scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals The Outcomes of Tracheostomy in Pediatric Cardiac Surgical Patients

2021 ◽  
Vol 5 (02) ◽  
pp. 124-133
Author(s):  
Manoj Kumar Sahu ◽  
Challatil Bipin ◽  
Ummed Singh Dhatterwal ◽  
Sarvesh Pal Singh ◽  
Velayoudam Devagourou ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Pediatric Patients ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Survivor Group

Abstract Objectives To describe the outcomes of postoperative tracheostomy and determine the predictors of survival. Design Prospective, observational study. Setting Cardiac surgical intensive care unit of a tertiary care hospital. Participants All pediatric patients below 10 years of age who underwent tracheostomy after cardiac surgery from January 2019 to December 2019. Different variables were compared between survivors and nonsurvivors. Intervention Tracheostomy. Results Among 1084 pediatric patients who underwent cardiac surgery during the study period, 41 (3.7%) received tracheostomy. Survival rate was 71%.Earlier, sternal closure (SC) (p = 0.04), acute kidney injury (AKI) (p = 0.001), serum C-reactive protein (CRP) (p = 0.007), duration of total parenteral nutrition (TPN) (p = 0.005) and days of feed interruption (FI) (p = 0.02), activated partial thromboplastin time (aPTT) before tracheostomy (p = 0.006), and bleeding from tracheostomy site (p = 0.02) were significantly low in the survivor group.Among the peritracheostomy variables taken at different time points, the levels of pH on tracheostomy day 1 (p = 0.03), serum lactate on tracheostomy day 2 (p = 0.01) and day 3 (p = 0.01), and random blood sugar (RBS) on tracheostomy day 3 (p = 0.04) were significantly lower in the survivor group.The arterial oxygen saturation (SaO2) on tracheostomy day 1 (p = 0.04) and the platelet count before tracheostomy (p = 0.02) were significantly higher in the survivor group. Conclusions Our study demonstrated a survival of 71% among the study cohort. Lesser duration of open sternum, lower incidence of AKI, less number of days on TPN and FI, lower posttracheostomy aPTT, bleeding, RBS, lactate, and higher pretracheostomy platelet count and posttracheostomy SaO2 were found to be the predictors of survival.

Periodically Changing Ventilator Circuits Is Not Necessary to Prevent Ventilator-Associated Pneumonia When a Heat and Moisture Exchanger Is Used

2004 ◽  
Vol 25 (12) ◽  
pp. 1077-1082 ◽  
Author(s):  
Leonardo Lorente ◽  
María Lecuona ◽  
Ramón Galván ◽  
María J. Ramos ◽  
María L. Mora ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Heat And Moisture Exchanger ◽  
Surgical Intensive Care ◽  
Moisture Exchanger ◽  
Significant Difference ◽  
Heat And Moisture

AbstractObjective:To analyze the efficacy of periodically changing ventilator circuits for decreasing the rate of ventilator-associated pneumonia when a heat and moisture exchanger (HME) is used for humidification. The Centers for Disease Control and Prevention recommended not changing the circuits periodically.Design:Randomized, controlled trial conducted between April 2001 and August 2002.Setting:A 24-bed, medical–surgical intensive care unit in a 650-bed, tertiary-care hospital.Patients:All patients requiring mechanical ventilation during more than 72 hours from April 2001 to August 2002.Interventions:Patients were randomized into two groups: (1) ventilation with change of ventilator circuits every 48 hours and (2) ventilation with no change of circuits. Throat swabs were taken on admission and twice weekly until discharge to classify pneumonia as endogenous or exogenous.Results:Three hundred four patients (143 from group 1 and 161 from group 2) with similar characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic group, and mortality) were analyzed. There was no significant difference in the rate of pneumonia between the groups (23.1% vs 23.0% and 15.5 vs 14.8 per 1,000 ventilator-days). There was no significant difference in the incidence of exogenous pneumonia per 1,000 days of mechanical ventilation (1.71 vs 1.25). There was no difference in the distribution of microorganisms causing pneumonia.Conclusions:Circuit change using an HME for humidification does not decrease pneumonia and represents an unnecessary cost.

scholarly journals Incidence and outcomes of acute lung injury in the surgical intensive care unit of a tertiary care hospital in Bangkok, Thailand

2017 ◽  
Vol 10 (4) ◽  
pp. 379-385
Author(s):  
Onuma Chaiwat ◽  
Worawan Suwannasri ◽  
Jedsadayoot Sak-aroonchai ◽  
Sawita Kanavitoon ◽  
Annop Piriyapathsom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Lung Injury ◽  
Mortality Rate ◽  
Lung Injury ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Surgical Intensive Care

