scholarly journals Factors influencing length of intensive care unit stay following a bidirectional cavopulmonary shunt

2021 ◽  
Author(s):  
Takashi Kido ◽  
Masamichi Ono ◽  
Lisa Anderl ◽  
Melchior Burri ◽  
Martina Strbad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Pulmonary Artery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Icu Stay ◽  
Prolonged Icu Stay ◽  
Cavopulmonary Shunt

Abstract OBJECTIVES The goal of this study was to identify the risk factors for prolonged length of stay (LOS) in the intensive care unit (ICU) after a bidirectional cavopulmonary shunt (BCPS) procedure and its impact on the number of deaths. METHODS In total, 556 patients who underwent BCPS between January 1998 and December 2019 were included in the study. RESULTS Eighteen patients died while in the ICU, and 35 died after discharge from the ICU. Reduced ventricular function was significantly associated with death during the ICU stay (P = 0.002). In patients who were discharged alive from the ICU, LOS in the ICU [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02–1.06; P < 0.001] and a dominant right ventricle (HR 2.41, 95% CI 1.03–6.63; P = 0.04) were independent risk factors for death. Receiver operating characteristic analysis identified a cut-off value for length of ICU stay of 19 days. Mean pulmonary artery pressure (HR 1.03, 95% CI 1.01–1.05; P = 0.04) was a significant risk factor for a prolonged ICU stay. CONCLUSIONS Prolonged LOS in the ICU with a cut-off value of 19 days after BCPS was a significant risk factor for mortality. High pulmonary artery pressure at BCPS was a significant risk factor for a prolonged ICU stay.

scholarly journals Risk Factors for Delirium and Cognitive Decline Following Coronary Artery Bypass Grafting Surgery: A Systematic Review and Meta‐Analysis

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Danielle Greaves ◽  
Peter J. Psaltis ◽  
Daniel H. J. Davis ◽  
Tyler J. Ross ◽  
Erica S. Ghezzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Significant Risk ◽  
Bypass Grafting ◽  
Intubation Time

Background Coronary artery bypass grafting (CABG) is known to improve heart function and quality of life, while rates of surgery‐related mortality are low. However, delirium and cognitive decline are common complications. We sought to identify preoperative, intraoperative, and postoperative risk or protective factors associated with delirium and cognitive decline (across time) in patients undergoing CABG. Methods and Results We conducted a systematic search of Medline, PsycINFO, EMBASE, and Cochrane (March 26, 2019) for peer‐reviewed, English publications reporting post‐CABG delirium or cognitive decline data, for at least one risk factor. Random‐effects meta‐analyses estimated pooled odds ratio for categorical data and mean difference or standardized mean difference for continuous data. Ninety‐seven studies, comprising data from 60 479 patients who underwent CABG, were included. Moderate to large and statistically significant risk factors for delirium were as follows: (1) preoperative cognitive impairment, depression, stroke history, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) score, (2) intraoperative increase in intubation time, and (3) postoperative presence of arrythmia and increased days in the intensive care unit; higher preoperative cognitive performance was protective for delirium. Moderate to large and statistically significant risk factors for acute cognitive decline were as follows: (1) preoperative depression and older age, (2) intraoperative increase in intubation time, and (3) postoperative presence of delirium and increased days in the intensive care unit. Presence of depression preoperatively was a moderate risk factor for midterm (1–6 months) post‐CABG cognitive decline. Conclusions This meta‐analysis identified several key risk factors for delirium and cognitive decline following CABG, most of which are nonmodifiable. Future research should target preoperative risk factors, such as depression or cognitive impairment, which are potentially modifiable. Registration URL: https://www.crd.york.ac.uk/prosp​ero/ ; Unique identifier: CRD42020149276.

scholarly journals Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

2020 ◽  
Author(s):  
Likui Fang ◽  
Guocan Yu ◽  
Jinpeng Huang ◽  
Wuchen Zhao ◽  
Bo Ye
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Postoperative Complication ◽  
Constrictive Pericarditis ◽  
Functional Class ◽  
Cox Regression Analysis ◽  
Nyha Functional Class ◽  
Icu Stay ◽  
Prolonged Icu Stay

