scholarly journals 219: DISCHARGE DISPOSITION OF COVID-19 PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

2021 ◽  
Vol 50 (1) ◽  
pp. 94-94
Author(s):  
Zachary Creech ◽  
Gia Thinh Truong ◽  
Renuga Vivekanandan ◽  
Chris Destache ◽  
Maureen Tierney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Discharge Disposition

Executive Function, Dexterity, and Discharge Disposition in Older Intensive Care Unit Survivors

2020 ◽  
Vol 29 (6) ◽  
pp. 484-488
Author(s):  
Maya N. Elías ◽  
Cindy L. Munro ◽  
Zhan Liang
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Executive Function ◽  
Cognitive Flexibility ◽  
Motor Coordination ◽  
Functional Decline ◽  
Dimensional Change ◽  
Fine Motor ◽  
Discharge Disposition

Background Dexterity is a component of motor function. Executive function, a subdomain of cognition, may affect dexterity in older adults recovering from critical illness after discharge from an intensive care unit (ICU). Objectives To explore associations between executive function (attention and cognitive flexibility) and dexterity (fine motor coordination) in the early post-ICU period and examine dexterity by acuity of discharge disposition. Methods The study involved 30 older adults who were functionally independent before hospitalization, underwent mechanical ventilation in the ICU, and had been discharged from the ICU 24 to 48 hours previously. Dexterity was evaluated with the National Institutes of Health Toolbox (NIHTB) Motor Battery 9-Hole Pegboard Dexterity Test (PDT); attention, with the NIHTB Cognition Battery Flanker Inhibitory Control and Attention Test (FICAT); and cognitive flexibility, with the NIHTB Cognition Battery Dimensional Change Card Sort Test (DCCST). Exploratory regression was used to examine associations between executive function and dexterity (fully corrected T scores). Independent-samples t tests were used to compare dexterity between participants discharged home and those discharged to a facility. Results FICAT (β = 0.375, P = .03) and DCCST (β = 0.698, P = .001) scores were independently and positively associated with PDT scores. Further, PDT scores were worse among participants discharged to a facility than among those discharged home (mean [SD], 26.71 [6.14] vs 36.33 [10.30]; t24 = 3.003; P = .006). Conclusions Poor executive function is associated with worse dexterity; thus, dexterity may be a correlate of both post-ICU cognitive impairment and functional decline. Performance on dexterity tests could identify frail older ICU survivors at risk for worse discharge outcomes.

Management and Outcomes of Laryngeal Injuries in the Pediatric Population

2011 ◽  
Vol 120 (12) ◽  
pp. 787-795 ◽  
Author(s):  
Douglas Sidell ◽  
Abie H. Mendelsohn ◽  
Nina L. Shapiro ◽  
Maie St. John
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Procedures ◽  
Data Bank ◽  
Fracture Repair ◽  
Laryngeal Trauma ◽  
Discharge Disposition ◽  
National Trauma ◽  
Organ Systems ◽  
National Trauma Data Bank

Objectives: Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature. Methods: The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted. Results: There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge. Conclusions: Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.

Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. 23-29
Author(s):  
Kim Martz ◽  
Jenny Alderden ◽  
Rick Bassett ◽  
Dawn Swick
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Screening Tool ◽  
Care Delivery ◽  
Screening Tools ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
To Receive

Background Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. Objective To identify outcomes associated with specialty palliative care referral among patients with critical illness. Methods Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. Results Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P < .001). Conclusions Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.

Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room

2017 ◽  
Vol 127 (6) ◽  
pp. 1443-1448 ◽  
Author(s):  
Alexander C. Flint ◽  
Sheila L. Chan ◽  
Vivek A. Rao ◽  
Allen D. Efron ◽  
Maziyar A. Kalani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Care Delivery ◽  
Chronic Subdural Hematoma ◽  
Performance Characteristics ◽  
Recurrence Rates ◽  
Discharge Disposition ◽  
Port System ◽  
Over Time

OBJECTIVEThe aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room.METHODSAll cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates.RESULTSA total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups.CONCLUSIONSOverall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.

scholarly journals The Relation between Sarcopenia and Mortality in Patients at Intensive Care Unit

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Mehmet Toptas ◽  
Mazhar Yalcin ◽  
İbrahim Akkoc ◽  
Eren Demir ◽  
Cagatay Metin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Postoperative Mortality ◽  
Psoas Muscle ◽  
Whole Body ◽  
Transfusion Rate ◽  
Discharge Disposition ◽  
Operation Rate ◽  
Significant Difference ◽  
The Mean

Background and Aim. Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). Materials and Method. The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records. Results. The mean age was 61.2±18.2 years, and the percentage of female was 33.3%. The mean duration of stay was 10.3±24.4 days. Exitus ratio, partial healing, and healing were 25%, 70%, and 5%, respectively. The mean right, left, and total PMA were 8.7±3.6, 8.9±3.4, and 17.6±6.9, respectively. The left and total PMA averages of the nonoperation patients were statistically significantly lower (p=0.021  p=0.043). The mean PMA between the ex and recovered patients were statistically significantly lower (p=0.001, p=0.001, p<0.001). Dyspnoea, renal insufficiency, COPD, transfusion rate, operation rate, ventilator needy, and mean duration of hospitalization were statistically significant higher in patients with exitus. There is a significant difference in operation types, anesthesia type, and clinic rates. Conclusion. Our data suggest that sarcopenia can be used to risk stratification in ICU patients. Future studies may use this technique to individualize postoperative interventions that may reduce the risk for an adverse discharge disposition related to critical illness, such as early mobilization, optimized nutritional support, and reduction of sedation and opioid dose.

