scholarly journals TRANSCOV cohort protocol: an epidemiological study assessing the impact of critically ill COVID-19 patients long distance transfers between intensive care units

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e054774
Author(s):  
Olivier Grimaud ◽  
Sahar Bayat ◽  
Anne Renault ◽  
Eric Maury ◽  
Julien Pottecher ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Severity ◽  
Long Distance ◽  
Respiratory Parameters ◽  
Severity Scores ◽  
Registration Number ◽  
Origin Region ◽  
Transferred Patients ◽  
The Impact

IntroductionDuring spring 2020, four regions of France faced a surge of severe COVID-19 patients which threatened to overflow local intensive care units (ICU) capacities. As an emergency response, between 13 March 2020 and 10 April 2020, an estimated 661 patients were transferred from overcrowded ICUs to eight other French regions and four neighbouring countries. The intensity, geographical spread and the diversity of vectors used are unprecedented. The study aims at assessing the impact of these inter-ICU transfers on the short-term and medium-term physical and psychological outcomes in this population of severe COVID-19 patients.Methods and analysisThe TRANSCOV cohort is a multicentre observational retrospective study. All transferred patients between ICUs outside the origin region will be invited to take part. For each transfer, up to four control patients will be selected among those admitted in the same ICU during the same period (±4 days of transfer date). Clinical data will be extracted from medical records and will include haemodynamic and respiratory parameters, as well as clinical severity scores before, during and after transfer. Data linkage with medicoadministrative data will enrich the clinical database and allow follow-up up to 1 year after initial admission.Ethics and disseminationThe study has been approved by the French Ethics and Scientific Committee on the 16 July 2020 (file no. 2046524). The results will be disseminated via publication of scientific articles and communications in national and international conferences.Trial registration number20 CO 015 CZ.

scholarly journals The impact of intensive care admission criteria on elderly mortality

2019 ◽  
Vol 65 (7) ◽  
pp. 1015-1020 ◽  
Author(s):  
Marco Túlio Gualberto Cintra ◽  
Dinah Belém ◽  
Edgar Nunes Moraes ◽  
Fernando Antônio Botoni ◽  
Maria Aparecida Camargos Bicalho
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Severity Score ◽  
Intensive Therapy ◽  
The Elderly ◽  
Admission Criteria ◽  
Severity Scores ◽  
Retrospective Cohort Studies ◽  
The Impact

SUMMARY OBJECTIVE To review systematically the influence of admission criteria on the mortality of elderly patients under intensive therapy. METHODS We performed a search on the PUBMED and BIREME databases by using the MeSH and DeCS terms “intensive care units”, “patient admission”, and “aged” in Portuguese, English, and Spanish. Only prospective and retrospective cohort studies were included. We analyzed the severity score, type of hospital admission, quality of life, co-morbidities, functionality, and elderly institutionalization. RESULTS Of the 1,276 articles found, thirteen were selected after evaluation of the inclusion and exclusion criteria. It was observed that the severity score, functionality, and co-morbidities had an impact on mortality. It was not possible to determine which severity score was more suitable. CONCLUSION We suggest that analysis of functionality, co-morbidities, and severity scores should be conducted to estimate the elderly mortality in relation to the admission to intensive care units.

scholarly journals Utilisation of medications among elderly patients in intensive care units: a cross-sectional study using a nationwide claims database

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026605 ◽  
Author(s):  
Sun-Young Jung ◽  
Hyun Joo Lee
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Intensive Care Units ◽  
Medication Use ◽  
Cross Sectional Study ◽  
Clinical Severity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Claims Database ◽  
Severity Scores

ObjectivesClinical practice guidelines for the management of pain and sedation in critically ill patients have been developed and applied; however, there is limited data on medication use among elderly patients. This study identifies current practice patterns for analgo-sedative use in mechanically ventilated elderly patients in Korea using a national claims database.DesignCross-sectional study.Setting and participantsVentilated elderly patients aged 65 years or older in intensive care units (ICUs) from an aged patients’ national claims database in KoreaPrimary outcome measuresUse of sedatives including benzodiazepines, opioids and non-opioid analgesics, neuromuscular blocking agents (NMBAs) and antipsychotic drugs were analysed by the duration of mechanical ventilation (MV), age and time.ResultsFrom 2012 to 2016, 22 677 elderly patients underwent MV in 267 general or tertiary ICUs. Mean age was 77.2 (±6.9) years and the median duration of MV was 4.1 days; 77.2% of patients received sedatives, 65.0% analgesics, 29.1% NMBAs and 19.6% antipsychotics. Midazolam (62.0%) was the most commonly prescribed medication. The proportions of sedatives, analgesics and NMBAs increased, whereas the percentages of person-days decreased with longer MV duration (p<0.01). With advanced age, the prevalence and duration of sedative, analgesic and NMBA use decreased (adjusted OR (95% CI) 0.98 (0.97 to 0.98) in all three classes) while antipsychotic did not (adjusted OR 1.00 (1.00–1.01)). Annually, benzodiazepines showed reduced administration (76.2% in 2012 and 71.4% in 2016, p<0.01), while daily opioid dose increased (21.6 in 2012 vs 30.0 mg in 2016, p<0.01).ConclusionsThe prevalence of sedative, analgesic and NMBAs use and daily opioid doses were lower, whereas antipsychotic use was higher compared with those in previous studies in adult patients. The findings warrant further studies investigating appropriateness and safety of medication use that consider clinical severity scores with a focus on elderly patients in ICUs.

