Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients

Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m2, Group 2-BMI = 25 to 29.9 kg/m2, Group 3-BMI = 30 to 39.9 kg/m2, Group 4-BMI ≥ 40 kg/m2. Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 ( P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 ( P = 0.005). Group 4 required mechanical ventilation longer than Group 1 ( P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m2.

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Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days

Journal of Critical Care ◽

10.1016/j.jcrc.2015.09.030 ◽

2016 ◽

Vol 31 (1) ◽

pp. 201-205 ◽

Cited By ~ 5

Author(s):

Galinos Barmparas ◽

Ara Ko ◽

Megan Y. Harada ◽

Andrea A. Zaw ◽

Jason S. Murry ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Stay ◽

Trauma Patients ◽

Maintenance Fluids

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Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: An evaluation of the physiologic and laboratory parameters on admission

Journal of Critical Care ◽

10.1016/j.jcrc.2010.08.009 ◽

2011 ◽

Vol 26 (2) ◽

pp. 160-165 ◽

Cited By ~ 25

Author(s):

Janne Henrik Liisanantti ◽

Pasi Ohtonen ◽

Outi Kiviniemi ◽

Jouko J. Laurila ◽

Tero I. Ala-Kokko

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Unit Stay ◽

Laboratory Parameters

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Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical-trauma ICU: a prospective, two-period cross-over, interventional study

10.21203/rs.2.15320/v1 ◽

2019 ◽

Author(s):

Rispah Chomba ◽

Maeyane Steve Moeng ◽

Warren Lowman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Antibiotic Treatment ◽

Intervention Group ◽

Control Group ◽

Surgical Trauma ◽

Trauma Patients ◽

Significant Difference ◽

Antibiotic Duration

Abstract Background: Biomarkers like procalcitonin (PCT) are an important antimicrobial stewardship tool for critically ill patients. The purpose of our study was to compare a procalcitonin guided antibiotic algorithm to standard antibiotic treatment in surgical trauma patients admitted to the intensive care unit (ICU).Methods: A prospective, two period cross-over study was conducted in a surgical trauma intensive care unit in South Africa. In the first period, 40 patients were recruited into the control group and antibiotics were discontinued as per standard of care. In the second period, 40 patients were recruited into the procalcitonin group and antibiotics were discontinued if the PCT decreased by ≥ 80% from the peak PCT level, or to an absolute value of less than 0.5 µg/L. Antibiotic duration of treatment was the primary outcome. Patients were followed up for 28 days from the first sepsis event.Results: For the first sepsis event the PCT group had a mean antibiotic duration of 9.3 days while the control group had a mean duration of 10.9 days (p=0.10). Patients in the intervention group had more antibiotic free days alive (mean 7.7±6.57 days) compared to the control group ﴾mean 3.8±5.22 days, (p=0.004﴿. The length of ICU stay and length of hospital stay for the two groups were similar. The in-hospital mortality was reduced in the intervention group (15%) compared to the control group (30%).Conclusion: There was no significant difference in duration of antibiotic treatment between the two groups. However, the PCT group had more antibiotic free days alive and lower in-hospital mortality compared to the control group.Trial registration: Pan African clinical trial registry, PACTR201909715467725, date of registration: 20.9.2019; retrospectively registered, https://pactr.samrc.ac.za/Search.aspx

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Serum Vitamin D levels at admission predict the length of intensive care unit stay but not in-hospital mortality of critically ill surgical patients

Journal of Research in Pharmacy Practice ◽

10.4103/2279-042x.167051 ◽

2015 ◽

Vol 4 (4) ◽

pp. 193 ◽

Cited By ~ 7

Author(s):

Hossein Khalili ◽

Nafiseh Alizadeh ◽

Mostafa Mohammadi ◽

Alireza Abdollahi

Keyword(s):

Intensive Care Unit ◽

Vitamin D ◽

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Unit Stay ◽

Serum Vitamin ◽

Surgical Patients ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

Critically Ill Surgical Patients

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Predictors of Mortality in Septic Shock: Findings for 57 Patients Diagnosed on Admission to Emergency or within 24 hours of Admission to Intensive Care

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791201900602 ◽

2012 ◽

Vol 19 (6) ◽

pp. 375-386

Author(s):

