Respiratory viral infections in pragmatically selected adults in intensive care units

AbstractRespiratory viruses can be detected in 18.3 to 48.9% of critically ill adults with severe respiratory tract infections (RTIs). The present study aims to assess the clinical significance of respiratory viruses in pragmatically selected adults in medical intensive care unit patients and to identify factors associated with viral respiratory viral tract infections (VRTIs). We conducted a prospective study on critically ill adults with suspected RTIs without recognized respiratory pathogens. Viral cultures with monoclonal antibody identification, in-house real-time polymerase chain reaction (PCR) for influenza virus, and FilmArray respiratory panel were used to detect viral pathogens. Multivariable logistic regression was applied to identify factors associated with VRTIs. Sixty-four (40.5%) of the included 158 critically ill adults had respiratory viruses detected in their respiratory specimens. The commonly detected viruses included influenza virus (20), followed by human rhinovirus/enterovirus (11), respiratory syncitial virus (9), human metapneumovirus (9), human parainfluenza viruses (8), human adenovirus (7), and human coronaviruses (2). The FilmArray respiratory panel detected respiratory viruses in 54 (34.6%) patients, but showed negative results for seven of 13 patients with influenza A/H3 infection. In the multivariable logistic regression model, patient characters associated with VRTIs included those aged < 65 years, household contact with individuals with upper RTI, the presence of fever, cough with sputum production, and sore throat. Respiratory viruses were not uncommonly detected in the pragmatically selected adults with critical illness. The application of multiplex PCR testing for respiratory viruses in selected patient population is a practical strategy, and the viral detection rate could be further improved by the patient characters recognized in this study.

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Respiratory Viral Infections in Pragmatically Selected Adults in Intensive Care Units: A Prospective Cohort Study

10.21203/rs.3.rs-599214/v1 ◽

2021 ◽

Author(s):

Cong-Tat Cia ◽

I-Ting Ling ◽

Jen-Chieh Lee ◽

Huey-Pin Tsai ◽

Jen-Ren Wang ◽

...

Keyword(s):

Logistic Regression ◽

Influenza Virus ◽

Intensive Care ◽

Critically Ill ◽

Respiratory Viruses ◽

Factors Associated ◽

Multivariable Logistic Regression ◽

Critically Ill Adults ◽

Tract Infections ◽

Ill Adults

Abstract BackgroundRespiratory viruses can be detected in 18.3% to 48.9% of critically ill adults with severe respiratory tract infections (RTIs). The present study aims to assess the clinical significance of respiratory viruses in pragmatically selected adults in medical intensive care unit patients and to identify factors associated with viral respiratory viral tract infections (VRTIs).MethodsWe conducted a prospective study on critically ill adults with suspected RTIs without recognized respiratory pathogens. Viral cultures with monoclonal antibody identification, in-house real-time polymerase chain reaction (PCR) for influenza virus, and FilmArray® respiratory panel were used to detect viral pathogens. Multivariable logistic regression was applied to identify factors associated with VRTIs.ResultsSixty-four (40.5%) of the included 158 critically ill adults had respiratory viruses detected in their respiratory specimens. The commonly detected viruses included influenza virus (20), followed by human rhinovirus/enterovirus (11), respiratory syncitial virus (9), human metapneumovirus (9), human parainfluenza viruses (8), human adenovirus (7), and human coronaviruses (2). The FilmArray® respiratory panel detected respiratory viruses in 54 (34.6%) patients, but showed negative results for seven of 13 patients with influenza A/H3 infection. In the multivariable logistic regression model, patient characters associated with VRTIs included those aged < 65 years, household contact with individuals with upper RTI, the presence of fever, cough with sputum production, and sore throat.ConclusionsRespiratory viruses were not uncommonly detected in the pragmatically selected adults with critical illness. Selective multiplex PCR testing for respiratory viruses is a practical strategy, and the detection rate could be further improved in selected patient population.

