scholarly journals Clinical Application of Ultrasound in Intensive Care Unit-Acquired Weakness

2020 ◽  
Vol 41 (03) ◽  
pp. 244-266
Author(s):  
Sunil Patel ◽  
Danielle Bear ◽  
Brijesh Patel ◽  
Zudin Puthucheary
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Recognition ◽  
Imaging Modality ◽  
Surrogate Marker ◽  
Diagnostic Tools ◽  
Muscle Groups

AbstractIntensive care unit-acquired weakness (ICUAW) is common and prolongs the duration of mechanical ventilation and ICU length of stay and is also a leading cause of physical restriction up to five years later. Developing diagnostic tools that allow early identification and risk stratification in all critically ill patients is vital. Ultrasound is a cheap, reproducible and noninvasive imaging modality that can be used to assess multiple muscle groups. It has advantages over other imaging techniques that entail risks of radiation as well as the logistical concerns of moving critically ill patients. Ultrasound muscle indices can be monitored over time and may serve as predictors for ventilatory weaning and long-term outcomes. The diaphragm is frequently perturbed during critical illness, specifically when mechanical ventilation is initiated. Diaphragm thickness and excursion have been shown to support extubation strategy with the former serving as a marker of inspiratory effort in the absence of more specialist tests. The techniques are reproducible with appropriate training and practice and have been applied in clinical trials. Peripheral skeletal muscle ultrasound has been the subject of intense research in ICU-acquired muscle weakness. The technique has also been found to be reproducible and can serve as a surrogate marker to current volitional and non-volitional tests in the assessment of muscle ICUAW. This article outlines the application of musculoskeletal ultrasound and its role in the early recognition of ICUAW in three distinct muscle groups: (1) diaphragm (2) rectus femoris and introduces the potential of (3) parasternal muscles.

scholarly journals Utility of transthoracic echocardiography (TTE) in assessing fluid responsiveness in critically ill patients – a challenge for the bedside sonographer.

2016 ◽  
Vol 18 (4) ◽  
pp. 508 ◽  
Author(s):  
Wojciech Mielnicki ◽  
Agnieszka Dyla ◽  
Tomasz Zawada
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Transthoracic Echocardiography ◽  
Diagnostic Tools ◽  
Dynamic Parameters ◽  
Hemodynamic Assessment ◽  
Life Threatening

Transthoracic echocardiography (TTE) has become one of the most important diagnostic tools in the treatment of critically ill patients. It allows clinicians to recognise potentially reversible life-threatening situations and is also very effective in the monitoring of the fluid status of patients, slowly substituting invasive methods in the intensive care unit. Hemodynamic assessment is based on a few static and dynamic parameters. Dynamic parameters change during the respiratory cycle in mechanical ventilation and the level of this change directly corresponds to fluid responsiveness. Most of the parameters cannot be used in spontaneously breathing patients. For these patients the most important test is passive leg raising, which is a good substitute for fluid bolus. Although TTE is very useful in the critical care setting, we should not forget the important limitations, not only technical ones but also caused by the critical illness itself. Unfortunately, this method does not allow continuous monitoring and every change in the patient’s condition requires repeated examination.Keywords: hypovolaemia; non-invasive monitoring; intensive care unit; transthoracic echocardiography

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

2019 ◽  
Vol 9 (1) ◽  
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.

scholarly journals Obesity May Not Be Associated with 28-Day Mortality, Duration of Invasive Mechanical Ventilation and Length of Intensive Care Unit and Hospital Stay in Critically Ill Patients with Severe Acute Respiratory Syndrome Coronavirus-2: A Retrospective Cohort Study

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 674
Author(s):  
Sjaak Pouwels ◽  
Dharmanand Ramnarain ◽  
Emily Aupers ◽  
Laura Rutjes-Weurding ◽  
Jos van Oers
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Significant Difference