Abstract Background Although the pathophysiology and treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well established, the incidence and outcomes of ALI have not been extensively reported. Variations in healthcare systems, demographics, socioeconomics, and levels of intensive care units (ICU) may explain remarkable differences in outcomes reported. Objectives To evaluate the incidence and outcomes of ALI/ARDS at the surgical ICU (SICU) at Siriraj Hospital of Mahidol University, Bangkok. Methods We included patients aged ≥18 years admitted to the general SICU between June 1, 2010 and May 31, 2013 in this prospective, cohort observational study. All patients required ≥24 h of ventilatory support. The study outcomes were the incidence of ALI/ARDS, SICU length of stay, and mortality rate. Results Of 2523 patients admitted to the SICU, 495 (20%) required ≥24 h ventilatory support, and 15 (3%) developed ALI/ARDS. ALI/ARDS occurred on day 2 of ventilatory support. ARDS was caused by sepsis and pneumonia. The patients who developed ALI/ARDS had a higher APACHE II score (P = 0.001) and end-stage renal disease (P = 0.01). Pneumonia and acute kidney injury were more severe in patients with ALI and ARDS (40% vs 9%, P = 0.002; 33% vs 10%, P = 0.02, respectively). Ventilatory support duration, SICU lengths of stay and hospital mortality were higher in the ALI/ARDS group. Conclusions The incidence of ALI/ARDS in the SICU was low, but the mortality rate was high. A larger sample size is necessary to identify independent risk factors for ALI/ARDS.

scholarly journals Patient characteristics and cardiac surgical outcomes at a tertiary care hospital in Kenya, 2008–2017: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11191
Author(s):  
Tamara Chavez-Lindell ◽  
Bob Kikwe ◽  
Anthony Gikonyo ◽  
Agricola Odoi
Keyword(s):  
Surgical Complications ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Adult Patients ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
Care Hospital ◽  
Risk Of Death

Background Cardiac surgeries are high risk procedures that require specialized care and access to these procedures is often limited in resource-poor countries. Although fatalities for surgical patients across Africa are twice that of the global rate, cardiac surgical mortality continent-wide is only slightly higher than all-surgical mortality. Understanding demographic and health characteristics of patients and the associations of these characteristics with morbidity and mortality events is important in guiding care decisions. Therefore, the objectives of this study were to: (a) describe the characteristics of cardiac surgical patients; (b) identify the associations between these characteristics and morbidity and mortality events following cardiac surgery. Methods Patient characteristics and post-surgical complications were abstracted for all cardiac surgical patients treated at a tertiary care hospital in Kenya from 2008 to 2017. Descriptive analyses of demographic factors, co-morbidities, peri-operative conditions, and post-surgical complications were conducted for adult and pediatric patients. Cochran-Armitage trend test was used to assess temporal trends in risk of death. Multivariable ordinary logistic and Firth logistic models were used to investigate predictors of surgical outcomes. Results The study included a total of 181 patients (150 adult and 31 pediatric patients). Most (91.3%) adult patients had acquired conditions while 45.2% of the pediatric patients had congenital defects. Adult patients tended to have co-morbid conditions including hypertension (16.7%), diabetes mellitus (7.3%), and nephropathy (6.7%). Most patients (76.0% adults and 96.8% pediatric patients) underwent ≤ 2 surgical procedures during their hospital stay. Seventy percent of adult and 54.8% of the pediatric patients experienced at least one post-surgical complication including mediastinal hemorrhage, acute kidney injury and death. Patient characteristics played the greatest roles in predicting post-surgical complications. For adult patients, significant predictors of acute kidney injury included atrial fibrillation (OR = 18.25; p = .001), mitral valve replacement (OR = 0.14; p = .019), and use of cardiopulmonary bypass (OR = 0.06; p = .002). Significant predictors of 30-day mortality were age (OR = 1.05; p = .015) and atrial fibrillation (OR = 4.12, p = .018). Although the number of surgeries increased over the decade-long study period, there were no significant (p = .467) temporal trends in the risk of death. Conclusions Awareness of demographic and peri-surgical factors that are predictors of complications is useful in guiding clinical decisions to reduce morbidity and mortality. Identification of co-morbidities as the most useful predictors of post-surgical complications suggests that patient characteristics may be a larger contributor to the incidence of complications than surgical practices.

scholarly journals 817. Appropriate Sites for the Active Surveillance of Carbapenemase-producing Enterobacteriaceae

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S501-S502
Author(s):  
Joung Ha Park ◽  
Hye-Suk Choi ◽  
Hyejin Yang ◽  
Hyun-Ju Lee ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Negative Group ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Transmission Rates

