Effect of coenzyme Q10 supplementation on oxidative stress and clinical outcomes in patients with low levels of coenzyme Q10 admitted to the intensive care unit

Abstract Today, trauma is known to be the third leading cause of death in most countries. Studies have demonstrated below-normal plasma levels of antioxidants in trauma patients. The present study aimed to assess the efficacy of Coenzyme Q10 (CoQ10) on oxidative stress, clinical outcomes and anthropometrical parameters in traumatic mechanical ventilated patients admitted to the intensive care unit. Patients were randomised to receive sublingual CoQ10 (400 mg/d) or placebo for 7 d. Primary and secondary outcomes were measured at the baseline and end of the study. We enrolled forty patients for this trial: twenty in the CoQ10 group and twenty in the placebo group. There was not any significant difference in the baseline variables (P > 0⋅05). At the end of the study, CoQ10 administration caused a considerable reduction in the Malondialdehyde (MDA) and Interleukin 6 (IL-6) concentrations (P < 0⋅001), Glasgow Coma Score (GCS; P = 0⋅02), ICU and hospital length of stay and mechanical ventilation (MV) duration (P < 0⋅001). We found that CoQ10 administration could increase Fat-Free Mass (P < 0⋅001) (FFM; P = 0⋅04), Skeletal Muscle Mass (SMM; P = 0⋅04) and Body Cell Mass (BCM) percent (P = 0⋅03). There was not any significant difference in other factors between the two groups (P > 0⋅05). CoQ10 administration has beneficial effects on patients with traumatic injury and has no side effects. However, since the possibility of the type II error was high, the outcomes on the duration of MV, ICU stay and hospital stay, and GCS may very well be false positives.

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Among Trauma Patients, Younger Men with Ventilator-Associated Pneumonia Have Worse Outcomes Compared to Older Men—An Exploratory Study

Healthcare ◽

10.3390/healthcare7020067 ◽

2019 ◽

Vol 7 (2) ◽

pp. 67

Author(s):

Duraid Younan ◽

Sarah Delozier ◽

Nathaniel McQuay ◽

John Adamski ◽

Aisha Violette ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Older Men ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Icu Stay ◽

Younger Men

Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Methods: We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival. Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, (p < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days (p = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, p = 0.09). Conclusions: Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database.

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‘Normal’ Vital Signs Belie Occult Hypoperfusion in Geriatric Trauma Patients

The American Surgeon ◽

10.1177/000313481007600113 ◽

2010 ◽

Vol 76 (1) ◽

pp. 65-69 ◽

Cited By ~ 22

Author(s):

Jeremiah T. Martin ◽

Fuad Alkhoury ◽

Judith A. O'Connor ◽

Tassos C. Kyriakides ◽

John A. Bonadies

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Unit Length ◽

Vital Signs ◽

Intensive Care Unit Length ◽

Hospital Length Of Stay ◽

Common Finding ◽

Trauma Patients ◽

Severity Scores

Base deficit (BD) and lactic acid (LA) are accepted markers of hypoperfusion and predictors of outcome in the trauma patient and we aim to assess the value of these markers in the triage of the elderly with “normal” vital signs. Patients older than age 65 who presented between 1997 and 2004 but who did not have isolated head injuries were included. Three patient groups were established: normal, occult hypoperfusion (OH), and shock. Outcome measures included mortality, hospital length of stay, intensive care unit length of stay, and discharge disposition. One hundred six patients were included in the analysis and had similar Injury Severity Scores. Mean systolic blood pressure was similar in the normal and OH groups. Forty-two per cent of patients had abnormal BD or LA in the emergency room indicating OH. These patients were more likely to have a longer intensive care unit length of stay (8.6 days vs 3 days; P = 0.01) and were also more likely to be discharged to a nursing facility ( P = 0.03). The trend was toward increased mortality in the OH group. OH is a common finding in elderly trauma patients. Outcomes in these patients are different and more like those presenting in shock.

