang ◽

Lin Han ◽

...

Keyword(s):

Mechanical Ventilation ◽

Dimensionality Reduction ◽

Critically Ill ◽

Critically Ill Patients ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sedation And Analgesia ◽

Ventilated Patients

Abstract Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

Download Full-text

Serum syndecan-1 reflects organ dysfunction in critically ill patients

Scientific Reports ◽

10.1038/s41598-021-88303-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Keiko Suzuki ◽

Hideshi Okada ◽

Kazuyuki Sumi ◽

Hiroyuki Tomita ◽

Ryo Kobayashi ◽

...

Keyword(s):

Risk Factor ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Repeated Measures ◽

Significant Risk ◽

Mixed Effects ◽

Mixed Effects Models ◽

Endothelial Glycocalyx ◽

Outcome Variable

AbstractSyndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. We investigated organ dysfunction associated with changing serum SDC-1 levels for early detection of organ dysfunction in critically ill patients. To evaluate the effect of SDC-1 on laboratory parameters measured the day after SDC-1 measurement with consideration for repeated measures, linear mixed effects models were constructed with each parameter as an outcome variable. A total of 94 patients were enrolled, and 831 samples were obtained. Analysis using mixed effects models for repeated measures with adjustment for age and sex showed that serum SDC-1 levels measured the day before significantly affected several outcomes, including aspartate aminotransferase (AST), alanine transaminase (ALT), creatinine (CRE), blood urea nitrogen (BUN), antithrombin III, fibrin degradation products, and D-dimer. Moreover, serum SDC-1 levels of the prior day significantly modified the effect between time and several outcomes, including AST, ALT, CRE, and BUN. Additionally, increasing serum SDC-1 level was a significant risk factor for mortality. Serum SDC-1 may be a useful biomarker for daily monitoring to detect early signs of kidney, liver and coagulation system dysfunction, and may be an important risk factor for mortality in critically ill patients.

Download Full-text