744. Antifungal De-escalation Strategy in ICU Patients: Clinical Success and Cost Savings

Abstract Background The incidence of Candida spp infections in critically ill patients is increasing. Initial broad-spectrum empiric antifungal agents (e.g., echinocandins), followed by immediate switching to fluconazole if isolates are fluconazole sensitive could be a low-cost de-escalation strategy. The aim of this study was to evaluate the budget impact of the de-escalation strategy using fungostatin in ICU patients and clinical effectiveness. Methods This prospective study was conducted in a 30-bed mixed ICU, from January 2015 through January 2017. Critically ill patients with invasive candidiasis were placed on initial empiric broad-spectrum antifungal agents either on echinocandins or liposomal amphoteric B. De-escalation to fungostatin strategy at day 3 vs. patients without de-escalation were compared. Clinical characteristics and the presence of clinical success by the eighth-day of treatment and 28-day outcome were evaluated. Clinical success was defined as the complete eradication of Candida spp. in blood cultures. Economic outcomes included budget impact was also evaluated. Results Forty-seven ICU patients with documented invasive candidemia enrolled and received empiric broad-spectrum antifungal agents with either echinocandins or liposomal amphotericin B. Of those, 22 (47%) were eligible for de-escalation at day 3 to fungostatin based on susceptibility test for fungi. Specific Candida species isolated in the de-escalation group were C. albicans (14, 64%), and non-C. albicans (8, 36%). Interestingly 6/22 (27%) invasive candidemia de-escalated cases relapsed by day 8 of initiation of the empiric therapy, vs. 2/25 (8%) of the control group (P = 0.12). Survival rates at day 28 were not statistically significant among the two groups [15/22 (68%) vs. 11/25 (44%), P = 0.12]. The budget impact of using de-escalation was greater, producing cost savings of €3,200 per patient but did not translate into significant clinical and mycological success. Conclusion Critically ill patients who had received empiric antifungal therapy for documented candidemia and underwent de-escalation from echinocandins or liposomal ambisome B to fungostatin had a potential economic cost–benefit but did not associate with significantly improved clinical success rates. Disclosures All authors: No reported disclosures.

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Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

Journal of Fungi ◽

10.3390/jof7050376 ◽

2021 ◽

Vol 7 (5) ◽

pp. 376

Author(s):

Tobias Lahmer ◽

Gonzalo Batres Baires ◽

Roland M. Schmid ◽

Johannes R. Wiessner ◽

Jörg Ulrich ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Ascites Fluid ◽

Candida Spp ◽

Fungal Peritonitis ◽

Penetration Ratio ◽

Threatening Condition ◽

Liquid Chromatography Tandem Mass ◽

Life Threatening ◽

Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

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Effect of applying nurses driven electrolyte repletion protocol on electrolyte disturbances control among critically ill patients

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n4p72 ◽

2020 ◽

Vol 10 (4) ◽

pp. 72

Author(s):

Mohamed E. Abdelgawad ◽

Nadia T. Ahmed ◽

Ahmed M. Elmenshawy

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Improve Patient Care ◽

University Hospital ◽

Treatment Modalities ◽

Control Group ◽

Electrolyte Disturbances ◽

Electrolyte Loss

Background and objective: Electrolyte disturbances remain a common lifesaving issue in the intensive care units. They are associated with increased morbidity and mortality. They are mostly resulted secondary to critical illness itself or associated treatment modalities. Therefore, electrolytes repletion should be done effectively and timely. This could be ensured using nurse driven protocols rather than traditional methods of repletion. These protocols are nurse initiated and collaboratively developed. They have been shown to improve patient care outcomes through the provision of high quality care. They are increasingly being used in the critical care setting. Objective: Determine the effect of applying nurses driven electrolytes repletion protocol on electrolytes disturbance control among critically ill patients.Methods: Quasi experimental research design was used. Sixty two critically ill patients with electrolytes loss were enrolled in the study at Alexandria Main University Hospital intensive care units, Egypt. All episodes of electrolyte loss were evaluated. Repletion of electrolyte loss was done according to unit routine for the control group and nurses driven electrolytes repletion protocol for the study group. Episodes of electrolyte disturbances, adverse events and timing of repletion were evaluated.Results: Neurological disorders represent the most encountered diagnosis. The most common cause of electrolyte loss in was the use of diuretics. Furthermore, there was a highly statistical difference between the two groups as regard electrolytes levels, effectiveness and timing of replacement.Conclusions: Application of nurses driven electrolyte repletion protocol resulted in improvements in the effectiveness and timeliness of electrolyte replacement.