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The effect of sex hormone on COVID-19: analysis of laboratory-confirmed 5061 patients in South Korea

10.21203/rs.3.rs-33353/v1 ◽

2020 ◽

Author(s):

Jae Hoon Lee ◽

Yong Chan Kim ◽

Si Hyun Cho ◽

Jinae Lee ◽

Seng Chan You ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

South Korea ◽

Clinical Outcomes ◽

Sex Hormone ◽

Significant Difference ◽

Matched Case ◽

Independent Risk Factors ◽

Cox Analysis ◽

To Receive

Abstract Limited data describing the effect of sex hormone on coronavirus disease (COVID-19) is available. We evaluated the effect of sex hormone on prevalence and clinical outcomes of COVID-19. Retrospective cohort study was performed using the nationwide claims data of 5061 adult patients with laboratory-confirmed COVID-19 in South Korea, from January 20 to April 8, 2020. COVID-19 was most prevalent in women of the 20-39 age group (1250 [44.14%]). Men were more likely to receive oxygen therapy (144 [6.46%] vs 131 [4.63%], P=0.004), be admitted to the intensive care unit (60 [2.69%] vs 53 [1.87%], P=0.049), and stay longer after admission to the intensive care unit (19.70±11.80 vs 14.75±9.23, P=0.016). However, there was no significant difference in mortality rates between men and women. In multivariable Cox analysis, independent risk factors for mortality were older age and underlying co-morbidities, rather than sex. To evaluate the effect of HRT among women, subgroup analysis was implemented using age-matched case-control data with a 1:3 ratio of females receiving HRT to those who did not. HRT did not have statistically significant association with clinical outcomes. This study suggests that sex hormone may not affect prevalence and clinical outcome of COVID-19 in South Korea.

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Performance of Prognostic Scoring Systems in Trauma Patients in the Intensive Care Unit of a Trauma Center

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197226 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7226

Author(s):

Shao-Chun Wu ◽

Sheng-En Chou ◽

Hang-Tsung Liu ◽

Ting-Min Hsieh ◽

Wei-Ti Su ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Organ Dysfunction ◽

Scoring Systems ◽

Predictive Performance ◽

Apache Ii ◽

Trauma Patients ◽

Saps Ii ◽

Significant Difference ◽

Prognostic Scoring Systems

Background: Prediction of mortality outcomes in trauma patients in the intensive care unit (ICU) is important for patient care and quality improvement. We aimed to measure the performance of 11 prognostic scoring systems for predicting mortality outcomes in trauma patients in the ICU. Methods: Prospectively registered data in the Trauma Registry System from 1 January 2016 to 31 December 2018 were used to extract scores from prognostic scoring systems for 1554 trauma patients in the ICU. The following systems were used: the Trauma and Injury Severity Score (TRISS); the Acute Physiology and Chronic Health Evaluation (APACHE II); the Simplified Acute Physiology Score (SAPS II); mortality prediction models (MPM II) at admission, 24, 48, and 72 h; the Multiple Organ Dysfunction Score (MODS); the Sequential Organ Failure Assessment (SOFA); the Logistic Organ Dysfunction Score (LODS); and the Three Days Recalibrated ICU Outcome Score (TRIOS). Predictive performance was determined according to the area under the receiver operator characteristic curve (AUC). Results: MPM II at 24 h had the highest AUC (0.9213), followed by MPM II at 48 h (AUC: 0.9105). MPM II at 24, 48, and 72 h (0.8956) had a significantly higher AUC than the TRISS (AUC: 0.8814), APACHE II (AUC: 0.8923), SAPS II (AUC: 0.9044), MPM II at admission (AUC: 0.9063), MODS (AUC: 0.8179), SOFA (AUC: 0.7073), LODS (AUC: 0.9013), and TRIOS (AUC: 0.8701). There was no significant difference in the predictive performance of MPM II at 24 and 48 h (p = 0.37) or at 72 h (p = 0.10). Conclusions: We compared 11 prognostic scoring systems and demonstrated that MPM II at 24 h had the best predictive performance for 1554 trauma patients in the ICU.

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Impact of early home psychotropic medication reinitiation on surrogate measures of intensive care unit delirium

Mental Health Clinician ◽

10.9740/mhc.2019.07.263 ◽

2019 ◽

Vol 9 (4) ◽

pp. 263-268 ◽

Cited By ~ 1

Author(s):

Matthew Li ◽

Mei H. Chang ◽

Yeismel Miranda-Valdes ◽

Kirsten Vest ◽

Troy D. Kish

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Retrospective Chart Review ◽

Hospital Length ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Icu Length Of Stay ◽

