scholarly journals Paradox of Predictors in Critically ill COVID-19 Patients: Outcome of a COVID-dedicated Intensive Care Unit

2021 ◽  
Author(s):  
Morshed Nasir ◽  
Rawshan Ara Perveen ◽  
Rumana Nazneen ◽  
Tahmina Zahan ◽  
Sonia Nasreen Ahmad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Demographic Data ◽  
Tertiary Care ◽  
Predictive Biomarkers ◽  
Nasopharyngeal Swab ◽  
Treatment Schedule ◽  
Care Hospital ◽  
Icu Stay ◽  
Significant Difference

Background: The study aimed to analyze the demographic, comorbidities, biomarkers, pharmacotherapy, and ICU-stay with the mortality outcome of COVID-19 patients admitted in the intensive care unit of a tertiary care hospital in a low-middle income country, Bangladesh. Methods: The retrospective cohort study was done in Holy Family Red Crescent Medical College Hospital from May to September 2020. All 112 patients who were admitted to ICU as COVID-19 cases (confirmed by RT-PCR of the nasopharyngeal swab) were included in the study. Demographic data, laboratory reports of predictive biomarkers, treatment schedule, and duration of ICU-stay of 99 patients were available and obtained from hospital records (non-electronic) and treatment sheets, and compared between the survived and deceased patients. Results: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age was 61.08 years. Most of the ICU patients were in the 60 - 69 years of age group and the highest mortality rates (35.89%) were observed in this age range. Diabetes mellitus and hypertension were the predominant comorbidities in the deceased group of patients. A significant difference was observed in neutrophil count, creatinine and, NLR, d-NLR levels that raised in deceased patients. There was no significant difference as a survival outcome of antiviral drugs remdesivir or favipiravir, while the use of cephalosporin was found much higher in the survived group than the deceased group (46.66% vs 20.51%) in ICU. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males aged more than 60 years. There were wide variations of the biomarkers in critical COVID-19 patients in a different population, which put the healthcare workers into far more challenge to minimize the mortality in ICU in Bangladesh and around the globe during the peak of the pandemic.

scholarly journals Drug utilization pattern in an intensive care unit of a teaching hospital in South India

2019 ◽  
Vol 8 (7) ◽  
pp. 1527
Author(s):  
Suraj B. ◽  
Srikanth . ◽  
Somashekara S. C. ◽  
Sandeep B. ◽  
Tanuja .
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Utilization ◽  
Demographic Data ◽  
Tertiary Care ◽  
Care Hospital ◽  
Antibiotic Policy ◽  
Inappropriate Use ◽  
Icu Stay ◽  
Bed Days

Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated.  About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively. Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay.  Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics.Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated.  About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively.Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay.  Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics. Keywords: Antibiotics, Daily defined doses, Drug utilization, Intensive care unit

scholarly journals Frequency and predictors of colonization of the respiratory tract by VIM-2-producing Pseudomonas aeruginosa in patients of a newly established intensive care unit

2006 ◽  
Vol 55 (10) ◽  
pp. 1435-1439 ◽  
Author(s):  
Maria Horianopoulou ◽  
Nicholas J. Legakis ◽  
Maria Kanellopoulou ◽  
Sotiris Lambropoulos ◽  
Athanassios Tsakris ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Respiratory Tract ◽  
Tertiary Care ◽  
Nucleotide Sequencing ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Icu Stay