Abstract Purpose The risk factors of postoperative outcomes after pericardiectomy in tuberculous constrictive pericarditis have still been unclear. This study aimed to investigate the predictors of postoperative complication and prolonged intensive care unit (ICU) stay in the patients with tuberculous constrictive pericarditis undergoing pericardiectomy. Methods A total of 88 patients with tuberculous constrictive pericarditis undergoing pericardiectomy were retrospectively enrolled. Logistic regression and Cox regression analysis were performed to identify the predictors of postoperative complication and prolonged ICU stay, respectively. Results All patients underwent complete pericardiectomy and 35 (39.8%) had postoperative complications with no mortality within 30 days after surgery. Postoperative complication delayed postoperative ICU stay (P < 0.001), duration of chest drainage (P < 0.001) and postoperative hospital stay (P < 0.001). Preoperative NYHA functional class (P = 0.004, OR 4.051, 95%CI 1.558–10.533) and preoperative central venous pressure (CVP) (P = 0.031, OR 1.151, 95%CI 1.013–1.309) were independent risk factors of postoperative complication. Postoperative complication (P < 0.001, HR 4.132, 95%CI 2.217–7.692) was the independent risk factor for prolonged ICU stay. Conclusion Complete pericardiectomy was associated with high risk of postoperative complication in tuberculous constrictive pericarditis. Poor preoperative NYHA functional class and high preoperative CVP were shown to predict postoperative complication which was the predictor of prolonged ICU stay.

Risk Stratification for the Intensive Care Unit Following Pancreaticoduodenectomy

2020 ◽  
Author(s):  
Steffen Deichmann ◽  
Uwe Ballies ◽  
Ekaterina Petrova ◽  
Louisa Bolm ◽  
Kim Honselmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Operation Time ◽  
Multivariate Regression Analysis ◽  
Icu Stay ◽  
Efficient Planning ◽  
Elevated Creatinine

Abstract Introduction In view of the limited capacities in intensive care units and the increasing economic burden, identification of risk factors could allow better and more efficient planning. Therefore, the aim of this study was to assess independent risk factors for the duration of intensive care unit stay after pancreatoduodenectomy (PD). Methods 147 patients who underwent pancreatoduodenectomy in the time period from 2013 to 2015 were identified from a prospective database and a retrospective analysis was performed. The primary endpoint was length of time spent in the ICU. A retrograde analysis was performed using univariate and multivariate regression analysis. All pre-, intra- and postoperative parameters were considered in the analysis. Results The median time spent in the intensive care unit (ICU) is one day. The univariate analysis demonstrated increased pack years, cerebrovascular events, anticoagulation, elevated creatinine and CA 19-9 as preoperative risk factors. In multivariate analysis, antihypertensive medication (AHT; OR 2.46; 95% CI 1.57 – 3.87; p = 0.05), operation time (OR 1.01; 95% CI 1.00 – 1.01; p = 0.03), extended LAD (OR 5.46; 95% CI 2.77 – 10.75; p = 0.01) and severe PPH (OR 4.01; 95% CI 2.07 – 7.76; p = 0.04) are significant risk factors for longer ICU stay. Discussion Patients with cardiovascular risk factors and elevated preoperative creatinine level are at greater risk for a prolonged ICU stay. Risk and benefit of an extended LAD should be weighed during the operation. Median duration on ICU/IMC after PD is one day or less for patients without risk factors. Whether routine monitoring in the ICU/IMC after PD is necessary must be clarified in further studies.

scholarly journals Carbapenem resistant Acinetobacter Species infection in intensive care unit: The outcome and risk factors of mortality

2019 ◽  
Vol 19 (1) ◽  
pp. 98-104
Author(s):  
Wan Mohd Nazaruddin Wan Hassan ◽  
Mohd Samsul Puzizer ◽  
Zakuan Zaini Deris ◽  
Rhendra Hardy Mohamed Zaini
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Independent Risk Factor ◽  
Significant Risk ◽  
Icu Mortality ◽  
Acinetobacter Species ◽  
Carbapenem Resistant ◽  
Acinetobacter Spp

