The Prehospital Sepsis Project: Out-of-Hospital Physiologic Predictors of Sepsis Outcomes

2013 ◽  
Vol 28 (6) ◽  
pp. 632-635 ◽  
Author(s):  
Amado Alejandro Baez ◽  
Priscilla Hanudel ◽  
Susan Renee Wilcox
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Respiratory Rate ◽  
Statistical Significance ◽  
Unit Length ◽  
Hospital Setting ◽  
Hospital Length Of Stay ◽  
Shock Index ◽  
Publication Type

AbstractIntroductionSevere sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis.MethodsThis was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the .05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI).ResultsSixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P = .003) and OR 4.81 (CI, 1.16-21.01; P = .0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P = .39; HR >90: P = .60; RR >20 P = .11; SI >0.7 P = .35).ConclusionsThis study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.BaezAA, HanudelP, WilcoxSR. The prehospital sepsis project: out-of-hospital physiologic predictors of sepsis outcomes. Prehosp Disaster Med. 2013;28(6):1-4.

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

2010 ◽  
Vol 76 (1) ◽  
pp. 65-69 ◽  
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.

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

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.

scholarly journals Predictors and Incidence of Extubation Failure Post Modified Blalock Taussig Shunt in Infants

2021 ◽  
Author(s):  
Mohammed Al Ghafri ◽  
Safa Al Hadhrami ◽  
Hamid Al Badi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Prolonged Mechanical Ventilation ◽  
Unit Length ◽  
Extubation Failure ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Royal Hospital ◽  
Blalock Taussig Shunt

Abstract Objectives: To identify the characteristics of infants with extubation failure post Modified Blalock-Taussig Shunt (MBTS) and to determine the incidence and predictors of extubation failure in this group of infants and to compare it with the international figures.Methods: A single-center retrospective cohort study of infants < 1 year of age who underwent MBTS at the pediatric cardiac intensive care unit at Royal Hospital, Oman, from January 2010 to December 2019. We excluded infants who died before extubation, infants with missing data, and infants who underwent another surgical intervention before extubation. Ethical approval was obtained from the scientific research committee at the Royal Hospital. All categorical variables were presented as numbers and percentages. Analyses were performed using SPSS version 25. Results: A total of 146 infants were included in the study. Extubation failure occurred in 27 (18.5%) patients. Among those who failed extubation, 18 (66.7%) patients were ventilated before the surgery with statistically significant p-value of 0.019. A systolic blood pressure (SBP) ≤ 50th percentile was associated with extubation failure. Infants with extubation failure had longer intensive care unit length of stay and longer hospital length of stay. Severe respiratory distress and hemodynamic instability were the two main reasons for re-intubation.Conclusions: The lower incidence rate (18.5%) for extubation failure might indicate higher quality performance of our institution. Prolonged mechanical ventilation, requirements for escalation of inotropes, and SBP ≤ 50th percentile might be as predictors for extubation failure in infants post MBTS. Extubation failure is associated with longer intensive care unit and hospital admission.

scholarly journals Effect of treatment applied in sepsis on intensive care unit and hospital stay: how effective are albumin/steroid/vasopressor agents?

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Selda Kayaalti ◽  
Ömer Kayaalti
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Unit Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Vasopressor Agents ◽  
Increasing Risk

Abstract Background The incidence and prevalence of sepsis have increased in recent years and it is the most common cause of intensive care admission. The aim of this study was to determine the effects of albumin, steroid, and vasopressor agents and other possible factors on the duration of intensive care unit and hospital stay in sepsis patients. Open access data set obtained from Tohoku Sepsis Registry database was used. Four hundred sixty-two patients admitted to intensive care unit with the diagnosis of sepsis were divided into four groups according to their intensive care unit (≤ 5 or > 5 days) and hospital length of stay (≤ 24 or > 24 days). Demographic data, vital signs, laboratory values, mechanical ventilation requirement, and treatment protocols such as albumin, steroid, and vasopressor agent use were used in the evaluation of the groups. Results The use of albumin (odds ratio [OR] = 3.76 [95% confidence interval (CI), 2.16–6.56]; p < 0.001), steroids (OR = 2.85 [95% CI, 1.67–4.86]; p < 0.001), and vasopressor agents (OR = 3.56 [95% CI, 2.42–5.24]; p < 0.001) were associated with an increasing risk of prolonged intensive care unit length of stay. Also, it was found that the use of albumin (OR = 3.43 [95% CI, 2.00–5.89]; p < 0.001), steroids (OR = 2.81 [95% CI, 1.66–4.78]; p < 0.001), and vasopressor agents (OR = 4.47 [95% CI, 3.02–6.62]; p < 0.001) were associated with an increasing risk of prolonged hospital length of stay. In addition, prognostic scoring systems, body temperature, mean arterial pressure, pH, PaO2/FiO2 ratio, and mechanical ventilation requirement in the first 24 h were also found to be associated with length of stay in intensive care unit and hospital. There was a significant relationship between platelet count, creatinine, Na, lactic acid, and time between diagnosis of sepsis and source control and intensive care unit length of stay, and between hematocrit and C-reactive protein and hospital length of stay. Conclusions The use of albumin, steroid, and vasopressor agents has been found to be significantly correlated with both intensive care unit and hospital length of stay. Further studies are needed to determine in what order or at what dosage these agents will be administered in sepsis treatment.

