scholarly journals Percutaneous dilatational tracheotomy in high-risk ICU patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Luesebrink ◽  
S Massberg ◽  
M Orban
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Triple Therapy ◽  
Bleeding Risk ◽  
Icu Patients ◽  
Procedural Complications ◽  
Multivariable Regression ◽  
International Multicenter Study ◽  
International Multicenter

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models. Results In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk. Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.

scholarly journals Percutaneous dilatational tracheotomy in high-risk ICU patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Enzo Lüsebrink ◽  
Alexander Krogmann ◽  
Franziska Tietz ◽  
Matthias Riebisch ◽  
Rainer Okrojek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Platelet Count ◽  
High Risk ◽  
Kidney Disease ◽  
Triple Therapy ◽  
Therapeutic Dosage ◽  
Icu Patients ◽  
Procedural Complications ◽  
Low Platelet Count

Abstract Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. Therefore, the purpose of this study, including such a high proportion of patients on antithrombotic therapy, was to investigate whether PDT in high-risk ICU patients is associated with elevated procedural complications and to analyse the risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed and the predictors of bleeding occurrence were analysed. Results In total, 671 patients receiving PDT were included and stratified into four clinically relevant antithrombotic treatment groups: (1) intravenous unfractionated heparin (iUFH, prophylactic dosage) (n = 101); (2) iUFH (therapeutic dosage) (n = 131); (3) antiplatelet therapy (aspirin and/or P2Y12 receptor inhibitor) with iUFH (prophylactic or therapeutic dosage) except for triple therapy (n = 290) and (4) triple therapy (DAPT with iUFH in therapeutic dosage) (n = 149). Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related. Bleeding occurrence during and after PDT was independently associated with low platelet count (OR 0.73, 95% CI [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Low platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT but not triple therapy.

scholarly journals Identifying High-Risk Individuals for Chronic Kidney Disease: Results of the CHERISH Community Demonstration Project

2018 ◽  
Vol 48 (6) ◽  
pp. 447-455 ◽  
Author(s):  
Nilka Ríos Burrows ◽  
Joseph A. Vassalotti ◽  
Sharon H. Saydah ◽  
Rebecca Stewart ◽  
Monica Gannon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Demonstration Project ◽  
Screening Criteria ◽  
State And Local

Background: Most people with chronic kidney disease (CKD) are not aware of their condition. Objectives: To assess screening criteria in identifying a population with or at high risk for CKD and to determine their level of control of CKD risk factors. Method: CKD Health Evaluation Risk Information Sharing (CHERISH), a demonstration project of the Centers for Disease Control and Prevention, hosted screenings at 2 community locations in each of 4 states. People with diabetes, hypertension, or aged ≥50 years were eligible to participate. In addition to CKD, screening included testing and measures of hemoglobin A1C, blood pressure, and lipids. ­Results: In this targeted population, among 894 people screened, CKD prevalence was 34%. Of participants with diabetes, 61% had A1C < 7%; of those with hypertension, 23% had blood pressure < 130/80 mm Hg; and of those with high cholesterol, 22% had low-density lipoprotein < 100 mg/dL. Conclusions: Using targeted selection criteria and simple clinical measures, CHERISH successfully identified a population with a high CKD prevalence and with poor control of CKD risk factors. CHERISH may prove helpful to state and local programs in implementing CKD detection programs in their communities.

scholarly journals EVALUATION OF CEFOPERAZONE/SULBACTAM AND VITAMIN K USE IN PATIENTS WITH BACTERIAL INFECTIONS

2019 ◽  
pp. 191-193 ◽  
Author(s):  
THEERAPONG SEESIN ◽  
PITIPONG PENGSUPSIN ◽  
SARAWUT WEESAPHEN ◽  
PEERAYA SRIPHONG ◽  
UAEPONG LIMPAPANASIT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Vitamin K ◽  
Bacterial Infections ◽  
Drug Allergy ◽  
High Risk Patient ◽  
General Medicine ◽  
Drug Related Problems ◽  
High Doses