Abstract Background Active surveillance tests for carbapenemase-producing Enterobacteriaceae (CPE) are recommended in patients showing risk factors for colonization by these bacteria. There are limited data however on whether surveillance tests for anatomic sites other than the stool would be useful to detect CPE colonization, and we investigated this in our present study. Methods Retrospective analysis was performed on cases at our tertiary care hospital during a 5-year period. The study patients with CPE colonization had been admitted to our surgical intensive care unit (SICU) or sub-ICU for liver transplantation in this period and undergone surveillance tests for both the stool and other sites. Patients were grouped as stool CPE negative (but which included CPE positive cases from initial sputum and other site tests) or positive. Results Among the total study cohort of 158 patients, 138 (87.3%) were included in the stool CPE positive group and the remaining 20 (12.7%) in the stool CPE negative group. While the sensitivity of CPE surveillance testing of the stool was 87.3% (95% CI 81.1-92.1), the sensitivity when combining stool and sputum samples was 93.7% (88.7-96.9). The transmission rates were similar for patients showing CPE positivity in the stool, sputum and other sites, at 4.8% (27/557), 4.7% (3/64), and 6.7% (1/15), respectively (p = 0.95). Conclusion The sensitivity of CPE detection in a stool sample is suboptimal for ruling out CPE colonization and the transmission rates are similar between stool-positive or -negative cases. Combining surveillance of the stool with other sites may be needed for detecting CPE. Disclosures All Authors: No reported disclosures

scholarly journals Appropriate sites for the active surveillance of carbapenemase-producing Enterobacteriaceae

2021 ◽  
Author(s):  
Joung Ha Park ◽  
Hye-Suk Choi ◽  
Hyejin Yang ◽  
Hyun-Ju Lee ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Negative Group ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Transmission Rates

Abstract Background: Active surveillance tests for carbapenemase-producing Enterobacteriaceae (CPE) are recommended in patients showing risk factors for colonization by these bacteria. There are limited data however on whether surveillance tests for anatomic sites other than the stool would be useful to detect CPE colonization, and we investigated this in our present study.Methods: Retrospective analysis was performed on cases at our tertiary care hospital during a 5-year period. Patients with CPE colonization had been admitted to our surgical intensive care unit (SICU) or sub-ICU for liver transplantation in this period and undergone surveillance tests for both the stool and other sites. Patients were grouped as stool CPE negative (but which included CPE positive cases from initial sputum and other site tests) or positive. Results: Among the total study cohort of 158 patients, 138 (87.3%) were included in the stool CPE positive group and the remaining 20 (12.7%) in the stool CPE negative group. While the sensitivity of CPE surveillance testing of the stool was 87.3% (95% CI 81.1-92.1), the sensitivity when combining stool and sputum samples was 93.7% (88.7-96.9). The transmission rates were similar for patients showing CPE positivity in the stool, sputum and other sites, at 4.8% (27/557), 4.7% (3/64), and 6.7% (1/15), respectively (p = 0.95).Conclusions: The sensitivity of CPE detection in a stool sample is suboptimal for ruling out CPE colonization and the transmission rates are similar between stool-positive or -negative cases. Thus, combining surveillance of the stool with other sites may be needed for detecting CPE.

Weaning Readiness and Fluid Balance in Older Critically Ill Surgical Patients

2006 ◽  
Vol 15 (1) ◽  
pp. 54-64 ◽  
Author(s):  
Carol Diane Epstein ◽  
Joel R. Peerless
Keyword(s):  
Mechanical Ventilation ◽  
Fluid Balance ◽  
Older Patients ◽  
Prolonged Mechanical Ventilation ◽  
Venous Pressure ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
In The Beginning

• BackgroundFew studies address predictors for successful weaning of older adults from mechanical ventilation. • ObjectiveTo develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation. • MethodsForty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study. Hemodynamic and gas exchange variables, fluid balance, oxygen cost of breathing, and scores on the Burns Weaning Assessment Program were analyzed. • ResultsCompared with patients who were not weaned, successfully weaned patients required mechanical ventilation for 5.3 days, started active weaning earlier (mean 10.7 vs 14.5 days, P = .04), had lower mean negative daily fluid balances in the beginning (−0.394 vs 1.107 L, P = .004), and had lower mean net cumulative fluid balances (6.856 vs 16.212 L) at the time of enrollment. They also maintained both a lower mean net cumulative fluid balance (10.753 vs 25.049 L, P= .02) and a negative daily fluid balance (−0.389 vs 1.904 L, P = .03) throughout. Their mean central venous pressure decreased over time and was significantly lower (P<.001). • ConclusionPersistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.

scholarly journals A COMPARATIVE STUDY ON DRUG USE OF ANTIMICROBIAL AGENTS IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL.

2018 ◽  
Vol 11 (1) ◽  
pp. 310
Author(s):  
Nimin Paul ◽  
Santhosh Kumar V
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Total Drug ◽  
Surgical Intensive Care

 Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs.Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1st 2016 to March 1st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed.Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test.Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent’s usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.

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