N Yücel ◽

T Togal ◽

E Gedik ◽

C Ertan ◽

U Kayabas ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Renal Failure ◽

Intensive Care ◽

Hospital Mortality ◽

Bicarbonate Level ◽

Duration Of Symptoms ◽

Blood Ph

Objective To identify the risk factors that influence outcome for patients who are diagnosed with septic shock in the emergency department at presentation or within 24 hours after admission to intensive care unit. Methods A retrospective study of 57 adult patients with septic shock was conducted between March 1, 2006 and August 31, 2009. Results The patients were 23 males and 34 females with a median age of 67 years (20 to 92 years). Thirty-three (58%) of 57 patients died in hospital and 24 (42%) survived. Multivariate analysis identified low blood pH (OR <0.001; 95% CI <0.001-0.53) and low bicarbonate level (OR 0.81; 95% CI 0.70-0.95) at emergency department or intensive care unit admission as useful predictors of 3-day in-hospital mortality. Low blood pH (OR <0.001; 95% CI <0.001-0.05), low bicarbonate level (OR 0.75; 95% CIs 0.61-0.91), long duration of symptoms (OR 1.49; 95% CI 1.04-2.13), high MEDS score (OR 1.56; 95% CIs 1.06-2.30), and high SOFA score (OR 1.57; 95% CI 1.12-2.20) were risk factors for 14-day in-hospital mortality. Renal failure (OR 7.58; 95% CI 1.28-44.77), lower pulmonary tract infection (OR 3.58; 95% CI 1.10-11.58), high MEDS score (OR 1.42; 95% CI 1.05-1.93) and high APACHE II score (OR 1.34; 95% CI 1.13-1.60) were risk factors for 28-day in-hospital mortality. Conclusions Several factors signaling poor short-term outcome for this patient group are low blood pH, low serum bicarbonate level, longer duration of symptoms, lower respiratory tract infection and renal failure. MEDS and SOFA scores might be helpful in the ED to stratify patients with septic shock according to mortality risk.

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P058: Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective cohort study

CJEM ◽

10.1017/cem.2019.249 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S84

Author(s):

J. Coles ◽

M. Erdogan ◽

S. Higgins ◽

R. Green

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Injury Severity ◽

Transition Period ◽

Early Mobilization ◽

Trauma Patients ◽

Icu Mortality ◽

Implementation Period ◽

The Impact

Introduction: Long-term immobility has detrimental effects for critically ill patients admitted to the intensive care unit (ICU) including ICU-acquired weakness. Early mobilization of patients admitted to ICU has been demonstrated to be a safe, feasible and effective strategy to improve patient outcomes. The optimal mobilization of trauma ICU patients has not been extensively studied. Our objective was to determine the impact of an early mobilization protocol on outcomes among trauma patients admitted to the ICU. Methods: We analyzed all adult trauma patients ( > 18 years old) admitted to ICU over a 2-year period prior to and following implementation of an early mobilization protocol, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared patient characteristics and outcomes (mortality, length of stay [LOS], ventilator days) between the pre- and post-implementation groups. Associations between early mobilization and clinical outcomes were estimated using binary and linear regression models. Results: Overall, there were 526 patients included in the analysis (292 pre-implementation, 234 post-implementation). The study population ranged in age from 18 to 92 years (mean age 49.0 ± 20.4 years) and 74.3% of all patients were male. The pre- and post-implementation groups were similar in age, sex, and injury severity. In-hospital mortality was reduced in the post-implementation group (25.3% vs. 17.5%; p = 0.031). In addition, there was a reduction in ICU mortality in the post-implementation group (21.6% vs. 12.8%; p = 0.009). We did not observe any difference in overall hospital LOS, ICU LOS, or ventilator days between the two groups. Compared to the pre-implementation period, trauma patients admitted to the ICU following protocol implementation were less likely to die in-hospital (OR = 0.52, 95% CI 0.30-0.91; p = 0.021) or in the ICU (OR = 0.40, 95% CI 0.21- 0.76, p = 0.005). Results were similar following a sensitivity analysis limited to patients with blunt or penetrating injuries. There was no difference between the pre- and post-implementation groups with respect to in-hospital LOS, ICU LOS, or the number of ventilator days. Conclusion: We found that trauma patients admitted to ICU during the post-implementation period had decreased odds of in-hospital mortality and ICU mortality. Ours is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.

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