Critically ill patients boarding in the emergency department and the association with intensive care unit length of stay and hospital mortality during the COVID-19 pandemic

2022 ◽  
pp. 1-4
Author(s):  
Erin Tuttle ◽  
Ciara Wisecup ◽  
Eric Lemieux ◽  
Xuan Wang ◽  
Ariel Modrykamien
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length

scholarly journals Intensive care unit admission protocol controlled by intensivists can reduce transfer delays from the emergency department in critically ill patients

2018 ◽  
Vol 26 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Ji Eun Kim ◽  
Seul Lee ◽  
Jinwoo Jeong ◽  
Dong Hyun Lee ◽  
Jin-Heon Jeong
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Before And After

Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher in-hospital mortality and increased hospital length of stay. Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients. Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention. Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3–1665.3) min to 392.0 (279.3–686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0–11.8) days to 5.0 (3.0–10.0) days (p = 0.015). Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

scholarly journals Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255005
Author(s):  
Anwar Hassan ◽  
William Lai ◽  
Jennifer Alison ◽  
Stephen Huang ◽  
Maree Milross
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Gas Exchange ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Pulmonary Atelectasis ◽  
Respiratory Outcomes

Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respiratory failure leading to ventilatory support are a common occurrence in critically ill patients. Intrapulmonary percussive ventilation (IPV) is used to improve gas exchange and promote airway clearance in these patients. The current evidence regarding the effectiveness of intrapulmonary percussive ventilation in critical care settings remains unclear. This systematic review aims to summarise the evidence of the effectiveness of intrapulmonary percussive ventilation on intensive care unit length of stay (ICU-LOS) and respiratory outcomes in critically ill patients. Research question In critically ill patients, is intrapulmonary percussive ventilation effective in improving respiratory outcomes and reducing intensive care unit length of stay. Methods A systematic search of intrapulmonary percussive ventilation in intensive care unit (ICU) was performed on five databases from 1979 to 2021. Studies were considered for inclusion if they evaluated the effectiveness of IPV in patients aged ≥16 years receiving invasive or non-invasive ventilation or breathing spontaneously in critical care or high dependency units. Study titles and abstracts were screened, followed by data extraction by a full-text review. Due to a small number of studies and observed heterogeneities in the study methodology and patient population, a meta-analysis could not be included in this review. Outcomes of interest were summarised narratively. Results Out of 306 identified abstracts, seven studies (630 patients) met the eligibility criteria. Results of the included studies provide weak evidence to support the effectiveness of intrapulmonary percussive ventilation in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate. Interpretation Based on the findings of this review, the evidence to support the role of IPV in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate is weak. The therapeutic value of IPV in airway clearance, preventing pneumonia, and treating pulmonary atelectasis requires further investigation.

scholarly journals Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study

2017 ◽  
Author(s):  
Charles Chin Han Lew ◽  
Gabriel Jun Yung Wong ◽  
Ka Po Cheung ◽  
Ai Ping Chua ◽  
Mary Foong Fong Chong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Unit Length ◽  
Increased Risk

There is limited evidence for the association between malnutrition and hospital mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with &ge;24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients&rsquo; nutritional status within 48 hours of ICU admission. Multivariate analyses were conducted in two ways: 1) presence versus absence of malnutrition, and 2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and 29.6% died before hospital discharge. Malnutrition was associated with an increased risk of hospital mortality [adjusted-RR 1.39 (95%CI: 1.10&ndash;1.76)], and this risk increased with a greater degree of malnutrition [adjusted-RR 1.09 (95%CI: 1.01&ndash;1.18) for each 1-point decrease in the 7-point SGA]. No significant association was found between malnutrition and ICU-LOS. Conclusion: There was a clear association between malnutrition and higher hospital mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

The Impact of Continuous Infusion Compared to Intravenous Bolus Administration of Pantoprazole on Length of Intensive Care Unit Stay in Critically Ill Patients

2021 ◽  
pp. 089719002110360
Author(s):  
Katelynn Callaway ◽  
Mrinmayee Lakkad ◽  
Jacob T Painter ◽  
Lindsey Dayer ◽  
Allison K Oswalt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Continuous Infusion ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intravenous Bolus ◽  
Gi Bleeding ◽  
Icu Length Of Stay

