Cerebral monitoring in surgical ICU patients

Abstract Background Hospital-acquired pressure injuries (HAPrIs) are areas of damage to the skin occurring among 5–10% of surgical intensive care unit (ICU) patients. HAPrIs are mostly preventable; however, prevention may require measures not feasible for every patient because of the cost or intensity of nursing care. Therefore, recommended standards of practice include HAPrI risk assessment at routine intervals. However, no HAPrI risk-prediction tools demonstrate adequate predictive validity in the ICU population. The purpose of the current study was to develop and compare models predicting HAPrIs among surgical ICU patients using electronic health record (EHR) data. Methods In this retrospective cohort study, we obtained data for patients admitted to the surgical ICU or cardiovascular surgical ICU between 2014 and 2018 via query of our institution's EHR. We developed predictive models utilizing three sets of variables: (1) variables obtained during routine care + the Braden Scale (a pressure-injury risk-assessment scale); (2) routine care only; and (3) a parsimonious set of five routine-care variables chosen based on availability from an EHR and data warehouse perspective. Aiming to select the best model for predicting HAPrIs, we split each data set into standard 80:20 train:test sets and applied five classification algorithms. We performed this process on each of the three data sets, evaluating model performance based on continuous performance on the receiver operating characteristic curve and the F1 score. Results Among 5,101 patients included in analysis, 333 (6.5%) developed a HAPrI. F1 scores of the five classification algorithms proved to be a valuable evaluation metric for model performance considering the class imbalance. Models developed with the parsimonious data set had comparable F1 scores to those developed with the larger set of predictor variables. Conclusions Results from this study show the feasibility of using EHR data for accurately predicting HAPrIs and that good performance can be found with a small group of easily accessible predictor variables. Future study is needed to test the models in an external sample.

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Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

Infection Control and Hospital Epidemiology ◽

10.1086/675292 ◽

2014 ◽

Vol 35 (3) ◽

pp. 243-250 ◽

Cited By ~ 23

Author(s):

Melissa A. Viray ◽

James C. Morley ◽

Craig M. Coopersmith ◽

Marin H. Kollef ◽

Victoria J. Fraser ◽

...

Keyword(s):

At Risk ◽

Staphylococcus Aureus ◽

Tertiary Care ◽

Control Unit ◽

Post Intervention ◽

Icu Patients ◽

Chlorhexidine Bathing ◽

Before And After ◽

Surgical Icu ◽

Time Series Methodology

Objective.Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.Design.Prospective pre-post-intervention study with control unit.Setting.A 1,250-bed tertiary care teaching hospital.Patients.Medical and surgical ICU patients.Methods.Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.Results.The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, −2.62 [95% confidence interval (CI), −5.19 to −0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, −11.10 [95% CI, −37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, −7.25 to −0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).Conclusions.Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.

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CAM-ICU and ICDSC Agreement in Medical and Surgical ICU Patients Is Influenced by Disease Severity

PLoS ONE ◽

10.1371/journal.pone.0051010 ◽

2012 ◽

Vol 7 (11) ◽

pp. e51010 ◽

Cited By ~ 13

Author(s):

Jorge Alberto de Oliveira Fagundes ◽

Cristiane Damiani Tomasi ◽

Vinicius Rene Giombelli ◽

Sarah Cascaes Alves ◽

Roberta Candal de Macedo ◽

...

Keyword(s):

Disease Severity ◽

Icu Patients ◽

Surgical Icu

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Thrombocytopenia in surgical ICU patients

Critical Care ◽

10.1186/cc8596 ◽

2010 ◽

Vol 14 (Suppl 1) ◽

pp. P364

Author(s):

O Yhiaoui ◽

M Metref

Keyword(s):

Icu Patients ◽

Surgical Icu

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Intensive insulin therapy increases glutathione synthesis rate in surgical ICU patients with stress hyperglycemia

PLoS ONE ◽

10.1371/journal.pone.0190291 ◽

2018 ◽

Vol 13 (1) ◽

pp. e0190291 ◽

Cited By ~ 5

Author(s):

Gianni Biolo ◽

Benedetta Massolino ◽

Filippo Giorgio Di Girolamo ◽

Nicola Fiotti ◽

Filippo Mearelli ◽

...

Keyword(s):

Insulin Therapy ◽

Intensive Insulin Therapy ◽

Synthesis Rate ◽

Stress Hyperglycemia ◽

Icu Patients ◽

Glutathione Synthesis ◽

Surgical Icu

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Hazard Ratio of 90-Day Mortality in ICU Patients with Abdominal Injuries Compared with Head Injuries

Archives of Iranian Medicine ◽

10.34172/aim.2021.134 ◽

2021 ◽

Vol 24 (12) ◽

pp. 897-902

Author(s):

Farshid Rahimi-Bashar ◽

Sara Ashtari ◽

Ali Fathi Jouzdani ◽

Seyed Jalal Madani ◽

Keivan Gohari-Moghadam

Keyword(s):

Head Trauma ◽

Abdominal Trauma ◽

Head Injuries ◽

Public Health Problem ◽

Hazard Ratio ◽

Major Public Health Problem ◽

Trauma Patients ◽

Abdominal Injuries ◽

Icu Patients ◽

Surgical Icu

Background: Despite advances in the treatment of abdominal injuries in patients with trauma, it remains a major public health problem worldwide. Evaluation of hazard ratio (HR) of 90-day mortality in intensive care unit (ICU) patients with abdominal injuries compare with head injuries in trauma patients and non-trauma surgical ICU patients. Methods: This single-center, prospective cohort study was conducted on 400 patients admitted to the ICU between 2018 and 2019 due to trauma or surgery in Hamadan, Iran. The main outcome was mortality at 90-day after ICU admission. Cox proportional hazards models were used to determine the HR and 95% confidence interval (CI) for 90-day mortality. Results: The 90-day mortality was 21.9% in abdominal injuries patients. According to multivariate Cox regression, the expected hazard mortality was 2.758 times higher in patients with abdominal injuries compared to non-trauma patients (HR: 2.758, 95% CI: 1.077–7.063, P=0.034). About more than 50% of all deaths in the abdominal and head trauma groups occurred within 20 days after admission. Mean time to death was 27.85±20.1, 30.27±18.22 and 31.43±26.24 days for abdominal-trauma, surgical-ICU, and head-trauma groups, respectively. Conclusion: Difficulty in accurate diagnosis due to the complex physiological variability of abdominal trauma, less obvious clinical symptoms in blunt abdominal injuries, multi-organ dysfunction in abdominal injuries, failure to provide timely acute care, as well as different treatment methods all account for the high 90-day mortality rate in abdominal-trauma patients. Therefore, these patients need a multidisciplinary team to care for them both in the ICU and afterwards in the general ward.

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