Stay Hospital and In-hospital Mortality by Stroke

BackgroundParoxysmal sympathetic hyperactivity (PSH) is a disorder with excessive sympathetic activity commonly recognized in patients with acquired brain injury. Autonomic instability is frequent in anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE). However, PSH in anti-NMDARE has gained little attention.MethodsWe retrospectively reviewed 24 patients diagnosed with severe anti-NMDARE in the neuro-intensive care unit (NICU) between 2014 and 2019. Patients were assessed with the PSH assessment measure (PSH-AM) scale, and categorized into “PSH+” group and “PSH-” group. The clinical characteristics, hospital mortality, and functional outcome by modified Rankin Scale (mRS) score at six months after discharge were compared between the two groups. Among patients with PSH+, the clinical features and pharmacotherapy of PSH were summarized and compared.ResultsTwenty-four patients were included in the study. Twelve of them (50%) were categorized as PSH+ based on PSH-AM scores. There were no significant differences in the demographic characteristic, GCS scores upon admission, incidence of status epilepticus, teratoma occurrence, hospital mortality, and 6-month mRS between PSH+ and PSH- groups. Patients with PSH+ had increased length of NICU stay, hospital stay and duration of mechanical ventilation. The most prominent clinical features of PSH in severe anti-NMDARE were tachycardia and hyperthermia, while posturing was the relatively mildest clinical feature. Propranolol and clonazepam were more commonly used than gabapentin in pharmacotherapy of PSH in severe anti-NMDARE.ConclusionsThe incidence of PSH in severe anti-NMDARE patients was as high as 50%. Patients with PSH demonstrated prolonged NICU stay, hospital stay and increased duration of mechanical ventilation, while no effect on hospital mortality and functional outcome. Clinicians should be aware of the distinctive characteristics and treatment options of PSH in severe anti-NMDARE.

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Role of Automatic Tube Compensation as Spontaneous Breathing Trial in Critically Ill Patients: A Systematic Review and Meta-Analysis

10.22514/sv.2020.16.0053 ◽

2020 ◽

Keyword(s):

Confidence Interval ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Spontaneous Breathing ◽

Meta Analysis ◽

Stay Hospital ◽

Successful Extubation ◽

Tube Compensation

Objectives: The role of automatic tube compensation (ATC) compared to other spontaneous breathing trials (SBTs) in critically ill receiving mechanical ventilation remains uncertain. The aim of this meta-analysis was to determine the role of ATC in critically ill patients compared to alternative SBT techniques. Methods: We searched PubMed, Cochrane Library, and Embase to capture all potential randomized controlled trials (RCTs) investigating the comparative efficacy of ATC related to other SBT techniques including pressure support (PS), T-piece, continuous positive airway pressure (CPAP) from their inception to February 2020. Primary outcomes were successful extubation rate. Duration of weaning, intensive care unit (ICU) stay, hospital stay, and hospital mortality was regarded as secondary outcomes. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Results: We included 13 studies enrolling 1117 patients in the final analysis. Pooled results indicated no significant difference when ATC plus CPAP (ATC/CAPA) compared to PS (6 RCTs; 572 patients; risk ratio [RR], 1.15; 95% confidence interval [CI], 1.00 to 1.31), ATC versus T-piece (2 RCTs; 157 patients; RR, 1.14; 95% CI, 0.93 to 1.40), ATC plus PS (ATC/PS) versus PS alone (1 RCTs; 100 patients; RR, 1.15; 95% CI, 0.98 to 1.35), ATC/CPAP versus CPAP alone (3 RCTs; 247 patients; RR, 1.12; 95% CI, 0.97 to 1.29) in terms of successful extubation. Additionally, ATC was also not superior to PS, T-piece, or CPAP in improving the rate of reintubation, the duration of weaning, ICU stay, hospital stay, and hospital mortality. Conclusions: Compared to alternative SBT techniques including PSV and T-piece, ATC may have comparable predictive power of successful extubation in critically ill patients. However, a definite conclusion on this topic can not be drawn due to limited data. Therefore, further studies were required to establish our findings due to limited number of eligible studies and small accumulated sample size.

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Tu1029 The Glasgow-Blatchford Bleeding Score Predicts Lenght of Stay, Hospital Mortality and Aids in Selecting ICU Care

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1259 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB546-AB547 ◽

Cited By ~ 1

Author(s):

Drew B. Schembre ◽

Robson E. Ely ◽

Jack Brandabur ◽

Kunjali Padhya

Keyword(s):

Hospital Mortality ◽

Bleeding Score ◽

Stay Hospital

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Frequency with which surgeons undertake pancreaticoduodenectomy determines length of stay, hospital charges, and in-hospital mortality

Journal of Gastrointestinal Surgery ◽

10.1016/s1091-255x(01)80009-3 ◽

2001 ◽

Vol 5 (1) ◽

pp. 21-26 ◽

Cited By ~ 71

Author(s):

A Rosemurgy

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Hospital Charges ◽

Stay Hospital

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Impacto da atenção primária à saúde sobre os indicadores da assistência hospitalar no Piauí