Purpose: To determine if intravenous (IV) bolus pantoprazole increases intensive care unit (ICU) length of stay compared to IV infusion pantoprazole for treatment of gastrointestinal (GI) bleeding in critically ill patients. Methods: This retrospective cohort study included adult patients admitted to the ICU with GI bleeds. Patients treated with IV pantoprazole from January 1, 2017 to December 31, 2017 were analyzed in the continuous infusion group, and patients treated from March 1, 2018 to February 28, 2019 were analyzed in the bolus only group. Patients with pregnancy, variceal bleeds, or lower GI bleeds were excluded. Intensive care unit length of stay was compared between the two cohorts using the Mann Whitney U test. Adjusted analysis was conducted using the generalized linear model with gamma log link to estimate the effect of type of infusion on ICU length of stay. Results: A total of 145 patients were included in the analysis, with 72 patients in the continuous infusion group and 73 patients in the bolus only group. The median ICU length of stay was 70.5 hours for continuous infusion and 64 hours for bolus only pantoprazole ( P-value = .577). In the adjusted analysis, there was no difference in ICU length of stay between the continuous infusion and bolus only groups (RR, 1.06; 95% CI, .76–1.47). Conclusion: Intensive care unit length of stay was not prolonged with the use of IV bolus only compared to continuous infusion pantoprazole. Intravenous bolus only pantoprazole may be used in critically ill patients for treatment of upper GI bleeding.

scholarly journals Differences in Characteristics, Hospital Care, and Outcomes between Acute Critically Ill Emergency Department Patients Receiving Palliative Care and Usual Care

2021 ◽  
Vol 18 (23) ◽  
pp. 12546
Author(s):  
Julia Chia-Yu Chang ◽  
Che Yang ◽  
Li-Ling Lai ◽  
Hsien-Hao Huang ◽  
Shih-Hung Tsai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Palliative Care ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Usual Care ◽  
Critically Ill ◽  
Resource Utilization ◽  
Critically Ill Patients ◽  
Hospital Care

Background: The early integration of palliative care in the emergency department (ED-PC) provides several benefits, including improved quality of life with optimal comfort measures, and symptom control. Whether palliative care could affect the intensive care unit admissions, hospital care and resource utilization requires further investigation. Aim: To determine the differences in inpatient characteristics, hospital care, survival, and resource utilization between patients receiving palliative care (ED-PC) and usual care (UC). Design: Retrospective observational study. Setting/participants: We enrolled consecutive, acute, critically ill patients admitted to the emergency intensive care unit at Taipei Veterans General Hospital from 1 February 2018 to 31 January 2020. Results: A total of 1273 patients were evaluated for unmet palliative care needs; 685 patients received ED-PC and 588 received UC. The palliative care patients were more severely frail (AOR 2.217 (1.295–3.797), p = 0.004), had functional deterioration with three ADLs (AOR 1.348 (1.040–1.748), p = 0.024), biopsychosocial discomfort (AOR 1.696 (1.315–2.187), p < 0.001), higher Taiwan Triage and Acuity Scale 1 (p = 0.024), higher in-hospital mortality (AOR 1.983 (1.540–2.555), p < 0.001), were four times more likely to sign an DNR (AOR 4.536 (2.522–8.158), p < 0.001), and were twice as likely to sign an DNR at admission (AOR 2.1331.619–2.811), p < 0.001). Palliative care patients received less epinephrine (AOR 0.424 (0.265–0.678), p < 0.001), more frequent withdrawal of an endotracheal tube (AOR 8.780 (1.122–68.720), p = 0.038), and more narcotics (AOR1.675 (1.132–2.477), p = 0.010). Palliative care patients exhibited lower 7-day, 30-day, and 90-day survival rates (p < 0.001). There was no significant difference in the hospital length of stay (LOS) (21.2 ± 26.6 vs. 21.7 ± 20.6, p = 0.709) nor total hospital expenses (293,169 ± 350,043 vs. 294,161 ± 315,275, p = 0.958). Conclusion: Acute critically ill patients receiving palliative care were more frail, more critical, and had higher in-hospital mortality. Palliative care patients received less epinephrine, more endotracheal extubation, and more narcotics. There was no difference in the hospital LOS or hospital costs between the palliative and usual care groups. The synthesis of ED-PC is new but achievable with potential benefits to align care with patient goals.

Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Barry Burstein ◽  
Vidhu Anand ◽  
Bradley Ternus ◽  
Meir Tabi ◽  
Nandan S Anavekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Power Output ◽  
Critically Ill Patients ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Power ◽  
The Mean ◽  
Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

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