scholarly journals The Effect of Rapid Initiation Versus Delayed Initiation of Antibiotics in Pediatric Patients With Sepsis

2021 ◽  
Vol 27 (1) ◽  
pp. 45-50
Author(s):  
Mallory C. Cowart ◽  
Travis S. Heath ◽  
Andrakeia Shipman
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Pediatric Patients ◽  
Unit Length ◽  
Group Versus ◽  
Intensive Care Unit Length ◽  
Hospital Length Of Stay

OBJECTIVE The purpose of this study was to determine if administration of antibiotics within 1 hour of meeting sepsis criteria improved patient outcomes versus antibiotics administered greater than 1 hour after meeting sepsis criteria in pediatric patients. The Surviving Sepsis Campaign's international guidelines recommend appropriate antimicrobial therapy be administered within 1 hour of recognition of severe sepsis or septic shock. Data regarding outcomes in pediatric patients with sepsis regarding antibiotic timing are currently limited. METHODS This was a retrospective chart review of 69 pediatric patients admitted between July 1, 2013, and June 30, 2016, with a diagnosis of sepsis. RESULTS The primary outcome of in-hospital mortality was 7.1% in the within 1 hour group versus 14.6% in the greater than 1 hour group (p = 0.3399). Median hospital length of stay was significantly shorter in the within 1 hour group (15.4 versus 39.2 days, p = 0.0022). Median intensive care unit length of stay was also significantly shorter in the within 1 hour group (3.1 versus 33.6 days, p = 0.0191). There were no differences between groups for pediatric intensive care unit admission, end organ dysfunction, time to intubation, or time on the ventilator. CONCLUSIONS Pediatric patients who receive antimicrobial therapy within 1 hour of meeting sepsis criteria had improved hospital and intensive care unit length of stay. This study supports the Surviving Sepsis Guidelines recommendation to administer antibiotics within 1 hour in pediatric patients with sepsis or septic shock.

Analysis of Vasopressor Discontinuation and the Incidence of Rebound Hypotension in Patients With Septic Shock

2019 ◽  
pp. 001857871986764
Author(s):  
Christopher T. Buckley ◽  
Ben Turner ◽  
Dalton Walsh ◽  
Meghan J. Garrett ◽  
Vishal N. Ooka
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Population ◽  
Secondary Outcomes ◽  
Stay Hospital

Purpose: The purpose of this study was to examine the incidence of rebound hypotension in patients with septic shock requiring both norepinephrine and vasopressin infusions once discontinuation of 1 of these agents is warranted. Methods: A multicenter, retrospective study was conducted in 3 hospitals within a single health system between January 1, 2016, and December 31, 2017. The study population included adults, 18 years and older, diagnosed with septic shock and requiring concurrent infusions of norepinephrine and vasopressin. The primary outcome evaluated the incidence of rebound hypotension within 24 hours after the first vasopressor was discontinued. Secondary outcomes included intensive care unit length of stay, hospital length of stay, total vasopressor duration, and the time to rebound hypotension after first vasopressor discontinuation. Results: A total of 69 patients were included in the study, 38 in the vasopressin discontinued first group and 31 in the norepinephrine discontinued first group. Rebound hypotension occurred in 82% of patients in the vasopressin discontinued first group compared with 48% in the norepinephrine discontinued first group ( P = .004). No differences were observed in secondary outcomes, including intensive care unit or hospital length of stay, total vasopressor duration, or the time to rebound hypotension. Conclusions: Discontinuation of norepinephrine before vasopressin may lead to less incidence of rebound hypotension in patients with septic shock who require concurrent norepinephrine and vasopressin infusions. Similar to previous studies, this study found no difference in secondary outcomes.

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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