Developing well-calibrated illness severity scores for decision support in the critically ill

BACKGROUND: Gastric bleeding in children is associated with critical illness, shock, and physical trauma. Histamine-2 receptor antagonist therapy is used prophylactically to treat gastric bleeding, but it is not known whether bolus dosing or continuous infusion dosing is more effective. OBJECTIVES: To compare the effects of continuous infusion intravenous ranitidine and intravenous bolus dosing of ranitidine on gastric pH in critically ill children and to look for correlation between illness severity scores and gastric pH. METHODS: Sixteen critically ill children were randomized into two groups. Children in group 1 received bolus dosing on day 1 and continuous infusion of ranitidine on day 2. Group 2 received the continuous infusion on day 1 and bolus dosing on day 2. Equivalent doses of ranitidine were based on weight. Continuous infusion regimen: ranitidine bolus of 0.15 mg/kg followed by continuous infusion at 0.15 mg/kg per hour for 12 hours. Bolus regimen: 1 mg/kg, two doses 6 hours apart. Pediatric risk of mortality scores were recorded upon admission to the study. RESULTS: There was no statistically significant difference between regimens. Both raised gastric pH values above 4.0 during the treatment phase. There was no correlation between illness severity scores and gastric pH values. CONCLUSIONS: Both bolus dosing and continuous infusion dosing of 4 mg/kg per day of intravenous ranitidine were effective at raising and maintaining gastric pH in critically ill children.

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Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study

Nutrition Journal ◽

10.1186/1475-2891-11-30 ◽

2012 ◽

Vol 11 (1) ◽

Cited By ~ 17

Author(s):

Hsiu-Hua Huang ◽

Chien-Wei Hsu ◽

Shiu-Ping Kang ◽

Ming-Yi Liu ◽

Sue-Joan Chang

Keyword(s):

Observational Study ◽

Critically Ill ◽

Enteral Feeding ◽

Critically Ill Patients ◽

Illness Severity ◽

Retrospective Observational Study

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Regulation and Prognostic Relevance of Symmetric Dimethylarginine Serum Concentrations in Critical Illness and Sepsis

Mediators of Inflammation ◽

10.1155/2013/413826 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Alexander Koch ◽

Ralf Weiskirchen ◽

Jan Bruensing ◽

Hanna Dückers ◽

Lukas Buendgens ◽

...

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Multiorgan Failure ◽

Microvascular Dysfunction ◽

Serum Levels ◽

Serum Concentrations ◽

Symmetric Dimethylarginine ◽

Term Survival ◽

Severity Scores

In systemic inflammation and sepsis, endothelial activation and microvascular dysfunction are characteristic features that promote multiorgan failure. As symmetric dimethylarginine (SDMA) impacts vascular tension and integrity via modulating nitric oxide (NO) pathways, we investigated circulating SDMA in critical illness and sepsis. 247 critically ill patients (160 with sepsis, 87 without sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU) and on day 7, in comparison to 84 healthy controls. SDMA serum levels were significantly elevated in critically ill patients at admission to ICU compared to controls and remained stably elevated during the first week of ICU treatment. The highest SDMA levels were found in patients with sepsis. SDMA levels closely correlated with disease severity scores, biomarkers of inflammation, and organ failure (renal, hepatic, and circulatory). We identified SDMA serum concentrations at admission as an independent prognostic biomarker in critically ill patients not only for short-term mortality at the ICU but also for unfavourable long-term survival. Thus, the significant increase of circulating SDMA in critically ill patients indicates a potential pathogenic involvement in endothelial dysfunction during sepsis and may be useful for mortality risk stratification at the ICU.

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Improved Survival in Critically Ill Patients after Implementing a Visual Clinical Decision Support System

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.09.013 ◽

2018 ◽

Vol 227 (4) ◽

pp. e1-e2

Author(s):

David H. Berger ◽

Christopher Howard ◽

John B. Holcomb ◽

James P. Herlihy

Keyword(s):

Decision Support ◽

Decision Support System ◽

Critically Ill ◽

Clinical Decision Support ◽

Support System ◽

Critically Ill Patients ◽

Clinical Decision Support System ◽

Clinical Decision

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Angiopoietin 2 Levels in the Risk Stratification and Mortality Outcome Prediction of Sepsis-Associated Coagulopathy

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618786029 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1223-1233 ◽

Cited By ~ 4

Author(s):

Stephen Statz ◽

Giselle Sabal ◽

Amanda Walborn ◽

Mark Williams ◽

Debra Hoppensteadt ◽

...

Keyword(s):

Plasma Levels ◽

Predictive Biomarker ◽

Illness Severity ◽

Assay Method ◽

Enzyme Linked Immunosorbent Assay ◽

Icu Admission ◽

Severity Scores ◽

Mortality Outcome ◽

Clinical Illness ◽

Angiopoietin 2

It has been well established that angiopoietin 2 (Ang-2), a glycoprotein involved in activation of the endothelium, plays an integral role in the pathophysiology of sepsis and many other inflammatory conditions. However, the role of Ang-2 in sepsis-associated coagulopathy (SAC) specifically has not been defined. The aim of this study was to measure Ang-2 plasma levels in patients with sepsis and suspected disseminated intravascular coagulation (DIC) in order to demonstrate its predictive value in SAC severity determination and 28-day mortality outcome. Plasma samples were collected from 102 patients with sepsis and suspected DIC at intensive care unit (ICU) admission. The Ang-2 plasma levels were quantified using a sandwich enzyme-linked immunosorbent assay method. The International Society on Thrombosis and Haemostasis DIC scoring system was used to compare the accuracy of Ang-2 levels versus clinical illness severity scores in predicting SAC severity. Mean Ang-2 levels in patients with sepsis and DIC were significantly higher in comparison to healthy controls ( P < 0.0001), and median Ang-2 levels showed a downward trend over time ( P = 0.0008). Baseline Ang-2 levels and clinical illness severity scores were higher with increasing severity of disease, and Ang-2 was a better predictor of DIC severity than clinical illness scores. This study demonstrates that Ang-2 levels are significantly upregulated in SAC, and this biomarker can be used to risk stratify patients with sepsis into non-overt DIC and overt DIC. Furthermore, the Ang-2 level at ICU admission in a patient with sepsis and suspected DIC may provide a predictive biomarker for mortality outcome.

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