scholarly journals 22. ASSOCIATION BETWEEN SYSTOLIC BLOOD PRESSURE, DIASTOLIC BLOOD PRESSURE, AND MEAN ARTERIAL PRESSURE ON ADMISSION WITH THE INTENSIVE CARE UNIT LENGTH OF STAY, TOTAL LENGTH OF STAY, AND IN-HOSPITAL MORTALITY AMONG ALL-CAUSE ACUTE HEART FAILURE PATIENTS

2021 ◽  
Vol 39 (Supplement 2) ◽  
pp. e6
Author(s):  
SRNA Haloho ◽  
Z Fahmi ◽  
FA Rahman ◽  
T Delfian
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mean Arterial Pressure ◽  
Length Of Stay ◽  
Arterial Pressure ◽  
Hospital Mortality ◽  
Unit Length ◽  
Heart Failure Patients

scholarly journals Mean Arterial Pressure Should Above 65 mmHg at Vasopressor Weaning — Exploratory Study of Optimal Weaning Blood Pressure for Patients in Intensive Care Unit

2021 ◽  
Author(s):  
Zichen Wang ◽  
Luming Zhang ◽  
Wen Ma ◽  
Chengzhuo Li ◽  
Haiyan Yin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hospital Mortality ◽  
Icu Patients ◽  
Arterial Blood ◽  
Mortality Probability ◽  
Severe Hypotension

Abstract Objective:Vasopressors are one of the main treatments for severe hypotension or shock, which commonly occurs in intensive care unit (ICU) patients. However, only a few studies have been conducted on the appropriate timing for vasopressor weaning. This study aims to explore the effect of blood pressure at vasopressor weaning on the probability of in-hospital mortality.Design: Single-center retrospective observational study.Setting: ICU from Beth Israel Deaconess Medical Center between 2008 and 2019.Patients: ICU patients who received vasopressor treatment were selected. Patients younger than 18 years old, died before vasopressor weaning or without blood pressure measurement at weaning were excluded. Finally, 8,298 patients were included.Result: General additive model (GAM) result showed that blood pressures at weaning had “U-shape” non-linear relationship with in-hospital mortality probability. The optimal levels of weaning mean arterial pressure(WMAP), weaning systolic blood pressure(WSBP), and weaning diastolic blood pressure(WDBP) were 85, 120, and 65 mmHg, respectively. Subgroup analysis showed the optimal WMAP, WSBP,WDBP has deviations between diagnoses. The “cut-point” of a lower mortality probability for WMAP was 65 mmHg. ROC curves showed that mean arterial blood pressure as an indicator exhibited the best prediction performance. Cox regression demonstrated that patients with WMAP equal to or higher than 65 mmHg will have 61% lower risk of in-hospital mortality.Conclusion: WMAP is a powerful indicator for in-hospital mortality, and its value should be greater than 65 mmHg and close to 85 mmHg to reach the highest survival probability for ICU patients after vasopressor treatment.

Consequences of Hyponatremia on Intensive Care Unit Cost and Length of Stay in Heart Failure Patients

2011 ◽  
Vol 17 (8) ◽  
pp. S72 ◽  
Author(s):  
Alpesh Amin ◽  
Steven Deitelzweig ◽  
Jay Lin ◽  
Kathy Belk ◽  
Dorothy Baumer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Cost ◽  
Intensive Care Unit Cost ◽  
Heart Failure Patients

scholarly journals Global Muscle Strength But Not Grip Strength Predicts Mortality and Length of Stay in a General Population in a Surgical Intensive Care Unit

2012 ◽  
Vol 92 (12) ◽  
pp. 1546-1555 ◽  
Author(s):  
Jeanette J. Lee ◽  
Karen Waak ◽  
Martina Grosse-Sundrup ◽  
Feifei Xue ◽  
Jarone Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Manual Muscle Testing ◽  
Surgical Intensive Care Unit ◽  
Muscle Testing

Background Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design This investigation was a prospective, observational study. Methods One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles=3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.

Association of Length of Stay at Emergency Services in the Outcome of Admitted Patients

2019 ◽  
Author(s):  
RP Neupane ◽  
S Raut ◽  
TM Shrestha ◽  
R Aacharya
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Emergency Services ◽  
Unit Length ◽  
University Teaching ◽  
Cross Sectional ◽  
Prolonged Stay ◽  
Icu Outcome ◽  
Ultimate Outcome