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Brain Death-Induced Inflammatory Activity is Similar to Sepsis-Induced Cytokine Release

Cell Transplantation ◽

10.1177/0963689718785629 ◽

2018 ◽

Vol 27 (10) ◽

pp. 1417-1424 ◽

Cited By ~ 2

Author(s):

Patrícia Schwarz ◽

Geisiane Custódio ◽

Jakeline Rheinheimer ◽

Daisy Crispim ◽

Cristiane B. Leitão ◽

...

Keyword(s):

Brain Death ◽

Critically Ill ◽

Critically Ill Patients ◽

Release Kinetics ◽

Magnetic Bead ◽

Control Group ◽

Cytokine Release ◽

Plasma Cytokine ◽

Ifn Γ ◽

Brain Dead

Brain death (BD) is associated with a systemic inflammation leading to worse graft outcomes. This study aimed to compare plasma cytokine values between brain-dead and critically ill patients, including septic and non-septic controls, and evaluate cytokine release kinetics in BD. Sixteen brain-dead and 32 control patients (16 with and 16 without sepsis) were included. Plasma cytokines were measured by magnetic bead assay after the first clinical exam consistent with BD and every 6 hours thereafter, and at the time of study entry in the control group. The values for IL-8 and IFN-γ were higher in brain-dead and septic patients than in non-septic patients [IL-8: 80.3 (18.7–169.6) vs. 68.2 (22.4–359.4) vs. 16.4 (9.2–42.7) pg/mL; P = 0.006; IFN-γ: 2.8 (1.6-6.1) vs. 3.4 (1.2–9.0) vs. 0.5 (0.5–1.8) pg/mL; P = 0.012]. TNF showed a clear tendency to increase in brain-dead patients [2.7 (1.0–4.8) vs. 1.0 (1.0–5.6) vs. 1.0 (1.0–1.0) pg/mL; P = 0.051], and IL-6 values were higher in brain-dead patients than in non-septic controls [174.5 (104.9–692.5) vs. 13.2 (7.3–38.6) pg/mL; P = 0.002]. These differences remained even after excluding brain-dead patients who also had sepsis ( n = 3). IL-1β and IL-10 values increased from baseline to time point 2 (∼6 hours later) [IL-1β: 5.39 (1.93–16.89) vs. 7.11 (1.93–29.13) pg/mL; P = 0.012; IL-10: 8.78 (3.62–16.49) vs. 15.73 (5.49–23.98) pg/mL; P = 0.009]. BD-induced and sepsis-induced plasma cytokine values were similarly high, and both were higher than the observed in non-septic critically ill patients.

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Kinetic Patterns of Candida albicans Germ Tube Antibody in Critically Ill Patients: Influence on Mortality

Clinical and Vaccine Immunology ◽

10.1128/cvi.00183-09 ◽

2009 ◽

Vol 16 (10) ◽

pp. 1527-1528 ◽

Cited By ~ 20

Author(s):

Rafael Zaragoza ◽

Javier Pemán ◽

Guillermo Quindós ◽

Jose R. Iruretagoyena ◽

María S. Cuétara ◽

...

Keyword(s):

Candida Albicans ◽

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Germ Tube ◽

Antifungal Agents ◽

Mortality Rates ◽

Antifungal Treatment ◽

Lower Mortality

ABSTRACT The influence of kinetic patterns of Candida albicans germ tube antibodies (CAGTA) on mortality was analyzed in six intensive care units. Statistically significant lower mortality rates were found in patients with patterns of increasing CAGTA titers who had been treated with antifungal agents. Thus, antifungal treatment should be considered when CAGTA titers are increasing in critically ill patients.

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The effects of gastrointestinal function on the incidence of ventilator-associated pneumonia in critically ill patients

Open Medicine ◽

10.1515/med-2018-0082 ◽

2018 ◽

Vol 13 (1) ◽

pp. 556-561

Author(s):

Yuanqiang Lin ◽

Zhixia Sun ◽

Hui Wang ◽

Meihan Liu

Keyword(s):