Background and Objectives: The aim of this study was to investigate the association between obesity and 28-day mortality, duration of invasive mechanical ventilation and length of stay at the Intensive Care Unit (ICU) and hospital in patients admitted to the ICU for SARS-CoV-2 pneumonia. Materials and Methods: This was a retrospective observational cohort study in patients admitted to the ICU for SARS-CoV-2 pneumonia, in a single Dutch center. The association between obesity (body mass index > 30 kg/m2) and 28-day mortality, duration of invasive mechanical ventilation and length of ICU and hospital stay was investigated. Results: In 121 critically ill patients, pneumonia due to SARS-CoV-2 was confirmed by RT-PCR. Forty-eight patients had obesity (33.5%). The 28-day all-cause mortality was 28.1%. Patients with obesity had no significant difference in 28-day survival in Kaplan–Meier curves (log rank p 0.545) compared with patients without obesity. Obesity made no significant contribution in a multivariate Cox regression model for prediction of 28-day mortality (p = 0.124), but age and the Sequential Organ Failure Assessment (SOFA) score were significant independent factors (p < 0.001 and 0.002, respectively). No statistically significant correlation was observed between obesity and duration of invasive mechanical ventilation and length of ICU and hospital stay. Conclusion: One-third of the patients admitted to the ICU for SARS-CoV-2 pneumonia had obesity. The present study showed no relationship between obesity and 28-day mortality, duration of invasive mechanical ventilation, ICU and hospital length of stay. Further studies are needed to substantiate these findings.

scholarly journals Non-cardio respiratory monitoring of mechanically ventilated critically ill patients

2019 ◽  
pp. S150-S159
Author(s):  
Chinmaya Kumar Panda ◽  
Habib Mohammad Reazaul Karim ◽  
Subrata Kumar Singha
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Well Being ◽  
Multiple Organ ◽  
Respiratory Monitoring ◽  
Arterial Oxygen ◽  
Mechanically Ventilated

Critically ill patients often require multiple organ supports; respiratory support in terms of mechanical ventilation (MV) is one of the commonest. But, only providing an organ support contributes less to the complete well being of the patients. Moreover, MV itself can affect various physiological systems, metabolic response, and cause side effects. A very close temporal relationship exists between patients, monitoring and management decision too, and therefore, appropriate information from monitoring can lead to better outcomes. The present review is intended to briefly highlight the current opinions and strategies for non cardio-respiratory monitoring in such critically ill patients.Abbreviations: AKI-Acute Kidney Injury; APACHE-Acute Physiology and Chronic Health Evaluation; BPS-Behavioral Pain Scale; CAM-ICU-Confusion Assessment Method for the Intensive Care Unit; CPOT–Critical Care Pain Observation Tool; EVLWI-Extra vascular lung water index; FDA-Food and Drug Administration; ISO-International Organization for Standardization; ICU-Intensive Care Unit; LOS-Length of stay; MODS-Multiple Organ Dysfunction Score; MV-Mechanical Ventilation; PaO2-Partial pressure of arterial oxygen; FiO2-Fraction of inspired oxygen; SAPS-Simplified Acute Physiologic Score; RASS-Richmond Agitation Sedation Scale; SOFA-Sequential Organ Failure Assessment; SAS-Sedation Agitation Scale; UO-Urine outputCitation: Panda CK, Karim HMR, Singha SK. Non-cardio respiratory monitoring of mechanically ventilated critically ill patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S150-S159Received: 9 Jul 2018 Reviewed: 1 Oct 2018 Corrected & Accepted: 9 Oct 2018

Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit

2015 ◽  
Vol 39 (6) ◽  
pp. 329-336 ◽  
Author(s):  
M. Llaurado-Serra ◽  
M. Ulldemolins ◽  
R. Güell-Baró ◽  
B. Coloma-Gómez ◽  
X. Alabart-Lorenzo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bed Elevation ◽  
Head Of Bed Elevation

scholarly journals Influenza Infections and Emergent Viral Infections in Intensive Care Unit

2019 ◽  
Vol 40 (04) ◽  
pp. 488-497 ◽  
Author(s):  
Ben Cantan ◽  
Charles-Edouard Luyt ◽  
Ignacio Martin-Loeches
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Viral Infections ◽  
Invasive Mechanical Ventilation ◽  
Current Evidence ◽  
Molecular Diagnostic ◽  
Diagnostic Tools ◽  
Medical Conditions

AbstractCritically ill patients are admitted to an intensive care unit (ICU) for multiple reasons. In this study, we aim to analyze the current evidence and findings associated with influenza and other emergent viral infections, namely, herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV).Among medical conditions, community-acquired respiratory infections are the most frequent reason for ventilatory support in ICUs. Community-acquired pneumonia in a severe form including the need of invasive mechanical ventilation and/or vasopressors is associated with high mortality rates. However, after the pandemic that occurred in 2009 by H1N1 influenza, the number of cases being admitted to ICUs with viral infections is on the rise. Patients in whom an etiology would not have been identified in the past are currently being tested with more sensitive viral molecular diagnostic tools, and patients being admitted to ICUs have more preexisting medical conditions that can predispose to viral infections. Viral infections can trigger the dysregulation of the immune system by inducing a massive cytokine response. This cytokine storm can cause endothelial damage and dysfunction, deregulation of coagulation, and, consequently, alteration of microvascular permeability, tissue edema, and shock. In severe influenza, this vascular hyperpermeability can lead to acute lung injury, multiorgan failure, and encephalopathy. In immunocompetent patients, the most common viral infections are respiratory, and influenza should be considered in patients with severe respiratory failure being admitted to ICU. Seasonality and coinfection are two important features when considering influenza as a pathogen in critically ill patients.Herpesviridae (HSV, CMV, and EBV) may reactivate in ICU patients, and their reactivation is associated with morbidity/mortality. However, whether a specific treatment may impact on outcome remains to be determined.