The aim of this study was to examine the frequency and predictors of colonization of the respiratory tract by metallo-β-lactamase (MBL)-producing Gram-negative bacteria in patients admitted to a newly established intensive care unit (ICU) of a tertiary care hospital. Specimens of tracheobronchial aspirates for microbiological studies were obtained every day for the first 3 days of the ICU stay and subsequently every third day for the rest of the ICU stay. PCR analysis and nucleotide sequencing were performed to identify bacteria that had MBL genes. Thirty-five patients (20 male, 15 female) were hospitalized during the initial 3 month period of functioning of the ICU. Colonization of the lower respiratory tract by Gram-negative bacteria was found in 29 of 35 patients (83 %) during the first 6–20 days (median 13 days) following admission to the ICU (13 patients with Acinetobacter baumannii, ten with Pseudomonas aeruginosa, three with Enterobacter aerogenes, two with Klebsiella pneumoniae and one with Stenotrophomonas maltophilia). Six of 29 patients (21 %) colonized with Gram-negative bacteria had bla VIM-2-positive P. aeruginosa isolates; one of these patients developed clinical infection due to this micro-organism. Previous use of carbapenems (P=0.01) or other β-lactams (P=0.03), as well as a stay in the ICU of >20 days (P<0.001), were associated with colonization with bla VIM-2-producing P. aeruginosa. In conclusion, colonization by Gram-negative bacteria of the respiratory tract of patients in this newly established ICU was common (83 %). Use of β-lactams, including carbapenems, was associated with subsequent colonization of the respiratory tract with MBL-positive P. aeruginosa.

scholarly journals Demographic and clinical profile with early outcome of critically ill COVID-19 patients admitted in an ICU of a tertiary care hospital in Dhaka, Bangladesh

2020 ◽  
pp. 51-55
Author(s):  
ASM Areef Ahsan ◽  
Rozina Sultana ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
Debasish Kumar Saha ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Rt Pcr ◽  
Demographic Profile ◽  
Icu Stay ◽  
Length Of Icu Stay

Background: First outbreak of corona virus disease (COVID-19) started in Wuhan, China at December 2019 and since then, it spread globally but information about critically ill patients with COVID-19 is still limited. So, it is important to know the demographic profile and overall outcome of COVID-19 patients. We aimed to describe the clinic-demographic characteristics and outcome of critically ill COVID-19 patients admitted in our intensive care unit. Methods: This prospective observational study was carried out in the intensive care unit of department of Critical Care Medicine of BIRDEM General Hospital, Dhaka, Bangladesh from 11th June to 31st October, 2020. Out of 382 suspected cases, 86 patients were found to be RT-PCR for COVID-19 positive and were included in this study. After admission in ICU, all patients were resuscitated according to ICU protocol. Length of ICU stay were recorded and patient outcomes were mentioned as survival (transferred or discharged) or death. Results: A total of 86 patients (male 53, female 33, mean age 63.6 ± 12.8 years) with RT-PCR for COVID-19 positive were enrolled in this study. Regarding COVID related symptoms, Ninety six percent(83) had respiratory distress, 93.02 % (n=80) had cough, 84.9% (n=73) had history of fever,11.6 % (n=10) had loose motion and 7% (n=6), had anosmia. Diabetes mellitus (DM) was the most common co morbidity (91.9%).For improvement of oxygenation of COVID patient, we treated 7% of patients (n=6) by nasal Cannula, 24.4% (n=21) by Face Mask, 20.9% (n=18) by Non Rebreather Mask, 22.1% (n= 19) by High Flow Nasal Cannula (HFNC) and 25.6% (n= 22) by Mechanical Ventilation. Mean length of ICU stay were 6.9 ± 3.6 days and range of icu stay were 1-20 days. Among 86 COVID patient, 51.16% (n=44) were transferred to the isolation ward or discharged at home and 48.8% (n=42) were died. Conclusion: This study showed the overall demographic and clinical features of critically ill COVID-19 patients, admitted in an icu of a tertiary care hospital. As it is a single centered study, we need more study with multi center approach to know the detail demographic profile and outcome of COVID-19 patients. Birdem Med J 2020; 10, COVID Supplement: 51-55

scholarly journals A study of dysnatremia in patients admitted in medical intensive care unit of a tertiary care teaching hospital

2021 ◽  
Vol 8 (2) ◽  
pp. 220
Author(s):  
Mantavya Patel ◽  
Sanjay Kumar Paliwal ◽  
Syed Javed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Female Ratio ◽  
Survival Status ◽  
Icu Stay ◽  
Significant Difference ◽  
Male Female Ratio ◽  
Medical Intensive Care

