SURVIVAL, HOSPITALIZATION CHARGES, AND FOLLOW-UP RESULTS IN CRITICALLY ILL PATIENTS

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

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Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan

Biological Research For Nursing ◽

10.1177/10998004211017241 ◽

2021 ◽

pp. 109980042110172

Author(s):

Eman Mahmoud Qasim Emleek ◽

Amani Anwar Khalil

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Scoring System ◽

Elevated Serum ◽

Underlying Disease ◽

Disseminated Intravascular Coagulopathy ◽

Period Prevalence ◽

Lower Baseline ◽

Intravascular Coagulopathy

Background: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. Methods: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. Results: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count ( t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level ( M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non–Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non–Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT ( U = 2,298, z = 5.7, p < 0.001), PTT ( U = 2,334, z = 2.0, p = 0.045) and INR ( U = 2,541, z = 5.1, p < 0.001) compared to those with non–Overt DIC. Conclusion: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

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The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

10.22514/sv.2021.068 ◽

2021 ◽

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lactate Dehydrogenase ◽

Critically Ill ◽

Critically Ill Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Group 2 ◽

D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

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Impact of Hospitalized Nutritional Formula on Anthropometric, Clinical and Biochemical Indices among Egyptian Adult Cardio-Thoracic Critically Ill Patients: A Single Institutional Study

Journal of Clinical Research and Reports ◽

10.31579/2690-1919/139 ◽

2021 ◽

Vol 7 (1) ◽

pp. 01-11

Author(s):

Khalil NS

Keyword(s):

Critically Ill ◽

Clinical Data ◽

Critically Ill Patients ◽

Skin Color ◽

Admission Time ◽

Chest Disease ◽

Disease Hospital ◽

Biochemical Indices ◽

The Impact

Background: Malnutrition is a common consequence notably in patients admitted to the intensive care unit. Aim of the study: was to assess the Impact of hospitalized nutritional formula on anthropometric, clinical and biochemical indices among Egyptian adult cardio-thoracic Critically Ill Patients on admission and discharge days. Methods: Totally, A convenient sample of 100 cardiothoracic patients was evaluated from admission to discharge in ICUs at Damietta Chest Disease Hospital in Egypt. The patients' anthropometric measurements, clinical data and biochemical indices were assessed As well, hospital diet prescription and intake was also evaluated. Results: High significant statistical difference patients' clinical data on admission and after one week such as body built (X2 = 52.6; p = 0.0), skin color (X2= 12.9; p = 0.02), skin turgor (X2= 13.19; p = 0.0), and occurrence of bed sore (X2= 27.7; p = 0.0). On the other hand, no significant statistical differences were found in the patients' weight and body mass index on admission and discharge (one week). Moreover, significant statistical differences were found in patients biochemical indices such as albumin (t= 3.03; p=0.003) and lymphocyte counts (3.74; p=0.000). So, the 88 % of patients showed decreased albumin after one week when compared to admission time. While, 10 % of patients showed increased lymphocytic count after one week of admission when compared to admission time. Conclusion and Recommendations: Clinical assessment, anthropometric, and biochemical indices are essential for evaluation, follow-up and management of cardiothoracic critically ill patients

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The Incidence of Chronic Kidney Disease Three Years after Non-Severe Acute Kidney Injury in Critically Ill Patients: A Single-Center Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm8122215 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2215 ◽

Cited By ~ 5

Author(s):

Sébastien Rubin ◽

Arthur Orieux ◽

Benjamin Clouzeau ◽

Claire Rigothier ◽

Christian Combe ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Single Center ◽