scholarly journals Assessment of geriatrics outcomes in the cardiac intensive care unit

2021 ◽  
Vol 9 (39) ◽  
pp. 1-8
Author(s):  
Carly Fabrizio ◽  
Matthew Langston ◽  
Keshab Subedi ◽  
Neil Wimmer ◽  
Usman Choudhry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Cardiac Intensive Care Unit ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Cardiac Intensive Care

Objective: Critically ill older adults greater than or equal to 80 years old are routinely admitted to contemporary cardiac intensive care units (CICU). Little has been reported about their outcomes when compared to the general CICU population. The primary aim of this study was to compare the mortality, length-of-stay, and disposition outcomes of elderly patients (greater or equal to 80 years old) admitted to the CICU with a younger cohort (less than 80 years old). Methods and Results: A single-center, retrospective cohort study was conducted including 6,194 adult patients admitted to a cardiovascular intensive care unit in Newark, Delaware, from July 1, 2012, to June 30, 2019. Coronary intensive care unit (CICU) mortality, CICU length-of-stay and discharge disposition were compared between elderly patients (greater than or equal to 80 years old) and younger patients (less than 80 years old), adjusted for comorbidities. We observed increased mortality for elderly patients (OR 1.686, CI 1.361-2.090, p<0.001) compared with patients less than 80 years old, even after adjusting for comorbidities. Median length of stay was not statistically different between the two groups. However, the elderly patients were significantly more likely to be discharged to a facility, such as a skilled nursing facility, than those less than 80 years old (26.8% versus 12.5%, respectively, p<0.001). Conclusions: Among patients admitted to the CICU, elderly patients have higher mortality rates than those less than 80 years old. Advanced age (greater or equal to 80 years old) was not a reliable predictor of outcome in the CICU. A large proportion of elderly patients are not able to live independently at home after CICU admissions. Key Words: octogenarians, nonagenarians, cardiac intensive care unit, elderly, ICU mortality

Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit

2006 ◽  
Vol 104 (5) ◽  
pp. 713-719 ◽  
Author(s):  
Panayiotis N. Varelas ◽  
Dan Eastwood ◽  
Hyun J. Yun ◽  
Marianna V. Spanaki ◽  
Lotfi Hacein Bey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Head Trauma ◽  
Positive Impact ◽  
Tertiary Care ◽  
University Hospital ◽  
Discharge Disposition ◽  
Gcs Score ◽  
The Impact

Object The aim of this study was to evaluate the impact of a newly appointed neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU). Methods The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database. Samples of medical records were reviewed for Glasgow Coma Scale (GCS) score documentation. The authors analyzed data pertaining to 328 patients before and 264 after the neurointensivist's appointment. The unadjusted mean in-hospital mortality rate increased 1.1% in the after period, but this increase was significantly lower compared with the UHC-based expected increase of 8.1% in the mortality rate during the same period (p < 0.0001). The unadjusted mean mortality rate in the NICU decreased from 13.4 to 12.9% (relative mortality rate reduction 4%) and the mean NICU LOS increased from 3.1 to 3.6 days (relative NICU LOS increase 16%), both nonsignificantly. A 51% reduction in the NICU-associated mortality rate (p = 0.01), a 12% shorter hospital LOS (p = 0.026), and 57% greater odds of being discharged to home or to rehabilitation (p = 0.009) were found in the after period in multivariate models after controlling for baseline differences between the two time periods. Better documentation of the GCS score by the NICU team was also found in the after period (from 60.4 to 82%, p = 0.02). Conclusions The institution of a neurointensivist-led team model had an independent, positive impact on patient outcomes, including a lower NICU-associated mortality rate and hospital LOS, improved disposition, and better chart documentation.

scholarly journals Baseline and clinical characteristics of older adults admitted to the intensive care unit through the emergency room: Analysis based on age groups

2019 ◽  
pp. 102490791988044
Author(s):  
Ye Lim Lee ◽  
Sang Ook Ha ◽  
Young Sun Park ◽  
Jeong Hyeon Yi ◽  
Sun Beom Hur ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Age Groups ◽  
Discharge Disposition ◽  
Neurologic Outcomes ◽  
Diagnosis Of Cancer ◽  
Overall Mortality

Background and Objectives: There is currently no consensus on the criteria for admitting older adults to the intensive care unit. Methods: This single-center retrospective study evaluated the baseline and clinical characteristics of older adults admitted to the intensive care unit between January 2017 and June 2017; patients were analyzed according to their age group. Factors associated with in-hospital mortality were specifically determined using logistic regression analysis. Results: Among 582 patients included in the present study, 34.2%, 46.6%, and 19.2% were aged 65–74, 75–84, and over 84 years, respectively. In terms of clinical outcomes, although there were no significant differences in the length of intensive care unit and hospital stay and intensive care unit mortality, significant differences were observed in terms of in-hospital mortality, hospital discharge disposition, and neurologic outcomes at discharge ( p = 0.039, p = 0.005, and p = 0.032, respectively). Predictive factors for in-hospital mortality were age (⩾85 years), initial mental status (stupor to coma), a Korean Triage and Acuity Scale level of 1, underlying diagnosis of cancer, abdominal pain or discomfort, apnea, and a chief compliant of dyspnea. Conclusion: Compared to those aged 65–84 years, in-hospital mortality was 1.96-fold higher in those aged over 84 years. However, the overall mortality in our cohort was not considerably different from that of the younger population. Intensive care unit admission should be considered in selected older adults after evaluating the risk factors for mortality.

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