Gastric Juice ◽

Critically Ill ◽

Critically Ill Patients ◽

Ph Value ◽

Serum Levels ◽

Control Group ◽

Gastrointestinal Function ◽

Ventilator Associated Pneumonia ◽

Observation Group ◽

Gastric Feeding

AbstractObjectiveTo investigate the effect of gastrointestinal function on the incidence of ventilator-associated pneumonia (VAP) in critically ill patients.MethodsFrom August 2012 to June 2016, 160 critically ill patients in the ICU (Intensive Care Unit) of our hospital were selected as the research group; patients were divided equally into an observation group and a control group, 80 patients in each group, based on the random draw envelope principle. The control group was given a nasogastric tube for gastric feeding, the observation group was given a dual lumen gastrointestinal enteral device for gastric feeding; the two groups’ enteral nutrition observation time was 7d; any changes in patient condition and prognosis were recorded.ResultsThe pH value of gastric juice in the control group and the observation group was 6.13±1.38 and 4.01±1.83, respectively: the pH for the observation group was significantly lower than that of the control group (t=4.982, P<0.05). The incidence of VAP in the observation group and the control group was 2.5% and 12.5%, respectively: the VAP for the observation group was significantly lower than that of the control group (P<0.05). The serum levels of pre-albumin and albumin after feeding in the two groups were significantly higher than before feeding (P<0.05); the serum levels of pre-albumin and albumin in the observation group after feeding were significantly higher than those in the control group (P<0.05). The mechanical ventilation time and ICU length of stay in the observation group were 9.12±2.13 days and 12.76±1.98 days, respectively, significantly lower than those of the control group of 10.56±2.89 days and 16.33±2.11 days (P<0.05).ConclusionObstacles to gastrointestinal function in critically ill ICU patients are common; enteral gastric feeding by dual lumen gastrointestinal for can improve the patient’s nutritional status, promote and maintain the normal pH value of gastric juice, thereby reducing the incidence of VAP through rehabilitation of patients.

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Impact of ascorbic acid in reducing the incidence of vancomycin associated nephrotoxicity in critically ill patients: A preliminary randomized controlled trial

F1000Research ◽

10.12688/f1000research.55619.1 ◽

2021 ◽

Vol 10 ◽

pp. 929

Author(s):

Nouran Hesham El-Sherazy ◽

Naglaa Samir Bazan ◽

Sara Mahmoud Shaheen ◽

Nagwa A. Sabri

Keyword(s):

Ascorbic Acid ◽

Critically Ill ◽

Critically Ill Patients ◽

Statistical Significance ◽

Intervention Group ◽

Secondary Outcome ◽

Control Group ◽

Control Groups ◽

The Absolute ◽

And Control

Background Antioxidants show nephroprotective effect against vancomycin associated nephrotoxicity (VAN) in animals. This study aimed to assess the ascorbic acid nephro-protective role against VAN clinically. Methods Forty-one critically ill patients were randomly assigned to one of two groups: intervention group (vancomycin IV plus ascorbic acid, n=21) or control group (vancomycin IV only, n=20). Primary outcomes were the incidence of VAN and the absolute change in creatinine parameters, while mortality rate was the secondary outcome. Nephrotoxicity was defined as an increase in serum creatinine (S.cr) by at least 0.5 mg/dL or 50% of baseline for at least two successive measurements. This study is registered at Clinicaltrials.gov (NCT03921099), April 2019. Results Mean absolute S.cr increase was significant when compared between both groups, P-value = 0.036, where S.cr increased by 0.05(0.12) and 0.34(0.55) mg/dL in the intervention and control groups, respectively. Mean absolute Cr.cl decline was significant when compared between both groups, P-value = 0.04, where Cr.cl was decreased by 5.9(17.8) and 22.3(30.4) ml/min in the intervention and control groups, respectively. Incidence of VAN was 1/21(4.7%) versus 5/20(25%) in the intervention and control groups, respectively (RR: 0.19; CI: 0.024–1.49; P-value = 0.093). Mortality was higher in the control group; however, it was not statistically significant, P-value = 0.141. Conclusion Co-administration of ascorbic acid with vancomycin preserved renal function and reduced the absolute risk of VAN by 20.3%, however, the reduction in VAN incidence didn’t reach statistical significance level. Further large multicenter prospective trials are recommended.

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Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses to Reduce Nonbeneficial Intensive Care Unit Treatments: Protocol for a Multicenter Quality Improvement Study (Preprint)

10.2196/preprints.16301 ◽

2019 ◽

Author(s):

Dong Chang ◽

Jennifer Parrish ◽

Nader Kamangar ◽

Janice Liebler ◽

May Lee ◽

...