Abstract Background: Access block and overcrowding leading to prolonged stay in emergency room is a common problem of Emergency services of Tribhuvan University Teaching Hospital (TUTH) Kathmandu. Those patients who stayed longer in emergency department might affect continuing care and the ultimate outcome of patients. Study aims to evaluate the association of emergency services length of stay and outcome of admitted patients in wards or Intensive Care Unit at the predefined cut-off value of 6 hour. Methods: It was a prospective cross sectional comparative study done in TUTH, Kathmandu. Data were collected from records from emergency services, wards, ICU and hospital record section from October, 2018 to April, 2019. Adult patients were grouped in to two groups; Emergency services to wards (ES to Wards) and Emergency services to ICU (ES to ICU). Outcome was compared between those admitted within 6hr and those admitted after 6hr of stay in emergency services. Results: A total of 2,059 patients were enrolled over 6 months. Out of them, Male were 55.5% and 42.6% patients were at the age of equal to or above 60 years. Total admitted patients who stayed equal to or less than 6 hr in emergency services was 26.7%. It was found that there was no significant association between Emergency services length of stay (ESLOS) and outcome of admitted total patients (p= 0.160) as well as in ICU (p= 0.559) or Ward admitted patients (p= 0.361). Age was found independent predictor for outcome (p= <0.01). Association of ESLOS and age was also found statistically significant (p= 0.02). Conclusions: Emergency service length of stay is not predictor for outcome of admitted patients. Key words: Emergency services, intensive care unit, length of stay, mortality.

P1674High intensity interval exercise program in heart failure patients seems to benefit cardiac power along with aorto-ventricular mechanical pump capacity and cardiorespiratory indices

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Chrysohoou ◽  
A Angelis ◽  
G Titsinakis ◽  
D Tsiachris ◽  
P Aggelopoulos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Wave Velocity ◽  
Pulse Wave ◽  
Intervention Group ◽  
Control Group ◽  
Interval Exercise ◽  
Cardiac Power

Abstract Background Cardiac power has been suggested as the most power predictor of mortality in heart failure (HF) patients. In those patients aorta elastic properties and compensation is lost, systolic (and pulse) pressure are therefore reduced and associated with a decrease in ejection duration and pump efficiency. Cardiac rehabilitation programs have showed enhancement in cardiac performance and quality of life in HF patients. Aim Aim of this work was to evaluate the effect of high-intensity interval exercise (i.e., 30 sec at 100% of max workload, followed by 30 sec at rest, on a day-by-day 30 minutes working-out schedule for 12 weeks), on cardiac power, diastolic function indices, right ventricle performance and cardiorespiratory parameters among chronic HF patients. Methods 72 consecutive HF patients (NYHA class II-IV, ejection fraction <50%) who completed the study (exercise training group, n=33, 63±9 years, 88% men, and control group, n=39, 56±11 years, 82% men), underwent cardiopulmonary stress test, non-invasive high-fidelity tonometry of the radial artery, pulse wave velocity measurement using a SphygmoCor device, and echocardiography before and after completion of the training program. Cardiac power output (CPO) (W) was calculated as mean arterial pressure × CO/451, where mean arterial pressure = [(systolic blood pressure − diastolic blood pressure)/3] + diastolic blood pressure. Results Both groups reported similar medical characteristics and physical activity status. General mixed effects models revealed that the intervention group increased 6MWT (by 13%, p<0.05); increased cycle ergometry WRpeak (by 25%, p<0.01), showed higher O2max by 31% (p<0.001) and lower VE/VCO2 (p=0.05), whereas patients in the control group showed nosignificant changes in the aforementioned indices. Also, in the intervention group Emv/Vp was decreased by 14% (p=0.06); E to A ratio by 24% (p=0.004) and E to Emv ratio by 8% (p=0.05); while Stv increased by 25% (p=0.01). Most importantly, the intervention group reduced pulse wave velocity by 9% (p=0.05) and increased augmentation index by 26%; and VTI by 4% (p=0.05); Those parameters were not significantly changed on control group (all p>0.05). Conclusion Hight intensity exercise rehabilitation program revealed beneficial effect on left ventricular diastolic indices and right ventricle performance. As, in those patients compensation of the aorta is also lost and the LV cannot generate the extra force necessary to completely overcome the late systolic augmented pressure, the increase in the augmented pressure (AIa) observed in the intervention group reflects the benefit in aorto-ventricular coupling and cardiac power that boosts systolic pressure and restores a positive influence in pressure, like in early stages of HF. Acknowledgement/Funding None

The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration

2020 ◽  
Vol 163 (2) ◽  
pp. 232-243 ◽  
Author(s):  
Rebecca L. Cherney ◽  
Vinciya Pandian ◽  
Ashly Ninan ◽  
Debra Eastman ◽  
Brian Barnes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Care Pathway ◽  
Interdisciplinary Collaboration ◽  
Unit Length ◽  
Control Group ◽  
Staff Nurse ◽  
Prospective Comparison

Objective To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Results Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 ( P < .05). The incidence of adverse events was unchanged. Discussion Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

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