Background: Both dysnatremia at admission and that acquired in the intensive care unit (ICU) have been shown to have a direct influence on prognosis. The present was planned to study dysnatremia in adult patients admitting in medical intensive care unit (MICU).Methods: The present prospective observational study was conducted on patients admitted in medical ICU over a period of 1 year who developed dysnatremia during ICU stay. Patient’s age, sex, diagnosis at the time of diagnosis, comorbidities, serum sodium levels, risk factors, length of ICU stay, and survival status were noted.Results: Out of total 798 patients during the study period; 207 (25.94%) were found to have hypernatremia and 87 (10.9%) were hyponatremic. In hypernatremic group male/ female ratio was 125/82 and it was 50/37 in hyponatremic group. The mean ICU stay was significantly more in hypernatremic patients (4.76±3.57) compared to hyponatremic group (4.06±2.80). (p˂0.05) Mortality in both hypernatremic patients and hyponatremic patients was found significantly more in hypervolemic group which was 84.38% and 53.84% respectively. (p˂0.05)Conclusions: This study concluded that nowadays hypernatremia is more common with longer ICU stay. In both hypernatremia and hyponatremia mortality was found similar without any significant difference.

scholarly journals Correlation of PeradeniyaOrganophosphorus Poisoning Scale (POP) and outcome of Organophosphorus poisoning

2020 ◽  
Vol 5 (1) ◽  
pp. 986-989
Author(s):  
Gunjan Regmi ◽  
Batsalya Arjyal ◽  
Kanak Khanal ◽  
Kumud Pyakurel ◽  
Rejina Shahi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Assessment Tool ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Intensive Care Admission ◽  
Icu Stay ◽  
Number Of Patients ◽  
Organophosphorus Poisoning

Introduction: Organophosphorus poisoning is one of the common causesfor the intensive care admission in the developing countries.This study was conducted to assess the correlation between Peradeniya Organophosphorus Poisoning (POP) scale and the outcomes in poisoningin a tertiary care hospital in Eastern Nepal. Objective: To assess the severity and outcome of OP compound poisoning with the correlation of POP score. Methodology: This was a prospective observational study conducted over 6 months in the intensive care unit at tertiary care hospital in the eastern part of Nepal. The study includedall OP poisoning patients presenting in the emergency department and finally admitted to intensive care unit who fulfilled the inclusion criteria.Correlation was made between POP scores and outcomes in terms of intensive care unit(ICU) stay, need of ventilation and mortality was assessed. Result: Fifty patients with OP poisoning wereincluded in the study. Suicide attempt was the most common reason for poisoning. The incidence of poisoning was more common among males(72%)and significant majority were aged younger than 35 years (84%). On admission, the number of patients in mild, moderate and severepoisoning group were 52%, 30% and 18% respectively. Rates for ICU stay, respiratory failure requiring ventilator and mortality was significantly (p<0.001) higher in severe POP scale. Conclusion: The POP scale is a useful clinical assessment tool to assess and categorize patients with OP poisoning according to severity and in predicting their clinical outcomes.

scholarly journals A Prospective Study on the Outcome of Semi-Closed Neurointensive Care in A Tertiary Care Hospital Located in A Rural Area of Eastern Nepal: A Lower-Income Developing Country

2020 ◽  
Vol 2 (3) ◽  
pp. 7-13
Author(s):  
Niraj Kumar Keyal ◽  
Pankaj Raj Nepal ◽  
Karuna Tamrakar ◽  
Robin Bhattarai ◽  
Dinesh Kumar Thapa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Care Hospital ◽  
Full Time ◽  
Do Not Resuscitate ◽  
Neurological Patient ◽  
Common Diagnosis

Background: High mortality and morbidity in neurological patients are found due to lack of closed ICU (Intensive Care Unit), neurointensivist, and training in neurocritical care in most of the developing countries. Therefore, this study was conducted to evaluate the outcome of the neurological patient managed by neurointensivist in a semi-closed ICU. Materials and methods: It was a prospective, descriptive observational cross-sectional study in a level three Neuro-intensive care unit of a tertiary care hospital of Eastern Nepal, for one year in 191 patients. All patients above 18 years admitted to the Neuro-intensive care unit were included in this study. Demographic data was collected for all patients at the time of presentation to the ICU. The outcome of the patient was defined as transferred to Neuro-Ward, leave against medical advice (LAMA), do not resuscitate (DNR) and death. Statistical analysis was done by using SPSS. The result was presented as frequency and percentage. Results: Out of 191 patients, Males (71.7%) was more common than females (28.2%). There were 107 (56%) patients were admitted after 24 hours of injury or illness. 28.2% of patients had a hemorrhagic stroke and was the most common diagnosis for admission in the ICU. This study showed that 58(82.72%) patients survived and were discharged, 23(12%) expired, 7(3.66%) went in LAMA) and 3(1.57%) gave do not resuscitate orders (DNR). Mean days on a mechanical ventilator was 3.17 ± 2.12 days. Mortality in the intubated patient was 19%. Conclusion: A semi-closed Neuro-intensive care unit that includes full-time neurointensivist may have a better outcome than the open ICU.