Keyword(s):

Intensive Care Unit ◽

Critically Ill ◽

Critically Ill Patients ◽

Decision Makers ◽

Care Planning ◽

Improvement Strategy ◽

Icu Patients ◽

Family Meetings ◽

Planning Approach ◽

Icu Physicians

BACKGROUND Invasive intensive care unit (ICU) treatments for patients with advanced medical illnesses and poor prognoses may prolong suffering with minimal benefit. Unfortunately, the quality of care planning and communication between clinicians and critically ill patients and their families in these situations are highly variable, frequently leading to overutilization of invasive ICU treatments. Time-limited trials (TLTs) are agreements between the clinicians and the patients and decision makers to use certain medical therapies over defined periods of time and to evaluate whether patients improve or worsen according to predetermined clinical parameters. For patients with advanced medical illnesses receiving aggressive ICU treatments, TLTs can promote effective dialogue, develop consensus in decision making, and set rational boundaries to treatments based on patients’ goals of care. OBJECTIVE The aim of this study will be to examine whether a multicomponent quality-improvement strategy that uses protocoled TLTs as the default ICU care-planning approach for critically ill patients with advanced medical illnesses will decrease duration and intensity of nonbeneficial ICU care without changing hospital mortality. METHODS This study will be conducted in medical ICUs of three public teaching hospitals in Los Angeles County. In Aim 1, we will conduct focus groups and semistructured interviews with key stakeholders to identify facilitators and barriers to implementing TLTs among ICU patients with advanced medical illnesses. In Aim 2, we will train clinicians to use protocol-enhanced TLTs as the default communication and care-planning approach in patients with advanced medical illnesses who receive invasive ICU treatments. Eligible patients will be those who the treating ICU physicians consider to be at high risk for nonbeneficial treatments according to guidelines from the Society of Critical Care Medicine. ICU physicians will be trained to use the TLT protocol through a curriculum of didactic lectures, case discussions, and simulations utilizing actors as family members in role-playing scenarios. Family meetings will be scheduled by trained care managers. The improvement strategy will be implemented sequentially in the three participating hospitals, and outcomes will be evaluated using a before-and-after study design. Key process outcomes will include frequency, timing, and content of family meetings. The primary clinical outcome will be ICU length of stay. Secondary outcomes will include hospital length of stay, days receiving life-sustaining treatments (eg, mechanical ventilation, vasopressors, and renal replacement therapy), number of attempts at cardiopulmonary resuscitation, frequency of invasive ICU procedures, and disposition from hospitalization. RESULTS The study began in August 2017. The implementation of interventions and data collection were completed at two of the three hospitals. As of September 2019, the study was at the postintervention stage at the third hospital. We have completed focus groups with physicians at each medical center (N=29) and interviews of family members and surrogate decision makers (N=18). The study is expected to be completed in the first quarter of 2020, and results are expected to be available in mid-2020. CONCLUSIONS The successful completion of the aims in this proposal may identify a systematic approach to improve communication and shared decision making and to reduce nonbeneficial invasive treatments for ICU patients with advanced medical illnesses. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16301

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Low albumin levels are associated with poorer outcomes in a case series of COVID-19 patients in Spain: a retrospective cohort study

10.1101/2020.05.07.20094987 ◽

2020 ◽

Cited By ~ 2

Author(s):

Roberto de la Rica ◽

Marcio Borges ◽

María Aranda ◽

Alberto del Castillo ◽

Antonia Socias ◽

...

Keyword(s):