scholarly journals Factors Associated with Mortality in Patients with a Solid Malignancy Admitted to the Intensive Care Unit - A Prospective Observational Study

2018 ◽  
Vol 4 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Pascal Kingah ◽  
Nasser Alzubaidi ◽  
Jihane Zaza Dit Yafawi ◽  
Emad Shehada ◽  
Khaled Alshabani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Performance Status ◽  
Academic Medical Center ◽  
Factors Associated ◽  
Solid Malignancy

Abstract Purpose: Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes. Methods and Materials: All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented. Results: There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 – 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races. Conclusion: This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.

The Impact of Venous Thromboembolism In Critically Ill Patients: A Meta-Analysis of Major Clinical outcomes

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3327-3327
Author(s):  
Alessandra Malato ◽  
Francesco Dentali ◽  
Francesco Fabbiano ◽  
Giorgia Saccullo ◽  
Vincenzo Abbadessa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mean Difference ◽  
Icu Mortality ◽  
Patient Stay

Abstract Abstract 3327 Background: Critically ill patients are at high risk of developing venous thromboembolism (VTE) during their stay in the intensive care unit (ICU) because of premorbid medical and surgical conditions. The clinical consequences of Deep Vein Thrombosis (DVT) have the potential to be serious yet are frequently unrecognized in the Intensive Care Unit (ICU). In contrast to the extensive documentation on the short and long–term outcomes of patients with DVT evaluated in other clinical settings, little is known about the clinical course of this disease in the ICU setting. We hypothesized that both undetected and clinically evident VTE would affect the prognosis of critically ill patients. Purpose: To systematically review whether a diagnosis of DVT in critically ill patients affects clinically important outcomes including length of stay, duration of mechanical ventilation and mortality. Material and Methods: MEDLINE and EMBASE databases were searched up to June 2010. Two reviewers performed study selection independently. Studies were selected if evaluate one or more of the following outcomes: hospital and ICU mortality, duration of patient stay in hospital and in ICU, and duration of mechanical ventilation. Two investigators independently extracted and reviewed data from each study; including study and patient characteristics and outcomes. Association between DVT and hospital and ICU mortality, and the mean difference of duration of patient stay in hospital and in ICU, and duration of mechanical ventilation in patients with and without DVT were calculated using a random-effects model (DerSimionan and Laird method). Pooled results are reported as relative risk (RR) and mean difference and are presented with 95% confidence interval (CI) and with 2-sided P values. A P value of .05 or less was considered statistically significant. Statistical heterogeneity was evaluated using the I2 statistic, which assesses the appropriateness of pooling the individual study results [22]. The I2 value provides an estimate of the amount of variance across studies due to heterogeneity rather than chance. Cohen's Kappa for inter-rater agreement was used to assess inter-rater reliability. Results: Six studies for a total of 1518 patients were included in the systematic review. Patients diagnosed with DVT compared to those without DVT had increased ICU and hospital stay (7.3 days (95% CI 1.4 to 13.2; P= 0.02) and 16.5 days (95% CI 1.51 to 30.59; P= 0.03), respectively. Duration of mechanical ventilation appeared to be increased in patients with DVT although this difference was not statistically significant (weighted mean difference: 3.41 days 95 % CI –1.12 to 7.94; P=0.14). Patients diagnosed with DVT also had a marginally significant increase in the RR of hospital mortality (RR 1.31 95%CI,0.99 to 1.74,P=0.06), and a non statistically significant increase in the RR of ICU mortality (RR 1.96; 95% CI 0.74 to 5.19; P = 0.17). Conclusions: A diagnosis of DVT upon ICU admission appears to affect clinically important outcomes including length of ICU and hospital stay and hospital mortality. Further research involving larger prospective study designs are warranted. Disclosures: No relevant conflicts of interest to declare.

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