Objective: The objectives of this study were to evaluate the effects of Vitamin K use for bleeding or coagulopathies prevention and to assess theoccurrence of drug-related problems in patients receiving cefoperazone/sulbactam.Methods: The prospective study was conducted between January and April 2018 at 5 general medicine wards in Mahasarakham Hospital, Thailand.Patients above 18 years of age with bacterial infections who received cefoperazone/sulbactam concurrent with Vitamin K were included. Rate ofbleeding, coagulopathies, and drug-related problems were evaluated.Results: Forty-three eligible patients enrolled in this study. Most were women (72.1%), average ages were 64.7 years old and 93.0% had comorbidities(most were diabetes, hypertension, and chronic kidney disease). High doses of cefoperazone/sulbactam have been used in 35 patients (81.4%).Gastrointestinal bleeding occurred in one patient (8.3%), 24 patients had prolonged prothrombin time (55.8%), and 8 patients had prolongedactivated partial thromboplastin time (18.6%). Anticipated risk factors were not associated with bleeding. Drug-related problems were missing ofdose adjustment for cefoperazone/sulbactam in patients with renal impairment (4.7%), drug interactions between warfarin and Vitamin K (4.7%),and drug allergy (2.3%).Conclusion: This study found that cefoperazone/sulbactam aggravated bleeding and coagulopathies despite using Vitamin K for prevention. Wesupport the use of Vitamin K for the prevention of bleeding in high-risk patient such as elderly who receive cefoperazone/sulbactam.

scholarly journals Clustering Heatmap for Visualizing and Exploring Complex and High-dimensional Data Related to Chronic Kidney Disease

2020 ◽  
Vol 9 (2) ◽  
pp. 403 ◽  
Author(s):  
Cheng-Sheng Yu ◽  
Chang-Hsien Lin ◽  
Yu-Jiun Lin ◽  
Shiyng-Yu Lin ◽  
Sen-Te Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Complex Disease ◽  
Early Recognition ◽  
Adverse Outcomes ◽  
Rapid Decline ◽  
Rapid Progression

Background: Preventive medicine and primary health care are essential for patients with chronic kidney disease (CKD) because the symptoms of CKD may not appear until the renal function is severely compromised. Early identification of the risk factors of CKD is critical for preventing kidney damage and adverse outcomes. Early recognition of rapid progression to advanced CKD in certain high-risk populations is vital. Methods: This is a retrospective cohort study, the population screened and the site where the study has been performed. Multivariate statistical analysis was used to assess the prediction of CKD as many potential risk factors are involved. The clustering heatmap and random forest provides an interactive visualization for the classification of patients with different CKD stages. Results: uric acid, blood urea nitrogen, waist circumference, serum glutamic oxaloacetic transaminase, and hemoglobin A1c (HbA1c) were significantly associated with CKD. CKD was highly associated with obesity, hyperglycemia, and liver function. Hypertension and HbA1c were in the same cluster with a similar pattern, whereas high-density lipoprotein cholesterol had an opposite pattern, which was also verified using heatmap. Early staged CKD patients who are grouped into the same cluster as advanced staged CKD patients could be at high risk for rapid decline of kidney function and should be closely monitored. Conclusions: The clustering heatmap provided a new predictive model of health care management for patients at high risk of rapid CKD progression. This model could help physicians make an accurate diagnosis of this progressive and complex disease.

scholarly journals THE PREDICTING FACTORS FOR CHRONIC KIDNEY DISEASE AMONG HIGH-RISK POPULATION IN LOWER NORTHERN, THAILAND

2020 ◽  
Vol 20 (2) ◽  
pp. 268-275
Author(s):  
Primprapha Konkaew ◽  
Pattama Suphunnakul
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Health Literacy ◽  
High Risk ◽  
Kidney Disease ◽  
Sampling Technique ◽  
High Risk Population ◽  
Cross Sectional ◽  
Risk Population ◽  
High Risk Populations