Significant Difference ◽

Icu Delirium

Abstract Introduction Intensive care unit (ICU) delirium is a major contributing factor to increased mortality, length of stay, and cost of care. Psychotropic medications may often require extensive tapering to prevent withdrawal symptoms; during ICU admission, home psychotropics are frequently held which may precipitate acute drug withdrawal and subsequent delirium. Methods This is a single-center, observational, retrospective chart review. The primary endpoint was the total number of new-start antipsychotics used to treat ICU delirium. Secondary endpoints included use of restraints, ICU length of stay, and hospital length of stay. Results A total of 2334 charts were reviewed for inclusion; 55 patients were categorized into each group. There was no statistically significant difference in the requirement for new-start antipsychotics (P = 1.0), restraint use (P = .057), or ICU length of stay (P = .71). There was a statistically significant decrease in hospital length of stay (P = .048). Discussion Early reinitiation was associated with a decrease in hospital length of stay but was not associated with a decrease in the number of new-start antipsychotics, use of restraints, or ICU length of stay.

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Acute Adrenal Insufficiency May Affect Outcome in the Trauma Patient

The American Surgeon ◽

10.1177/000313480907500404 ◽

2009 ◽

Vol 75 (4) ◽

pp. 287-290 ◽

Cited By ~ 5

Author(s):

Oscar D. Guillamondegui ◽

Oliver L. Gunter ◽

Shivani Patel ◽

Sloan Fleming ◽

Bryan A. Cotton ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Patient ◽

Adrenal Insufficiency ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Acute Adrenal Insufficiency ◽

Stimulation Tests ◽

Cortisol Levels ◽

The Impact

Acute adrenal insufficiency in the trauma patient is underrecognized and the impact poorly understood. Our hypothesis was that the identification and treatment of acute adrenal insufficiency reduces mortality in trauma patients. Institutional Review Board approval for the retrospective review of a prospective database from a Level 1 trauma center for 2002 to 2004 was obtained. The study population included patients receiving a cosyntropin stimulation test (250 μg) and/or random Cortisol level based on our practice management guideline and an intensive care unit stay longer than 24 hours. Demographic, acuity, and outcome data were collected. The nonresponders had baseline Cortisol levels less than 20 μg/dL or poststimulation rise less than 9 μg/dL. Independent t tests and χ2 statistics were used. One hundred thirty-seven patients had cosyntropin stimulation tests performed. Eighty-two (60%) patients were nonresponders of which 66 were treated with hydrocortisone and 16 went untreated as a result of the discretion of the attending physician. The 55 (40%) responders showed no statistical differences in outcome variables whether or not they received hydrocortisone. The untreated adrenal-insufficient patients had significantly higher mortality, longer hospital length of stay, intensive care unit days, and ventilator-free days. Conclusions were: 1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and 2) acute adrenal insufficiency recognized by low random Cortisol levels or nonresponse to a stimulation tests should be considered for treatment.

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Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical-trauma ICU: a prospective, two-period cross-over, interventional study

10.21203/rs.2.15320/v1 ◽

2019 ◽

Author(s):

Rispah Chomba ◽

Maeyane Steve Moeng ◽

Warren Lowman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Antibiotic Treatment ◽

Intervention Group ◽

Control Group ◽

Surgical Trauma ◽

Trauma Patients ◽

Significant Difference ◽

Antibiotic Duration

Abstract Background: Biomarkers like procalcitonin (PCT) are an important antimicrobial stewardship tool for critically ill patients. The purpose of our study was to compare a procalcitonin guided antibiotic algorithm to standard antibiotic treatment in surgical trauma patients admitted to the intensive care unit (ICU).Methods: A prospective, two period cross-over study was conducted in a surgical trauma intensive care unit in South Africa. In the first period, 40 patients were recruited into the control group and antibiotics were discontinued as per standard of care. In the second period, 40 patients were recruited into the procalcitonin group and antibiotics were discontinued if the PCT decreased by ≥ 80% from the peak PCT level, or to an absolute value of less than 0.5 µg/L. Antibiotic duration of treatment was the primary outcome. Patients were followed up for 28 days from the first sepsis event.Results: For the first sepsis event the PCT group had a mean antibiotic duration of 9.3 days while the control group had a mean duration of 10.9 days (p=0.10). Patients in the intervention group had more antibiotic free days alive (mean 7.7±6.57 days) compared to the control group ﴾mean 3.8±5.22 days, (p=0.004﴿. The length of ICU stay and length of hospital stay for the two groups were similar. The in-hospital mortality was reduced in the intervention group (15%) compared to the control group (30%).Conclusion: There was no significant difference in duration of antibiotic treatment between the two groups. However, the PCT group had more antibiotic free days alive and lower in-hospital mortality compared to the control group.Trial registration: Pan African clinical trial registry, PACTR201909715467725, date of registration: 20.9.2019; retrospectively registered, https://pactr.samrc.ac.za/Search.aspx