Disease Severity ◽

Critically Ill ◽

Critically Ill Patients ◽

Case Series ◽

Hospitalized Patients ◽

University Hospital ◽

Limited Information ◽

Icu Patients ◽

Epidemiological Features ◽

Initial Symptoms

ABSTRACTOBJECTIVETo describe the clinical characteristics and epidemiological features of severe (non-ICU) and critically patients (ICU) with COVID-19 at triage, prior hospitalization, in one of the main hospitals in The Balearic Islands health care system.DESIGNRetrospective observational studySETTINGSon Llatzer University Hospital in Palma de Mallorca (Spain)PARTICIPANTSAmong a cohort of 52 hospitalized patients as of 31 March 2020, 48 with complete demographic information and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test, were analyzed. Data were collected between March 15th, 2020, and March 31th 2020, inclusive of these dates.MAIN OUTCOMESClinical, vital signs and routine laboratory outcomes at the time of hospitalization, including symptoms reported prior to hospitalization. Demographics and baseline comorbidities were also collected. Mortality was reported at the end of the study.RESULTS48 patients (27 non-ICU and 21 ICU) resident in Mallorca, Spain (mean age, 66 years, [range, 33-88 years]; 67% males) with positive SARS-CoV-2 infection were analyzed. There were no differences in age or sex among groups (p >.05). Initial symptoms included fever (100%), coughing (85%), dyspnea (76%), diarrhea (42%) and asthenia (21%). The majority of patients in this case series were hospitalized because of low SpO2 (SpO2 below 90%) and presentation of bilateral pneumonia (94%) at triage. ICU patients had a higher prevalence of dyspnea compared to non-ICU patients (95% vs 61%, p = .022). Acute respiratory syndrome (ARDS) was presented in 100% of the ICU-patients. All the patients included in the study required oxygen therapy. ICU-patients had lymphopenia as well as hypoalbuminemia. Inflammatory markers such as lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin were significantly higher in ICU patients compared to non-ICU (p < .001).Lower albumin levels were associated with poor prognosis measured as longer hospital length (r= −0.472, p <.001) and mortality (r= −0.424, p=.003). Interestingly we also found, that MCV was lower among of those patients who died (p=.0002). As of April 28, 2020, 10 patients (8 ICU and 2 non-ICU) had died (21% mortality) and while 100% of the non-ICU patients had been discharged, 33% of ICU patients still remained hospitalized (5 in ICU and 2 had been transferred to ward).CONCLUSIONCritically ill patients with COVID-19 present lymphopenia, hypoalbuminemia as well high levels of inflammation. Lower levels of albumin were associated with poorer outcomes in COVID-19 patients. Albumin might be of importance because of its association with disease severity in patients infected with SARS-CoV-2.WHAT IS ALREADY KNOWN IN THIS TOPICSpain has been hit particularly hard by the pandemic. By the time that this manuscript was written more than 25.000 deaths related to COVID-19 have been confirmed. There is limited information available describing the clinical and epidemiological features of Spanish patients requiring hospitalization for COVID-19. Also, it is important to know the characteristics of the hospitalized patients who become critically illWHAT THIS STUDY ADDSThis small case series provides the first steps towards a comprehensive clinical characterization of severe and critical COVID-19 adult patients in Spain. The overall mortality in our patients was 21%. To our knowledge this is the first report with reporting these features in Spain. At triage the majority of patients had lower SpO2 (<90%) and bilateral pneumonia. The most common comorbidities were hypertension (70%), dyslipidemia (62%) and cardiovascular disease (30%). Critically ill patients present hypoalbuminemia and lymphopenia, as well as higher levels of inflammation. Albumin might be of importance because of its association with disease severity and mortality in patients infected with SARS-CoV-2.

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Observations on the Application of Nursing Risk Management in the Care of Critically Ill Patients in the Respiratory Unit

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i4.1352 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Yannan Sun

Keyword(s):

Risk Management ◽

Critically Ill ◽

Critically Ill Patients ◽

Treatment Satisfaction ◽

Clinical Symptoms ◽

Statistical Significance ◽

Management Model ◽

Control Group ◽

Observation Group ◽

Significant Difference

Objective: Investigate the effectiveness of nursing risk management in the care of critically ill patients in the respiratory unit. Methods: Among the critically ill respiratory patients admitted to our hospital between May 2019 and April 2020, 78 patients were randomly selected and divided into an observation group and a control group, each consisting of 39 patients. In the observation group, a nursing risk management model was implemented, i.e., patients' clinical symptoms were observed at any time to monitor their treatment satisfaction and the effectiveness of their care and routine care was implemented for the control group. Results: The heart rate, respiratory rate, and pH of patients in the observation group were more stable than those in the control group, and their respiratory status was better, with differences in data. There was also significant statistical significance (P<0.05). The incidence of patient-provider disputes, unplanned extubation, and unplanned events were lower in the observation group compared to the control group, and their data difference was statistically significant (P<0.05). The treatment satisfaction as well as the total effective rate of patients in the observation group was also much higher than that of the control group, and there was also a statistically significant difference in the data (P<0.05). Conclusion: The nursing risk management model has a significant therapeutic effect in the care of critically ill respiratory patients. Therefore, it is worth popularizing to use in the clinical nursing of respiratory critical patients.

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Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46882.14586 ◽

2021 ◽

Author(s):

Reetu Verma ◽

Sasmita Panda ◽

Rajeev Kumar Nishad

Keyword(s):

Intensive Care ◽

Environmental Factors ◽

Critically Ill ◽

Nursing Care ◽

Critically Ill Patients ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Icu Patients ◽

Common Cause

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

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