scholarly journals 940: INCIDENCE AND RISK FACTORS FOR IATROGENIC OPIOID WITHDRAWAL IN MEDICAL CRITICAL CARE PATIENTS

2021 ◽  
Vol 50 (1) ◽  
pp. 467-467
Author(s):  
Marlena Fox ◽  
William Carothers ◽  
Kara Birrer ◽  
Min Choi ◽  
Katie Dircksen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Opioid Withdrawal ◽  
Critical Care Patients

scholarly journals Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Blaivas ◽  
Konstantinos Stefanidis ◽  
Serafim Nanas ◽  
John Poularas ◽  
Mitchell Wachtel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Upper Extremity ◽  
Strong Predictor ◽  
Venous Catheter ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Therapeutic Anticoagulation ◽  
Deep Vein ◽  
Critical Care Patients

Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting.Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers.Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716,P=0.007)], malignancy (OR 1.483,P=0.036), total parenteral nutrition (OR 1.399,P=0.035), hypercoagulable state (OR 1.284,P=0.045), and obesity (OR 1.191,P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined.Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients

2020 ◽  
Vol 29 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Jill Cox ◽  
Marilyn Schallom ◽  
Christy Jung
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Scale Score ◽  
Critically Ill Patients ◽  
Braden Scale ◽  
Pressure Injury ◽  
Critical Care Patients

Background Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. Objective To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. Methods Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. Results In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. Conclusion Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.

Pressure Injury Risk Factors in Critical Care Patients

2018 ◽  
Vol 31 (7) ◽  
pp. 328-334 ◽  
Author(s):  
Jill Cox ◽  
Sharon Roche ◽  
Virginia Murphy
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Injury Risk ◽  
Pressure Injury ◽  
Injury Risk Factors ◽  
Critical Care Patients

scholarly journals Risk factors for pressure injuries among critical care patients: A systematic review

2017 ◽  
Vol 71 ◽  
pp. 97-114 ◽  
Author(s):  
Jenny Alderden ◽  
June Rondinelli ◽  
Ginette Pepper ◽  
Mollie Cummins ◽  
JoAnne Whitney
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critical Care ◽  
Critical Care Patients

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study (Preprint)

2021 ◽  
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the <i>χ<sup>2</sup></i> test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, <i>χ</i><sup>2</sup><sub>1</sub>=8.43, <i>P</i>=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, <i>P</i>=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure &lt;50 mmHg (OR 0.179, 95% CI 0.072-0.416, <i>P</i>&lt;.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, <i>P</i>=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

2013 ◽  
Vol 33 (6) ◽  
pp. 57-66 ◽  
Author(s):  
Karen L. Cooper
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Critical Care Unit ◽  
Pressure Ulcers ◽  
Hemodynamic Instability ◽  
Evidence Based ◽  
Never Event ◽  
Vasoactive Medications ◽  
Critical Care Patients

The development of stage III or IV pressure ulcers is currently considered a never event. Critical care patients are at high risk for development of pressure ulcers because of the increased use of devices, hemodynamic instability, and the use of vasoactive medications. This article addresses risk factors, risk scales such as the Norden, Braden, Waterlow, and Jackson-Cubbin scales used to determine the risk of pressure ulcers in critical care patients, and prevention of device-related pressure ulcers in patients in the critical care unit.

scholarly journals Risk Factors for Hospital-Acquired Pressure Injury in Surgical Critical Care Patients

2020 ◽  
Vol 29 (6) ◽  
pp. e128-e134
Author(s):  
Jenny Alderden ◽  
Linda J. Cowan ◽  
Jonathan B. Dimas ◽  
Danli Chen ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Odds Ratio ◽  
Academic Medical Center ◽  
Skin Irritation ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. Objective To identify factors associated with hospital-acquired pressure injuries among surgical critical care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature. Methods This retrospective cohort study included 5101 surgical critical care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention. Results Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P &lt; .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P &lt; .001), and duration of intensive care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P &lt; .001). Conclusions The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.

Risk Factors for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

2022 ◽  
Vol 31 (1) ◽  
pp. 42-50
Author(s):  
Phillip Kim ◽  
Vamsi K. Aribindi ◽  
Amy M. Shui ◽  
Sharvari S. Deshpande ◽  
Sachin Rangarajan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Scale Score ◽  
Arterial Oxygen ◽  
Effective Prevention ◽  
Braden Scale ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Relative contributions of risk factors for the incidence of pressure injury in adult critical care patients are not well understood. Objective To develop and validate a model to identify risk factors associated with hospital-acquired pressure injuries among adult critical care patients. Methods This retrospective cohort study included 23 806 adult patients (28 480 encounters) with an intensive care unit stay at an academic quaternary care center. Patient encounters were randomly split (7:3) into training and validation sets. The training set was used to develop a multivariable logistic regression model using the least absolute shrinkage and selection operator method. The model’s performance was evaluated with the validation set. Results Independent risk factors identified by logistic regression were length of hospital stay, preexisting diabetes, preexisting renal failure, maximum arterial carbon dioxide pressure, minimum arterial oxygen pressure, hypotension, gastrointestinal bleeding, cellulitis, and minimum Braden Scale score of 14 or less. On validation, the model differentiated between patients with and without pressure injury, with area under the receiver operating characteristic curve of 0.85, and performed better than a model with Braden Scale score alone (P &lt; .001). Conclusions A model that identified risk factors for hospital-acquired pressure injury among adult critical care patients was developed and validated using a large data set of clinical variables. This model may aid in selecting high-risk patients for focused interventions to prevent formation of hospital-acquired pressure injuries.

Psychische Komorbidität in der Intensivmedizin

2019 ◽  
Vol 144 (01) ◽  
pp. 54-60 ◽  
Author(s):  
Alexander Niecke ◽  
Valeska von Bassewitz ◽  
Guido Michels
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Intensive Care ◽  
Mental Disorders ◽  
Intensive Care Medicine ◽  
Treatment Strategies ◽  
Physical Illness ◽  
Psychische Komorbidität ◽  
Mental Comorbidity ◽  
Critical Care Patients

AbstractThis article aims to provide an overview of the nature and extent, risk factors and treatment strategies of co-morbid mental disorders in the context of intensive care medicine. Depressive, anxious and posttraumatic syndromes as well as deliria are common phenomena in critical care patients, which correspond with the course and outcome of the underlying physical illness. The most important factors for the occurrence of mental comorbidity and general principles of care are described.

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