Revista de Administração em Saúde ◽

10.23973/ras.78.211 ◽

2020 ◽

Vol 20 (78) ◽

Author(s):

Djalma Ribeiro Costa ◽

Lucas Palha Dias Parente ◽

Fábio Palha Dias Parente

Keyword(s):

Health Care ◽

Primary Health Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Hospital Care ◽

Patient Admission ◽

Percentage Increase ◽

Health Care Teams ◽

Primary Health ◽

Stay Hospital

Introdução: A atenção primária à saúde resolve cerca de 80% dos problemas de saúde da comunidade, promove a saúde e previne agravos, melhorando indicadores hospitalares. Objetivo: conhecer o impacto da implantação de equipes de saúde da atenção primária sobre internação, permanência média, taxa de mortalidade hospitalar e gastos hospitalares. Metodologia: Estudo ecológico em que se realizaram estatística descritiva, variação percentual acumulada mensal e correlação não-paramétrica rô de Spearman entre as variáveis equipes de saúde, quantidade de internações, permanência hospitalar média, taxa de mortalidade hospitalar e valor total gasto de janeiro de 2008 a outubro de 2019 no Piauí. Resultados: o aumento percentual acumulado no número de equipes instaladas acompanhou-se de redução percentual acumulada dos indicadores hospitalares. Identificaram-se significativa correlação negativa entre as variações percentuais mensais acumuladas de implantação de equipes e os indicadores de assistência hospitalar. Conclusão: a implementação de equipes de saúde tem sido uma estratégia gerencial eficaz em termos de economia da saúde e qualidade de saúde da população no Piauí por melhorar os indicadores da assistência hospitalar.Palavras-chave: Atenção Primária à Saúde; Estatísticas Hospitalares; Administração em Saúde Pública. ABSTRACTIntroduction: Primary health care solves about 80% of the community's health problems, promotes health and prevents diseases, improving hospital indicators. Objective: to know the impact of the implementation of primary health care teams on in-patient admission counting, average length of stay, hospital mortality rate and hospital expenses. Methodology: Ecological study in which descriptive statistics, accumulated monthly percentage variation and non-parametric Spearman’s Rho correlation between the variables implemented health care teams, in-patient admission counting, average hospital stay, hospital mortality rate and total amount spent in hospital assistance from January 2008 to October 2019 in Piaui. Results: the cumulative percentage increase in the number of implemented health care teams was accompanied by an accumulated percentage reduction in hospital indicators. A significant negative correlation was identified between the accumulated monthly percentage changes in the implemented health care teams and hospital care indicators. Conclusion: the implementation of health care teams has been an effective managerial strategy in terms of health economics and health quality of the population in Piaui for improving hospital care indicators.Keywords: Primary Health Care; Hospital Statistics; Public Health Administration

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Effect of Different Corticosteroid Regimens on the Outcome of Severe COVID-19-Related Acute Respiratory Failure. A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10214847 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4847

Author(s):

Michele Umbrello ◽

Paolo Formenti ◽

Stefano Nespoli ◽

Eleonora Pisano ◽

Cecilia Bonino ◽

...

Keyword(s):

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Retrospective Analysis ◽

Infectious Complications ◽

High Dose ◽

Short Term ◽

Systemic Corticosteroids ◽

Refractory Hypoxemia ◽

Stay Hospital

Background: Systemic corticosteroids are associated with reduced mortality in COVID-19-related acute respiratory failure; however, the type and dose has not yet been established. Objectives: To compare the outcomes of dexamethasone vs. methylprednisolone, along with the effects of rescue, short-term, high-dose boluses of corticosteroids. Methods: Before/after and case/control retrospective analysis of consecutive critically ill COVID-19 subjects. Subjects were initially given dexamethasone; however, after review of the local protocol, methylprednisolone was suggested. A three-day course of 1000 mg/day of methylprednisolone was administered in the case of refractory hypoxemia within the first 10 days of treatment. Propensity score-adjusted comparisons were performed. Results: A total of 81 consecutive subjects were included (85% males, 60 ± 10 years, SAPS II 27 ± 7, SOFA 4 [IQR 3, 6] points) and 51 of these subjects (62.9%) received dexamethasone and 29 (35.8%) had methylprednisolone. The groups were well matched for age, comorbidities, and severity at admission. No differences were found in the duration of ICU stay, hospital mortality, or infectious complications between the groups. A total of 22 subjects (27.2%) received a rescue bolus; these subjects had a significantly lower oxygenation, a higher driving pressure, and an increased ventilatory ratio during the first ten days. Short-term/high-dose boluses were associated with higher hospital mortality, longer mechanical ventilation and ICU and hospital stay, and more infectious complications. A subgroup of subjects who received the boluses had significantly improved oxygenation and lower hospital mortality. Conclusions: We were unable to find any difference between dexamethasone or methylprednisolone on the explored outcomes; high-dose boluses of corticosteroids were associated with a worse outcome. However, a subgroup of subjects was identified in whom the high-dose boluses seemed beneficial.

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