Objective: Acinetobacter spp. infection is a challenging problem in intensive care unit (ICU) because of its multi-drug resistant (MDR) in nature to antibiotic therapy including broadspectrum carbapenem group. The aims of the study were to determine the risk factors of mortality and the outcome of carbapenem-resistant Acinetobacter spp. (CRAs) infection in our ICU. Materials and Method: This is a retrospective, cross-sectional study, done in 2 years from January 2008 to December 2009. The list of the patients was obtained from hospital nosocomial infection surveillance unit and ICU infection record. The data of the patients were subsequently reviewed from their respective medical records after approval from university ethics committee and hospital medical record unit. Results and Discussion: A total of 92 patients were reviewed and only 54 were included and analyzed. The prevalence of CRAs over 24 months was 7.3%. Mortality was 50% among the reviewed patients and this contributed 13.6 % of the total ICU mortality. Age was significantly different between survival and non-survival groups; 43.07 (21.09) vs. 57.04 ± 14.33 year old (p = 0.006). Age was also the only significant independent risk factor associated with mortality in CRAs (adjusted OR = 1.045, 95% CI: 1.010, 1.081, p = 0.011). There were no other significant risk factors. The length of ICU stay was 17.00 (13.58) days whereas length of hospital stay was 41.37 (27.66) days in survival group. Conclusion: CRAs caused 13.6% of total ICU mortality and older age group was the independent risk factor for mortality. Bangladesh Journal of Medical Science Vol.19(1) 2020 p.98-104

scholarly journals Microbial findings and the role of difficult-to-treat pathogens in patients with periprosthetic infection admitted to the intensive care unit

2020 ◽  
Vol 12 (3) ◽  
Author(s):  
Christopher Ull ◽  
Emre Yilmaz ◽  
Hinnerk Baecker ◽  
Thomas Schildhauer ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Joint Infection ◽  
Candida Spp ◽  
Icu Stay ◽  
Tertiary Healthcare ◽  
Prolonged Icu Stay

Little is known about patients with Periprosthetic Joint Infection (PJI) admitted to the Intensive Care Unit (ICU). The purpose of this study was threefold: i) To report the microbiological findings of ICUpatients with PJI. ii) To compare the clinical data between Difficult-To-Treat (DTT) and non-DTT PJI. iii) To identify risk factors for mortality. This is a retrospective study from a tertiary healthcare center in Germany from 2012-2016. A total of 124 patients with 169 pathogens were included. The most common bacteria were Staphyloccous aureus (26.6%), Staphyloccus epidermidis (12.4%), Enterococci ssp. and Escherichia coli (respectively 9.4%). DTT PJI was diagnosed in 28 patients (22.6%). The main pathogens of DTT PJI were Staphylococus epidermidis (14.5%), Escherichia coli (12.7%), Staphylococcus aureus and Candida spp. (respectively 9.1%). Polymicrobial PJI, number of pathogens, ICU stay and mortality were significantly differrent between DTT PJI and non-DTT PJI (p≤0.05). Multivariate logistic regression identified prolonged ICU stay and DTT PJI as risk factors for mortality. In conclusion, we suggest, that the term of DTT pathogens is useful for the intensivist to assess the clinical outcome in ICU-patients with PJI.

scholarly journals IMPLICATIONS OF ANTIBIOTHERAPY IN CLOSTRIDIUM DIFFICILE INFECTION TO HOSPITALIZED PATIENTS IN DOLJ COUNTY (ROMANIA)

2017 ◽  
Vol 20 (2) ◽  
pp. 75-79
Author(s):  
Livia Dragonu ◽  
◽  
Augustin Cupsa ◽  
Irina Niculescu ◽  
Lucian Giubelan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Antibiotic Treatment ◽  
Clostridium Difficile Infection ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Significant Risk Factor

Objectives. The paper presents the role of the antibiotic treatment and of the favoring factors independent on the antibiotherapy, identified in the occurrence of Clostridium difficile infection (CDI) in hospitalized cases in Dolj County. Material and method. Two groups of patients were analyzed: the CDI AB group (178 cases of CDI that received antibiotic treatment) and the CDI non AB group (36 CDI cases which did not receive antibiotic treatment) recorded between July 2014 and December 2016). Results. The antibiotherapy was a significant risk factor, registered at 83.2% of the cases. The classes of antibiotics associated with the onset of CDI were cephalosporins (73.5% of cases), quinolones (24.2%), penicillins (13.4%), tuberculostatics (6.1%), carbapenems (5.6%). The cases came from the general surgery sections (25.2%), pneumophtiziology (16.8%), intensive care (13.5%), neurology (12.1%), nephrology (6.1%), orthopedics (6.1%), cardiology (4.2%), plastic surgery (4.2%), urology (3.7%). CDI non AB recorded a higher percentage compared to CDI AB in the Intensive care sections (30.6% versus10.1%). The comparative analysis of the characteristics of the patients with CDI AB and CDI non AB did not reveal significant differences linked to the age, sex, interval between admission and onset of the symptoms, recent gastrointestinal surgery or taking antacids. Conclusions. The antibiotherapy is an important risk factor for CDI, cephalosporins and quinolones being frequently-involved. Being admitted to the intensive care unit and the severity of the underlying conditions had a significant role in the appearance of CDI in patients without exposure to antibiotics.

Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

2020 ◽  
pp. 1-7
Author(s):  
Stephanie M. Cabral ◽  
Katherine E. Goodman ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Larry S. Magder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Community Hospital ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bivariate Analysis ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

scholarly journals Designing a bed-side system for predicting length of stay in a neonatal intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Harpreet Singh ◽  
Su Jin Cho ◽  
Shubham Gupta ◽  
Ravneet Kaur ◽  
S. Sunidhi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Financial Burden ◽  
Significant Risk ◽  
Model Performance ◽  
Significant Risk Factor ◽  
Validation Dataset ◽  
Patient Records

AbstractIncreased length of stay (LOS) in intensive care units is directly associated with the financial burden, anxiety, and increased mortality risks. In the current study, we have incorporated the association of day-to-day nutrition and medication data of the patient during its stay in hospital with its predicted LOS. To demonstrate the same, we developed a model to predict the LOS using risk factors (a) perinatal and antenatal details, (b) deviation of nutrition and medication dosage from guidelines, and (c) clinical diagnoses encountered during NICU stay. Data of 836 patient records (12 months) from two NICU sites were used and validated on 211 patient records (4 months). A bedside user interface integrated with EMR has been designed to display the model performance results on the validation dataset. The study shows that each gestation age group of patients has unique and independent risk factors associated with the LOS. The gestation is a significant risk factor for neonates < 34 weeks, nutrition deviation for < 32 weeks, and clinical diagnosis (sepsis) for ≥ 32 weeks. Patients on medications had considerable extra LOS for ≥ 32 weeks’ gestation. The presented LOS model is tailored for each patient, and deviations from the recommended nutrition and medication guidelines were significantly associated with the predicted LOS.

Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study

2021 ◽  
Vol 74 (6) ◽  
Author(s):  
Caroline Gonçalves Pustiglione Campos ◽  
Aline Pacheco ◽  
Maria Dagmar da Rocha Gaspar ◽  
Guilherme Arcaro ◽  
Péricles Martim Reche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Diagnostic Criteria ◽  
Statistical Tests ◽  
Significant Risk ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia

ABSTRACT Objectives: to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. Methods: retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. Results: the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. Conclusions: patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.

scholarly journals Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

2021 ◽  
Vol 41 (1) ◽  
pp. e17-e23
Author(s):  
Barbara M. Geven ◽  
Jolanda M. Maaskant ◽  
Catherine S. Ward ◽  
Job B.M. van Woensel
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Cumulative Dose ◽  
Withdrawal Syndrome ◽  
Significant Risk ◽  
Pediatric Intensive Care ◽  
Significant Risk Factor ◽  
Preventive Effect ◽  
Iatrogenic Withdrawal Syndrome

Background Iatrogenic withdrawal syndrome is a well-known adverse effect of sedatives and analgesics commonly used in patients receiving mechanical ventilation in the pediatric intensive care unit, with an incidence of up to 64.6%. When standard sedative and analgesic treatment is inadequate, dexmedetomidine may be added. The effect of supplemental dexmedetomidine on iatrogenic withdrawal syndrome is unclear. Objective To explore the potentially preventive effect of dexmedetomidine, used as a supplement to standard morphine and midazolam regimens, on the development of iatrogenic withdrawal syndrome in patients receiving mechanical ventilation in the pediatric intensive care unit. Methods This retrospective observational study used data from patients on a 10-bed general pediatric intensive care unit. Iatrogenic withdrawal syndrome was measured using the Sophia Observation withdrawal Symptoms-scale. Results In a sample of 102 patients, the cumulative dose of dexmedetomidine had no preventive effect on the development of iatrogenic withdrawal syndrome (P = .19). After correction for the imbalance in the baseline characteristics between patients who did and did not receive dexmedetomidine, the cumulative dose of midazolam was found to be a significant risk factor for iatrogenic withdrawal syndrome (P &lt; .03). Conclusion In this study, supplemental dexmedetomidine had no preventive effect on iatrogenic withdrawal syndrome in patients receiving sedative treatment in the pediatric intensive care unit. The cumulative dose of midazolam was a significant risk factor for iatrogenic withdrawal syndrome.

Sign in / Sign up

Export Citation Format

Share Document