Frequent Event ◽

Incidence Of Ckd

The risk of chronic kidney disease (CKD) following severe acute kidney injury (AKI) in critically ill patients is well documented, but not after less severe AKI. The main objective of this study was to evaluate the long-term incidence of CKD after non-severe AKI in critically ill patients. This prospective single-center observational three-years follow-up study was conducted in the medical intensive care unit in Bordeaux’s hospital (France). From 2013 to 2015, all patients with severe (kidney disease improving global outcomes (KDIGO) stage 3) and non-severe AKI (KDIGO stages 1, 2) were enrolled. Patients with prior eGFR < 90 mL/min/1.73 m2 were excluded. Primary outcome was the three-year incidence of CKD stages 3 to 5 in the non-severe AKI group. We enrolled 232 patients. Non-severe AKI was observed in 112 and severe AKI in 120. In the non-severe AKI group, 71 (63%) were male, age was 62 ± 16 years. The reason for admission was sepsis for 56/112 (50%). Sixty-two (55%) patients died and nine (8%) were lost to follow-up. At the end of the follow-up the incidence of CKD was 22% (9/41); Confidence Interval (CI) 95% (9.3–33.60)% in the non-severe AKI group, tending to be significantly lower than in the severe AKI group (44% (14/30); CI 95% (28.8–64.5)%; p = 0.052). The development of CKD three years after non-severe AKI, despite it being lower than after severe AKI, appears to be a frequent event highlighting the need for prolonged follow-up.

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Landmark survival as an end-point for trials in critically ill patients – comparison of alternative durations of follow-up: an exploratory analysis

Critical Care ◽

10.1186/cc7988 ◽

2009 ◽

Vol 13 (4) ◽

pp. R128 ◽

Cited By ~ 26

Author(s):

Gopal Taori ◽

Kwok M Ho ◽

Carol George ◽

Rinaldo Bellomo ◽

Steven AR Webb ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Exploratory Analysis ◽

End Point

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Physiotherapy during the Covid-19 pandemic: management of critically ill patients in the ICU and follow-up care

10.52057/erj.v1i1.2 ◽

2021 ◽

Vol 1 (1) ◽

pp. 1-8

Author(s):

Clément Médrinal ◽

Tristan Bonnevie ◽

Pauline Smondack ◽

Francis Edouard Gravier ◽

Marius Lebret ◽

...

Keyword(s):

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Critically Ill ◽

Critically Ill Patients ◽

Acute Respiratory Infection ◽

Care Providers ◽

Severe Acute Respiratory Infection ◽

Follow Up Care ◽

The World

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for the current pandemic and results in a large number of hospitalizations. This highly contagious disease causes severe acute respiratory infection; thus, many patients require management in intensive care. At a time when there is a high influx of patients with COVID-19 in Intensive Care Units (ICU) all over the world, there is little literature concerning the physiotherapy management of these patients. This article provides information based on the latest evidence to help physiotherapists optimize care, to protect patients and care providers in the ICU, and for follow-up care.

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Myocardial Injury at Early Stage and Its Association with Death Risk of Patients with COVID-19: A Hospital-Based Prospective Case-Cohort Study

10.21203/rs.3.rs-34902/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Lin Fu ◽

Xiu-Yong Li ◽

Jun Fei ◽

Ying Xiang ◽

Hui-Xian Xiang ◽

...

Keyword(s):

Cohort Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Myocardial Injury ◽

Early Stage ◽

Demographic Information ◽

Death Risk ◽

Acute Myocardial Injury ◽

Independent Risk Factors

Abstract Background: There are growing evidence demonstrating that coronavirus disease 2019 (COVID-19) is companied by acute myocardial injury. However, the association of SARS-CoV-2-induced myocardial injury with death risk of COVID-19 is unclear.Methods: This prospective case-cohort study analyzed 355 COVID-19 patients from two hospitals in different regions. Clinical and demographic information were collected. Myocardial injury was evaluated and its prognosis was followed up. Results: Of 355 hospitalized patients with COVID-19, 213 were mild, 90 severe and 52 critically ill patients. On admission, 220 (62.0%) patients were with myocardial injury. Myocardial injury was more popular in critically ill patients. Using multivariate logistic regression, male, older age and comorbidity with hypertension were three crucial independent risk factors predicting myocardial injury of COVID-19 patients. Among 220 COVID-19 patients with myocardial injury, 33 (15.0%) died on mean 10.9 day after hospitalization. Mortality was increased among COVID-19 patients with myocardial injury (15.0% vs 1.74%, RR=8.625, P<0.001). Follow-up study observed that at least one myocardial index of 21.3% patients remained abnormal 14 days after discharge. Conclusion: Myocardial injury at early stage elevates mortality of COVID-19 patients. Male elderly patients with hypertension are more vulnerable to myocardial injury. SARS-CoV-2-induced myocardial injury has not completely recovered 14 days after discharge.

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