This research aimed to explore the factors predicting chronic kidney disease (CKD) in the high-risk population. A cross-sectional study had been conducted in the high-risk populations investigated with and without CKD were the participants. A total of 1,463 samples was enrolled by a multistage sampling technique was used to recruit participants from five provinces in the lower northern of Thailand. Data were collected using a questionnaire and analyzed with descriptive statistics, and binary logistic regression. The results were revealed the risk factors affecting CKD including aged, dyslipidemia, being ill of diabetes mellitus, being unable to control blood pressure, being unable to control blood sugar level, taking add more salty seasoning to the cooked food, cooking with sodium salt over the prescribed amount, using the non-steroidal anti-inflammatory drug, lack of exercise, herbal plants consumption as drugs that are toxic to the kidney, edema, foamy urine, and nocturia. All risk factors were able to co-predict the risk to CKD about 83.2% at the 0.05 level of significance. Therefore, to prevent early states with CKD in the high-risk populations, the focus should be on encouraging health literacy because health literary it has a positive relationship with health-promoting behaviors. The health care provider needs to concentrate on increasing health literacy for self– management with them.

scholarly journals Seizures Among Patients with Brain Metastases: A Population- and Institutional-level Analysis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011459
Author(s):  
Nayan Lamba ◽  
Paul J. Catalano ◽  
Daniel N. Cagney ◽  
Daphne A. Haas-Kogan ◽  
Ellen J. Bubrick ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Brain Metastases ◽  
Tumor Type ◽  
Urban Residence ◽  
Stereotactic Radiation ◽  
Medicare Data ◽  
Increased Risk ◽  
Multivariable Regression

Objective:To test the hypothesis that subets of patients with brain metastases (BrM) without seizures at intracranial presentation are at increased risk for developing seizures, we characterized the incidence and risk factors for seizure development among seizure-naïve patients with brain metastases (BrM).Methods:We identified 15,863 and 1,453 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham and Women’s Hospital/Dana Farber Cancer Institute (2000-2015) institutional data, respectively. Cumulative incidence curves and Fine/Gray’s competing risks regression were used to characterize seizure incidence and risk factors, respectively.Results:Among SEER-Medicare and institutional patients, 1,588 (10.0%) and 169 (11.6%) developed seizures, respectively. On multivariable regression of the SEER-Medicare cohort, African American vs. White race (hazard ratio [HR]=1.45 [95% CI, 1.22-1.73], p<0.001), urban vs. non-urban residence (HR=1.41 [95% CI, 1.17-1.70], p<0.001), melanoma vs. NSCLC as primary tumor type (HR=1.44 [95% CI, 1.20-1.73], p<0.001), and receipt of brain-directed stereotactic radiation (HR=1.67 [95% CI, 1.44-1.94], p<0.001) were associated with greater seizure risk. On multivariable regression of the institutional cohort, melanoma vs. NSCLC (HR=1.70 [95% CI, 1.09-2.64], p=0.02), >4 BrM at diagnosis (HR=1.60 [95% CI, 1.12-2.29], p=0.01), presence of BrM in a high-risk location (HR=3.62 [95% CI, 1.60-8.18], p=0.002), and lack of local brain-directed therapy (HR=3.08 [95% CI, 1.45-6.52], p=0.003) were associated with greater risk of seizure development.Conclusions:The role of antiseizure medications among select patients with BrM should be re-explored, particularly for those with melanoma, a greater intracranial disease burden, and/or BrM in high-risk locations.

scholarly journals The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening.

2019 ◽  
Author(s):  
Frederick C. F. Otieno ◽  
Elijah N Ogola ◽  
Mercy W Kimando ◽  
Ken K Mutai
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
County Hospital ◽  
End Stage Kidney Disease ◽  
Long Duration ◽  
End Stage

Abstract Background: Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods: A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results: A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. Conclusion: Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

scholarly journals The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening

2020 ◽  
Author(s):  
Frederick C. F. Otieno ◽  
Elijah N Ogola ◽  
Mercy W Kimando ◽  
Ken K Mutai
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
County Hospital ◽  
End Stage Kidney Disease ◽  
Long Duration ◽  
End Stage

Abstract Background : Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances their cardiovascular risk and diseases, and a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that optimizes outcomes, including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods : A cross-sectional study was conducted at the out-patient of Nyeri County hospital where 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done. A spot sample of urine was obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results : A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. Conclusion : Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

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