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A systematic review on the role of extremity skin temperature as a non-invasive marker for hypoperfusion in critically ill adults in the intensive care setting

JBI Library of Systematic Reviews ◽

10.11124/jbisrir-2010-685 ◽

2010 ◽

Vol 8 (Supplement) ◽

pp. 1-26

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Skin Temperature ◽

Critically Ill ◽

Care Setting ◽

Intensive Care Setting ◽

Non Invasive ◽

Critically Ill Adults ◽

Ill Adults

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Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320962 ◽

2021 ◽

pp. archdischild-2020-320962

Author(s):

Ruchi Sinha ◽

Angela Aramburo ◽

Akash Deep ◽

Emma-Jane Bould ◽

Hannah L Buckley ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Clinical Care ◽

Adult Patients ◽

Paediatric Intensive Care ◽

Critically Ill Adults ◽

Care Capacity ◽

Ill Adults ◽

Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

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Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

Annals of Pharmacotherapy ◽

10.1177/10600280211048494 ◽

2021 ◽

pp. 106002802110484

Author(s):

Patricia R. Louzon ◽

Mojdeh S. Heavner ◽

Kyle Herod ◽

Ting Ting Wu ◽

John W. Devlin

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Data Extraction ◽

Implementation Strategies ◽

Sleep Time ◽

Mesh Terms ◽

Care Protocol ◽

Quasi Experimental ◽

Critically Ill Adults ◽

Ill Adults

Objective: To review evidence for intensive care unit (ICU) sleep improvement bundle use, identify preferred sleep bundle components and implementation strategies, and highlight the role for pharmacists in developing and evaluating bundle efforts. Data Sources: Multiple databases were searched from January 1, 1990, to September 1, 2021, using the MeSH terms sleep, intensive care or critical care, protocol or bundle to identify comparative studies evaluating ICU sleep bundle implementation. Study Selection and Data Extraction: Study screening, data extraction, and risk-of-bias evaluation were conducted in tandem. The ICU quality improvement literature and Institute for Healthcare Improvement bundle improvement guidance were also reviewed to identify recommended strategies for successful sleep bundle use. Data Synthesis: Nine studies (3 randomized, 1 quasi-experimental, 5 before-and-after) were identified. Bundle elements varied and were primarily focused on nonpharmacological interventions designed to be performed during either the day or night; only 2 studies included a medication-based strategy. Five studies were associated with reduced delirium; 2 studies were associated with improved total sleep time and 2 with improved patient-perceived sleep. Pharmacists were involved directly in 4 studies. Relevance to Patient Care and Clinical Practice: Sleep improvement bundles are recommended for use in all critically ill adults; specific bundle elements and ICU team member roles should be individualized at the institution/ICU level. Pharmacists can help lead bundle development efforts and routinely deliver key elements. Conclusions: Pharmacists can play an important role in the development and implementation of ICU sleep bundles. Further research regarding the relative benefit of individual bundle elements on relevant patient outcomes is needed.

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Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal critically ill adults: a before and after study

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2011.03.012 ◽

2011 ◽

Vol 48 (12) ◽

pp. 1495-1504 ◽

Cited By ~ 71

Author(s):

Céline Gélinas ◽

Caroline Arbour ◽

Cécile Michaud ◽

Francine Vaillant ◽

Sylvie Desjardins

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Pain Assessment ◽

Before And After ◽

Critically Ill Adults ◽

Ill Adults ◽

Before And After Study

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ICU and ventilator mortality among critically ill adults with COVID-19

10.1101/2020.04.23.20076737 ◽

2020 ◽

Cited By ~ 7

Author(s):

Sara C. Auld ◽

Mark Caridi-Scheible ◽

James M. Blum ◽

Chad Robichaux ◽

Colleen Kraft ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Preliminary Data ◽

Early Experience ◽

Mortality Rates ◽

Critically Ill Adults ◽

Ill Adults ◽

Overall Mortality

SummaryWe report preliminary data from a cohort of adults admitted to COVID-designated intensive care units from March 6 through April 17, 2020 across an academic healthcare system. Among 217 critically ill patients, mortality for those who required mechanical ventilation was 29.7% (49/165), with 8.5% (14/165) of patients still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 25.8% (56/217), and 40.1% (87/217) patients have survived to hospital discharge. Despite multiple reports of mortality rates exceeding 50% among critically ill adults with COVID-19, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.

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Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

Scientific Reports ◽

10.1038/s41598-019-55080-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Priscila Bellaver ◽

Ariell F. Schaeffer ◽

Diego P. Dullius ◽

Marina V. Viana ◽

Cristiane B. Leitão ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Glycemic Variability ◽

Stress Hyperglycemia ◽

Critically Ill Adults ◽

Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

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