scholarly journals Effect of Therapeutic Plasma Exchange on Plasma Constituents in Neurointensive Care Unit Patients: A Retrospective Study

2021 ◽  
Author(s):  
Deepti Srinivas ◽  
Kamath Sriganesh ◽  
Dhritiman Chakrabarti ◽  
Pavithra Venkateswaran
Keyword(s):  
Mechanical Ventilation ◽  
Plasma Exchange ◽  
Clinical Outcomes ◽  
Plasma Protein ◽  
Total Protein ◽  
Protein Intake ◽  
Plasma Proteins ◽  
Neurointensive Care ◽  
Neurointensive Care Unit ◽  
Before And After

Abstract Purpose Plasma exchange is one of the recommended therapeutic procedures for autoimmune neurological conditions and involves removal of plasma over multiple sessions for exclusion of autoantibodies responsible for the disease process. This study aimed to evaluate the changes in the concentration of plasma constituents with five cycles of alternate day therapeutic plasma exchange (TPE), identify contributing factors for hypoproteinemia, and examine its impact on clinical outcomes. Methods This was a single-center, retrospective cohort study involving patients with autoimmune neurological diseases who underwent at least five cycles of TPE in the neurointensive care unit (NICU). Data regarding plasma protein concentrations, serum electrolytes, fluid input/output before and after every TPE cycle and clinical outcomes in terms of duration of ventilation, and NICU and hospital stay were collected from the medical records over a 1-year period. Results The levels of plasma proteins (total protein, albumin and globulin) (p < 0.001), sodium (p < 0.001), calcium (p < 0.001), and hemoglobin (p = 0.002) declined significantly after TPE. Difference in plasma protein levels before and after TPE did not correlate with durations of mechanical ventilation and hospital and NICU stay. Difference in total protein and globulin correlated negatively with fluid balance and positively with daily protein intake (p < 0.05 for both). Conclusion A significant decrease in plasma proteins and other plasma constituents is seen with TPE. Changes in plasma proteins are related to hemodilution and protein intake. Decrease in plasma proteins did not affect duration of hospital or NICU stay and duration of mechanical ventilation.

scholarly journals 2200 The effect of antipyretics and fever on the mortality of mechanically ventilated patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 30-31
Author(s):  
Emily M. Evans ◽  
Rebecca J. Doctor ◽  
Brian M. Fuller ◽  
Richard S. Hotchkiss ◽  
Anne M. Drewry
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severity Of Illness ◽  
Primary Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Before And After ◽  
Patients At Risk ◽  
Forward Stepwise ◽  
Ventilated Patients

OBJECTIVES/SPECIFIC AIMS: (1) To evaluate clinical outcomes in mechanically ventilated patients with and without fever. We hypothesize that, after adjusting for confounding factors such as age and severity of illness: (a) In septic patients, fever will be associated with improved clinical outcomes. (b) In nonseptic patients, fever will be associated with worse clinical outcomes. (2) To examine the relationship between antipyretics and mortality in mechanically ventilated patients at risk for an acute lung injury. We hypothesize that antipyretics will have no effect on clinical outcomes in mechanically ventilated patients with and without sepsis. METHODS/STUDY POPULATION: This is a retrospective study of a “before and after” observational cohort of 1705 patients with acute initiation of mechanical ventilation in the Emergency Department from September 2009 to March 2016. Data were collected retrospectively on the first 72 hours of temperature and antipyretic medication from the EHR. Temperatures measurements were adjusted based on route of measurement. Patients intubated for cardiac arrest or brain injury were excluded from our primary analysis due to the known damage of hyperthermia in these subsets. Cox proportional hazard models and multivariable linear regression analyzed time-to-event and continuous outcomes, respectively. Predetermined patient demographics were entered into each multivariable model using backward and forward stepwise regression. Models were assessed for collinearity and residual plots were used to assure each model met assumptions. RESULTS/ANTICIPATED RESULTS: Antipyretic administration is currently undergoing analysis. Initial temperature results are reported here. In the overall group, presence of hypothermia or fever within 72 hours of intubation compared with normothermia conferred a hazard ratio (HR) of 1.95 (95% CI: 1.48–2.56) and 1.31 (95% CI: 0.97–1.78), respectively. Presence of hypothermia and fever reduced hospital free days by 3.29 (95% CI: 2.15–4.42) and 2.34 (95% CI: 1.21–3.46), respectively. In our subgroup analysis of patients with sepsis, HR for 28-day mortality 2.57 (95% CI: 1.68–3.93) for hypothermia. Fever had no effect on mortality (HR 1.11, 95% CI: 0.694–1.76). Both hypothermia and fever reduced hospital free days by 5.39 (95% CI: 4.33–7.54) and 3.98 (95% CI: 2.46–5.32) days, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: As expected, both hypothermia and fever increased 28-day mortality and decreased hospital free days. In our sepsis subgroup, hypothermia again resulted in higher mortality and fewer hospital free days, while fever did not have a survival benefit or cost, but reduced hospital free days. Antipyretic administration complicates these findings, as medication may mask fever or exert an effect on survival. Fever may also affect mechanically ventilated septic patients differently than septic patients not on mechanical ventilation. Continued analysis of this data including antipyretic administration, ventilator free days and progression to ARDS will address these questions.