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Clinical course and outcomes of critically ill COVID-19 patients in two successive pandemic waves

10.1101/2021.02.26.21251848 ◽

2021 ◽

Author(s):

Athanasios Chalkias ◽

Ioannis Pantazopoulos ◽

Nikolaos Papagiannakis ◽

Anargyros Skoulakis ◽

Eleni Laou ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Course ◽

Sinus Bradycardia ◽

Hospital Length Of Stay ◽

Significant Difference ◽

Second Wave

AbstractRationaleThe progress of COVID-19 from moderate to severe may be precipitous, while the heterogenous characteristics of the disease pose challenges to the management of these patients.ObjectivesTo characterize the clinical course and outcomes of critically ill patients with COVID-19 during two successive waves.MethodsWe leveraged the multi-center SuPAR in Adult Patients With COVID-19 (SPARCOL) study and collected data from consecutive patients requiring admission to the intensive care unit from April 1st to December 31st, 2020.Measurements and Main ResultsOf 252 patients, 81 (32%) required intubation and mechanical ventilation. Of them, 17 (20.9%) were intubated during the first wave, while 64 (79%) during the second wave. The most prominent difference between the two waves was the overall survival (first wave 58.9% vs. second wave 15.6%, adjusted p-value=0.006). This difference is reflected in the prolonged hospitalization during the first wave. The mean ICU length of stay (19.1 vs. 11.7 days, p=0.022), hospital length of stay (28.5 vs. 17.1 days, p=0.012), and days on ventilator (16.7 vs. 11.5, p=0.13) were higher during the first wave. A significant difference between the two waves was the development of bradycardia. In the first wave, 2 (11.7%) patients developed sinus bradycardia only after admission to the intensive care unit, while in the second wave, 63 (98.4%) patients developed sinus bradycardia during hospitalization.ConclusionsSurvival of critically ill patients with COVID-19 was significantly lower during the second wave. The majority of these patients developed sinus bradycardia during hospitalization.

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TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT: FIRST EXPERIENCE WITH A NEW TAVI SYSTEM

Wiadomości Lekarskie ◽

10.36740/wlek202104108 ◽

2021 ◽

Vol 74 (4) ◽

pp. 856-863

Author(s):

Glib I. Yemets ◽

Oleksandra V. Telehuzova ◽

Andrii V. Maksymenko ◽

Georgiy B. Mankovsky ◽

Yevhen Y. Marushko ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Unit Length ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Early Results ◽

Significant Difference

The aim: to reveal early results after transapical TAVI with a new self-manufactured XPand system, comparing them with SAVR and common transfemoral TAVI outcomes. Materials and methods: Eighty-four patients (mean age 79,5±10,2 years) with severe aortic stenosis were operated on from January 2016 to February 2019. Nine patients had undergone the TAVI (two with transfemoral access route and seven with transapical, using the XPand system). SAVR was performed in seventy five patients. For the latter, we estimate the in-hospital mortality, complication rates, intensive care unit and total hospital length of stay. Results: There was no intraoperative mortality. In the TAVI group, the frequency of intraoperative and postoperative complications was significantly lower (p<0.01). The SAVR group showed higher median intensive care unit length of stay (104 h, IQR 72 –112 versus 29 h, IQR 20–35,p<0.01), hemodynamic support duration (100,98 ± 78 minutes versus 11.13 ± 7.89 minutes, p<0.01) and paravalvular leakage causality (9,33% versus 0%). No significant difference in results depending on the TAVI access routes was obtained. Conclusions: We conclude that TAVI provides an alternative to the conventional approach in patients with severe aortic stenosis aged over 75 years. No significant difference in mortality rate between TAVI and SAVR groups was found. A novel transapical TAVI device is associated with good short-term results and lower complication rate.

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Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113802 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Farhad Soltani ◽

Seyedkamalaldin Tabatabaei ◽

Farahzad Jannatmakan ◽

Nozar Nasajian ◽

Fereshteh Amiri ◽

...

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Intensive Care ◽

Brain Injury ◽

Assessment Method ◽

Trauma Patients ◽

Moderate Traumatic Brain Injury ◽

Significant Difference ◽

Haloperidol Group

Background: Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined. Objectives: This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU. Methods: Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium. Results: Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05). Conclusions: There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.

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