Short-term outcomes in older intensive care unit patients with dementia*

Background Dynamic measures of heart rate variability (HRV) may uncover abnormalities that are not easily detectable with traditional time and frequency domain measures. The purpose of this study was to characterize changes in RR-interval dynamics in the immediate postoperative phase of coronary artery bypass graft (CABG) surgery using traditional and selected newer dynamic measures of HRV. Methods Continuous 24-h electrocardiograph recordings were performed in 40 elective CABG surgery patients up to 72 h postoperatively. In one half of the patients, Holter recordings were initiated 12-40 h before the surgery. Time and frequency domain measures of HRV were assessed. The dynamic measures included a quantitative and visual analysis of Poincaré plots, measurement of short- and intermediate-term fractal-like scaling exponents (alpha1 and alpha2), the slope (beta) of the power-law regression line of RR-interval dynamics, and approximate entropy. Results The SD of RR intervals (P < 0.001) and the ultra-low-, very-low-, low-, and high-frequency power (P < 0.01, P < 0.001, P < 0.001, P < 0.01, respectively) measures in the first postoperative 24 h decreased from the preoperative values. Analysis of Poincaré plots revealed increased randomness in beat-to-beat heart rate behavior demonstrated by an increase in the ratio between short-term and long-term HRV (P < 0.001) after CABG. Average scaling exponent alpha1 of the 3 postoperative days decreased significantly after CABG (from 1.22 +/- 0.15 to 0.85 +/- 0.20, P < 0.001), indicating increased randomness of short-term heart rate dynamics (i.e., loss of fractal-like heart rate dynamics). Reduced scaling exponent alpha1 of the first postoperative 24 h was the best HRV measure in differentiating between the patients that had normal (</= 48 h, n = 33) or prolonged (> 48 h, n = 7) intensive care unit stay (0.85 +/- 0.17 vs. 0.68 +/- 0.18; P < 0.05). In stepwise multivariate logistic regression analysis including typical clinical predictors, alpha1 was the most significant independent predictor (P < 0.05) of long intensive care unit stay. None of the preoperative HRV measures were able to predict prolonged intensive care unit stays. Conclusions In the selected group of patients studied, a decrease in overall HRV was associated with altered nonlinear heart rate dynamics after CABG surgery. Current results suggest that a more random short-term heart rate behavior may be associated with a complicated clinical course. Analysis of fractal-like dynamics of heart rate may provide new perspectives in detecting abnormal cardiovascular function after CABG.

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Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796019000039 ◽

2019 ◽

Vol 29 ◽

Cited By ~ 8

Author(s):

A. Vuagnat ◽

F. Jollant ◽

M. Abbar ◽

K. Hawton ◽

C. Quantin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Overdose ◽

Psychiatric Inpatient ◽

National Level ◽

Significant Risk ◽

Medical Decision ◽

Short Term ◽

Predictive Values ◽

Self Harm

Abstract Aims A large number of people present each day at hospitals for non-fatal deliberate self-harm (DSH). Examination of the short-term risk of non-fatal recurrence and mortality at the national level is of major importance for both individual medical decision-making and global organisation of care. Methods Following the almost exhaustive linkage (96%) of two national registries in France covering 45 million inhabitants (i.e. 70% of the whole population), information about hospitalisation for DSH in 2008–2009 and vital status at 1 year was obtained. Individuals who died during the index hospital stay were excluded from analyses. Results Over 2 years, 136,451 individuals were hospitalised in medicine or surgery for DSH. The sample comprised 62.8% women, median age 38 in both genders, with two peaks at 16 and 44 years in women, and one peak at 37 years in men. The method used for DSH was drug overdose in 82.1% of cases. Admission to an intensive care unit occurred in 12.9%. Following index hospitalisation, 71.3% returned home and 23.7% were transferred to a psychiatric inpatient care unit. DSH recurrence during the following year occurred in 12.4% of the sample, within the first 6 months in 75.2%, and only once in 74.6%. At 1 year, 2.6% of the sample had died. The overall standardised mortality ratio was 7.5 but reached more than 20 in young adults. The causes were natural causes (35.7%), suicide (34.4%), unspecified cause (17.5%) and accident (12.4%). Most (62.9%) deaths by suicide occurred within the first 6 months following index DSH. Violent means (i.e. not drug overdose) were used in 70% of suicide cases. Concordance between means used for index DSH and for suicide was low (30% overall), except for drug overdose. Main suicide risk factors were older age, being male, use of a violent means at index DSH, index admission to an intensive care unit, a transfer to another medical department or to a psychiatric inpatient unit, and recurrence of DSH. However, these factors had low positive predictive values individually (below 2%). Conclusions Non-fatal DSH represent frequent events with a significant risk of short-term recurrence and death from various causes. The first 6 months following hospital discharge appear to be a critical period. Specific short-term aftercare programs targeting all people with a DSH episode have to be developed, along other suicide prevention strategies.