RELATION OF PLASMA PROTEINS TO BIRTH WEIGHT, MULTIPLE BIRTHS AND EDEMA IN THE NEWBORN

PEDIATRICS ◽  
1949 ◽  
Vol 4 (4) ◽  
pp. 484-489
Author(s):  
MURDINA M. DESMOND ◽  
LEWIS K. SWEET
Keyword(s):  
Birth Weight ◽  
Premature Infants ◽  
Plasma Protein ◽  
Total Protein ◽  
Plasma Proteins ◽  
Newborn Infants ◽  
The Other ◽  
Multiple Births ◽  
Lower Plasma ◽  
Essentially Normal

The concentration of total protein, albumin and globulin in the plasma increase with increasing birth weight in premature infants. These values are relatively stable and independent of birth weight in mature newborn infants. Infants born as twins have lower plasma protein values than do singly born infants of corresponding birth weight. The plasma protein values of twins may vary widely one from the other. This finding supports the theory that plasma proteins in the infant are produced and regulated independently of the mother. Infants born with edema may have essentially normal plasma protein values.

scholarly journals Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: The PROTINVENT retrospective study

2019 ◽  
Vol 38 (2) ◽  
pp. 883-890 ◽  
Author(s):  
W.A.C. (Kristine) Koekkoek ◽  
C.H. (Coralien) van Setten ◽  
Laura E. Olthof ◽  
J.C.N. (Hans) Kars ◽  
Arthur R.H. van Zanten
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Prolonged Mechanical Ventilation

scholarly journals Clinical characteristics and factors associated with in hospital mortality of convulsive status epilepticus in adult patients admitted to neurointensive care unit

2014 ◽  
Vol 01 (01) ◽  
pp. 016-020
Author(s):  
Sudhindra Vooturi ◽  
Sita Jayalakshmi ◽  
Sambit Sahu ◽  
Surath Mohandas
Keyword(s):  
Mechanical Ventilation ◽  
Status Epilepticus ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Adult Patients ◽  
Neurointensive Care ◽  
Categorical Variables ◽  
Neurointensive Care Unit ◽  
Factors Associated ◽  
Risk Of Mortality

Abstract Background Status epilepticus (SE) is a common neurological emergency; convulsive SE has a distribution with peaks in children and elderly than adult population. Aim To determine the clinical characteristics and factors associated with in hospital mortality in adult patients admitted to the neurointensive care unit (NICU). Methods A retrospective analysis of the clinical characteristics and outcome of adult patients (aged 18 years and above, below 60 years) with CSE admitted into the NICU was performed. The outcome was classified as alive or death in NICU. The differences between the alive and dead patients for data collected were analyzed using t tests and chi-square test for continuous and categorical variables respectively. Spearman correlations were used to analyze association between the variables, where r > 0.3 and p < 0.05 were considered significant. Results A total of 105 adult patients formed the inclusion criteria and were included for data analysis. Forty two out of the 105 patients were women. Sixty one (58%) of the 105 patients had acute symptomatic etiology while 17.1% patients were known epileptics; acute symptomatic etiology increased risk of mortality 5.28 times (95% confidence interval (CI): 1.44–19.35) (p = <0.01). Thirty eight (36.1%) patients progressed to refractory SE. The mortality in the entire cohort was 19%. Complications of prolonged mechanical ventilation and refractory status epilepticus showed strong and significant association with mortality (r > 0.300; p < 0.0001). Mortality was significantly higher in patients with acute symptomatic etiology and than other etiologies (85.0% vs 54.1%; p = 0.011). Conclusion Acute symptomatic etiology was the most common cause of SE in adults. While requirement for mechanical ventilation and refractory SE were the major factors associated with mortality, acute symptomatic etiology increased the risk of mortality in adult patients with SE.

PAROTITIS IN NEUROINTENSIVE CARE UNIT: CASE REPORT AND REVIEW OF THE LITERATURE

2014 ◽  
Author(s):  
Hatice Ture ◽  
Sevgi Bilgen ◽  
Ozgul Keskin ◽  
Ozge Koner ◽  
Sibel Temur ◽  
...  
Keyword(s):  
Case Report ◽  
Neurointensive Care ◽  
Review Of The Literature ◽  
Neurointensive Care Unit
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