Decreased mortality rate and length of hospital stay in surgical intensive care unit patients with successful selective decontamination of the gut

Abstract Background Serum chloride (Cl−) is one of the most essential extracellular anions. Based on emerging evidence obtained from patients with kidney or heart disease, hypochloremia has been recognized as an independent predictor of mortality. Nevertheless, excessive Cl− can also cause death in severely ill patients. This study aimed to investigate the relationship between hyperchloremia and high mortality rate in patients admitted to the surgical intensive care unit (SICU). Methods We enrolled 2131 patients from the Multiparameter Intelligent Monitoring in Intensive Care III database version 1.4 (MIMIC-III v1.4) from 2001 to 2012. Selected SICU patients were more than 18 years old and survived more than 72 h. A serum Cl− level ≥ 108 mEq/L was defined as hyperchloremia. Clinical and laboratory variables were compared between hyperchloremia (n = 664) at 72 h post-ICU admission and no hyperchloremia (n = 1467). The Locally Weighted Scatterplot Smoothing (Lowess) approach was utilized to investigate the correlation between serum Cl- and the thirty-day mortality rate. The Cox proportional-hazards model was employed to investigate whether serum chlorine at 72 h post-ICU admission was independently related to in-hospital, thirty-day and ninety-day mortality from all causes. Kaplan-Meier curve of thirty-day and ninety-day mortality and serum Cl− at 72 h post-ICU admission was further constructed. Furthermore, we performed subgroup analyses to investigate the relationship between serum Cl− at 72 h post-ICU admission and the thirty-day mortality from all causes. Results A J-shaped correlation was observed, indicating that hyperchloremia was linked to an elevated risk of thirty-day mortality from all causes. In the multivariate analyses, it was established that hyperchloremia remained a valuable predictor of in-hospital, thirty-day and ninety-day mortality from all causes; with adjusted hazard ratios (95% CIs) for hyperchloremia of 1.35 (1.02 ~ 1.77), 1.67 (1.28 ~ 2.19), and 1.39 (1.12 ~ 1.73), respectively. In subgroup analysis, we observed hyperchloremia had a significant interaction with AKI (P for interaction: 0.017), but there were no interactions with coronary heart disease, hypertension, and diabetes mellitus (P for interaction: 0.418, 0.157, 0.103, respectively). Conclusion Hyperchloremia at 72 h post-ICU admission and increasing serum Cl− were associated with elevated mortality risk from all causes in severely ill SICU patients.

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Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients

Acta Médica Portuguesa ◽

10.20344/amp.7930 ◽

2017 ◽

Vol 30 (7-8) ◽

pp. 555 ◽

Cited By ~ 1

Author(s):

Ana Martins Lopes ◽

Diana Silva ◽

Gabriela Sousa ◽

Joana Silva ◽

Alice Santos ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Hospital Stay ◽

Univariate Analysis ◽

Simplified Acute Physiology Score ◽

Surgical Intensive Care Unit ◽

Haematocrit Level ◽

Cardiac Events ◽

Surgical Intensive Care

Introduction: Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes.Material and Methods: This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression.Results: A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001).Discussion: A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients.Conclusion: Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

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The Pathogen of Ventilator-Associated Pneumonia Does Not Influence the Mortality Rate of Surgical Intensive Care Unit Patients Treated with a Rotational Antibiotic System

Surgical Infections ◽

10.1089/sur.2008.025 ◽

2010 ◽

Vol 11 (1) ◽

pp. 13-20 ◽

Cited By ~ 11

Author(s):

Soumitra R. Eachempati ◽

Lynn J. Hydo ◽

Jian Shou ◽

Philip S. Barie

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Surgical Intensive Care Unit ◽

Ventilator Associated Pneumonia ◽

Surgical Intensive Care

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Effect of albumin administration on post-operation mortality, duration on ventilator, and hospital stay on patients in cardiac intensive care: An observational study

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v18i6.27 ◽

2021 ◽

Vol 18 (6) ◽

pp. 1339-1345

Author(s):

Zhen Zhang ◽

Xinlun Dai ◽

Ji Qi ◽

Yu Ao ◽

Chunfeng Yang ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Hospital Stay ◽

Normal Saline ◽

Wilcoxon Test ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Albumin Infusion ◽

Cardiac Intensive Care

Purpose: To justify the use of albumin infusion in patients in post-surgery cardiac intensive care unit. Methods: All patients who were hemodynamically stable before the operation and admitted into the surgical intensive care unit following coronary artery bypass, cardiopulmonary bypass, or aortic surgery, had no excessive postoperative bleeding and not on diuretic treatment, were included in the analysis. A total of 1998 patients were divided into two cohorts, viz, the first group was placed on albumin infusion (n = 999) while the second group received normal saline infusion (n = 999). Data were obtained from DICOM files of patients and records of pharmacy. Wilcoxon test or two-tailed paired t-test followed by Tukey post-hoc tests were performed for statistical analysis at 95 % of confidence level. Results: Albumin and normal saline administration did not decrease the duration of mechanical ventilation, incidence of mechanical ventilation, need for blood transfusion, and length of hospital stay (p > 0.05). Albumin infusion decreased the need for fresh frozen plasma transfusion from 85 to 67, reduced mortality (p = 0.0005, q = 3.959), lowered serum lactate level (p < 0.0001, q = 43.853), but increased cardiac index (p < 0.0001, q = 12.192) as well as financial burden (p < 0.0001, q = 95.158) for the patients, compared to normal saline group. Conclusion: In view of the foregoing, it is recommended that the use of restriction of albumin resuscitation in surgical intensive care unit should be restricted in this subset of patients evluated in this study.

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