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Subsequent Multidrug-Resistant Bacteremia Is a Risk Factor for Short-Term Mortality of Patients with Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii in Intensive Care Unit

Chinese Medical Journal ◽

10.4103/0366-6999.223859 ◽

2018 ◽

Vol 131 (3) ◽

pp. 361-363 ◽

Cited By ~ 1

Author(s):

Mo-Han Ju ◽

Yu-Long Yao ◽

Chun-Ling Du ◽

Shu Chen ◽

Yuan-Lin Song

Keyword(s):

Intensive Care Unit ◽

Risk Factor ◽

Intensive Care ◽

Acinetobacter Baumannii ◽

Multidrug Resistant ◽

Ventilator Associated Pneumonia ◽

Short Term ◽

Short Term Mortality

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The views of intensive care nurses regarding short-term deployment

Curationis ◽

10.4102/curationis.v38i1.1478 ◽

2015 ◽

Vol 38 (1) ◽

Author(s):

Mokgadi C. Matlakala

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Focus Group Interviews ◽

Short Term ◽

Gauteng Province ◽

Intensive Care Nurses ◽

Hospital Units ◽

Policies And Procedures ◽

Group Interviews ◽

Purposive Sample

Background: Short-term deployment of nurses is usually used within the hospital units in order to ‘balance the numbers’ or to cover the shortage of staff in the different units. Often nurses in the intensive care unit (ICU) are sent to go and assist in other units, where there is not enough nursing staff or when their own unit is not busy.Objectives: The objective of this study was to explore the views of the ICU nurses regarding short-term deployment to other units.Method: A qualitative design was used, following interpretivism. The study was conducted in the ICUs of two hospitals in Gauteng Province, South Africa. Data were collected through focus group interviews with a purposive sample of registered nurses working in the selected ICUs, transcribed verbatim and analysed using open coding.Results: The participants shared a similar view that deployment to other units should be based on a formal agreement, with policies and procedures. Consultation and negotiation are recommended prior to deployment of staff. Management should recognise and acknowledge expertise of ICU nurses in their own speciality area.Conclusion: The findings call for redesign of a deployment policy that will suit nurses from the speciality areas such as ICU.

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Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit

Journal of Critical Care Medicine ◽

10.1155/2014/821462 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

O. H. Hernandez ◽

J. F. Zapata ◽

M. Jimenez ◽

M. Massaro ◽

A. Guerra ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Status Epilepticus ◽

Refractory Status Epilepticus ◽

Short Term ◽

Neurological Intensive Care Unit ◽

Term Outcome ◽

Neurological Intensive Care ◽

Refractory Status ◽

Short Term Outcome

Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients.

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Mortality of Adult Patients With Cancer Admitted to an Intensive Care Unit in Chile: A Prospective Cohort Study

Journal of Global Oncology ◽

10.1200/jgo.18.00091 ◽

2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Sergio Panay ◽

Carolina Ruiz ◽

Marcelo Abarca ◽

Bruno Nervi ◽

Ignacio Salazar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prospective Cohort ◽

Admission Policy ◽

Short Term ◽

Assessment Scores ◽

Patients With Cancer ◽

Failure Assessment ◽

Short Term Mortality ◽

The Mean

Purpose Increasing numbers of reports have shown acceptable short-term mortality of patients with cancer admitted into the intensive care unit (ICU). The aim of this study was to determine the mortality of critically ill patients with cancer admitted to the ICU in a general hospital in Chile. Materials and Methods This was a prospective cohort trial in which we included all patients with cancer admitted to the ICU between July 2015 and September 2016. Demographic, physiologic, and treatment data were registered, and survival at 30 days and 6 months was evaluated. A prespecified subgroup analysis considering the admission policy was performed. These subgroups were (1) ICU admission for full code management and (2) ICU trial (IT). Results During the study period, 109 patients with cancer were included. Seventy-nine patients were considered in the full code management group and 30 in the IT. The mean age of patients was 60 years (standard deviation [SD], 15), and 56% were male. Lymphoma was the most frequent malignancy (17%), and 59% had not received cancer treatment because of a recent diagnosis. The mean Acute Physiology and Chronic Health Evaluation and Sequential-Related Organ Failure Assessment scores were 22.2 (SD, 7.3) and 7 (SD, 3), respectively. There were no differences in vasopressor, fluid, or transfusion requirements between subgroups. Lactate levels, Sequential-Related Organ Failure Assessment scores (day 1, 3, and 5), complications, and ICU length of stay were similar. In the entire cohort, 30-day and 6-month mortality was 47% and 66%, respectively. There was no difference in mortality between subgroups according to the admission policy. Conclusion Patients admitted to the ICU in a developing country are at high risk for short-term mortality. However, there is a relevant subgroup that achieves 6-month survival, even among patients who undergo an IT.

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