scholarly journals A ‘Shock Room’ for Early Management of the Acutely Ill

2009 ◽  
Vol 37 (3) ◽  
pp. 426-431 ◽  
Author(s):  
M. Piagnerelli ◽  
M. Van Nuffelen ◽  
Y. Maetens ◽  
P. Lheureux ◽  
J.-L. Vincent
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Demographic Data ◽  
Tertiary Care ◽  
Admission Diagnosis ◽  
Care Hospital ◽  
Early Management ◽  
Intensive Care Unit Staff ◽  
Shock Room ◽  
Coronary Care

Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated ‘shock room situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. In this article we describe our experiences using this shock room by detailing the demographic data, including time and source of admission, diagnosis and outcome, for the 2514 patients admitted to the shock room in 2006. The most common reasons for admission were cardiac (33%) and neurological (21%) diagnoses. After diagnosis and initial treatment, 54% of patients were transferred to an intensive care unit or a coronary care unit; 2.5% of patients died in the shock room. The shock room provides a useful area of collaboration between emergency department and intensive care unit staff and enables acutely ill patients to be assessed and treated rapidly to optimise outcomes.

scholarly journals Detection of SARS-CoV-2 and Other Infectious Agents in Lower Respiratory Tract Samples Belonging to Patients Admitted to Intensive Care Units of a Tertiary-Care Hospital, Located in an Epidemic Area, during the Italian Lockdown

2021 ◽  
Vol 9 (1) ◽  
pp. 185
Author(s):  
Adriana Calderaro ◽  
Mirko Buttrini ◽  
Sara Montecchini ◽  
Giovanna Piccolo ◽  
Monica Martinelli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Intensive Care Units ◽  
Lower Respiratory Tract ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Agents ◽  
Epidemic Area ◽  
Significant Difference

The aim of this study was the detection of infectious agents from lower respiratory tract (LRT) samples in order to describe their distribution in patients with severe acute respiratory failure and hospitalized in intensive care units (ICU) in an Italian tertiary-care hospital. LRT samples from 154 patients admitted to ICU from 27 February to 10 May 2020 were prospectively examined for respiratory viruses, including SARS-CoV-2, bacteria and/or fungi. SARS-CoV-2 was revealed in 90 patients (58.4%, 72 males, mean age 65 years). No significant difference was observed between SARS-CoV-2 positives and SARS-CoV-2 negatives with regard to sex, age and bacterial and/or fungal infections. Nonetheless, fungi were more frequently detected among SARS-CoV-2 positives (44/54, 81.4%, p = 0.0053). Candida albicans was the overall most frequently isolated agent, followed by Enterococcus faecalis among SARS-CoV-2 positives and Staphylococcus aureus among SARS-CoV-2 negatives. Overall mortality rate was 40.4%, accounting for 53 deaths: 37 among SARS-CoV-2 positives (mean age 69 years) and 16 among SARS-CoV-2 negatives (mean age 63 years). This study highlights the different patterns of infectious agents between the two patient categories: fungi were prevalently involved among SARS-CoV-2-positive patients and bacteria among the SARS-CoV-2-negative patients. The different therapies and the length of the ICU stay could have influenced these different patterns of infectious agents.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

2021 ◽  
pp. 000992282110472
Author(s):  
Andrew Brown ◽  
Mary Quaile ◽  
Hannah Morris ◽  
Dmitry Tumin ◽  
Clayten L. Parker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Care Coordination ◽  
Chronic Conditions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Admission ◽  
Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

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