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

2019 ◽  
Vol 50 ◽  
pp. 151191 ◽  
Author(s):  
Fiona Yu ◽  
Deborah Somerville ◽  
Anna King
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Nurse Fatigue ◽  
The Impact

Communicating with parents in neonatal intensive care units: The impact on parental stress

2017 ◽  
Vol 100 (4) ◽  
pp. 710-719 ◽  
Author(s):  
Christian Enke ◽  
Andrés Oliva y Hausmann ◽  
Felix Miedaner ◽  
Bernhard Roth ◽  
Christiane Woopen
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Parental Stress ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
The Impact

scholarly journals Improvement of APACHE II score system for disease severity based on XGBoost algorithm

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Luo ◽  
Zhiyu Wang ◽  
Cong Wang
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
External Validation ◽  
Apache Ii ◽  
Validation Dataset ◽  
Apache Ii Score ◽  
Severity Scores ◽  
The Impact ◽  
Improve Patient

Abstract Background Prognostication is an essential tool for risk adjustment and decision making in the intensive care units (ICUs). In order to improve patient outcomes, we have been trying to develop a more effective model than Acute Physiology and Chronic Health Evaluation (APACHE) II to measure the severity of the patients in ICUs. The aim of the present study was to provide a mortality prediction model for ICUs patients, and to assess its performance relative to prediction based on the APACHE II scoring system. Methods We used the Medical Information Mart for Intensive Care version III (MIMIC-III) database to build our model. After comparing the APACHE II with 6 typical machine learning (ML) methods, the best performing model was screened for external validation on anther independent dataset. Performance measures were calculated using cross-validation to avoid making biased assessments. The primary outcome was hospital mortality. Finally, we used TreeSHAP algorithm to explain the variable relationships in the extreme gradient boosting algorithm (XGBoost) model. Results We picked out 14 variables with 24,777 cases to form our basic data set. When the variables were the same as those contained in the APACHE II, the accuracy of XGBoost (accuracy: 0.858) was higher than that of APACHE II (accuracy: 0.742) and other algorithms. In addition, it exhibited better calibration properties than other methods, the result in the area under the ROC curve (AUC: 0.76). we then expand the variable set by adding five new variables to improve the performance of our model. The accuracy, precision, recall, F1, and AUC of the XGBoost model increased, and were still higher than other models (0.866, 0.853, 0.870, 0.845, and 0.81, respectively). On the external validation dataset, the AUC was 0.79 and calibration properties were good. Conclusions As compared to conventional severity scores APACHE II, our XGBoost proposal offers improved performance for predicting hospital mortality in ICUs patients. Furthermore, the TreeSHAP can help to enhance the understanding of our model by providing detailed insights into the impact of different features on the disease risk. In sum, our model could help clinicians determine prognosis and improve patient outcomes.

The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hattie Catherine Ann Moyes ◽  
Lana MacNaboe ◽  
Kate Townsend
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Substance Misuse ◽  
Well Being ◽  
Training Programme ◽  
Content Type ◽  
National Quality ◽  
Improvement Programme ◽  
The Uk ◽  
The Impact

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units

2007 ◽  
Vol 16 (6) ◽  
pp. 589-598 ◽  
Author(s):  
Mark A. Malesker ◽  
Pamela A. Foral ◽  
Ann C. McPhillips ◽  
Keith J. Christensen ◽  
Julie A. Chang ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Intensive Care Units ◽  
Tight Glycemic Control ◽  
Third Party ◽  
Full Time ◽  
Motion Data ◽  
Time Motion ◽  
The Impact

Background The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. Objectives To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. Methods Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. Results Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. Conclusions Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

scholarly journals Selection of an instrument to evaluate the organizational environment of nurses working in intensive care: an integrative review

2014 ◽  
Vol 3 (6) ◽  
pp. 143
Author(s):  
Brett Abbenbroek ◽  
Christine Duffield ◽  
Doug Elliott
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Outcome Measures ◽  
Organizational Structures ◽  
Survey Instrument ◽  
Integrative Review ◽  
Organizational Environment ◽  
Intensive Care Nurses ◽  
Survey Instruments ◽  
The Impact

Objective: To determine an appropriate survey instrument to evaluate the impact of organizational structures on the work environment of intensive care nurses. Background: Internationally the demand for intensive care is increasing. Solely increasing bed capacity is not sustainable. Large capacity multi-specialty Intensive Care Units are emerging as the preferred organizational model with benefits resulting from optimizing operational synergies and economies of scale. The impact of this organizational transition on intensive care nurses is not well understood. An appropriate survey instrument for intensive care nurses is required. Design: Integrative literature review. Data Sources: CINAHL, PubMed, EMBASE and OVID Nursing databases searched for studies published between 2005 and 2013. Review methods: An integrative review and quality assessment of the studies was undertaken to select nurse outcome measures associated with organizational structures across a range of acute and critical care settings. Congruence between nurse outcome measures and nurse survey instruments tested in the literature was assessed to select instruments for further psychometric evaluation. Results: Thirty-one cross sectional quantitative studies, from fourteen countries, were reviewed. Twenty one nurse outcome measures associated with organizational factors were identified and a total of twenty five survey instruments used in the studies reviewed. Assessment of congruence and psychometric properties determined that a combination of two instruments is required to comprehensively assess the organizational environment of nurses working in intensive care units. Conclusion: The environment of nurses working in intensive care is effectively evaluated with an instrument that combines subscales from the Practice Environment Scale-Nurse Work Index and Maslach’s Burnout Inventory. 

Implementation of Sepsis Bundles in Intensive Care Units of Bangladesh: A Prospective Observational Study

2013 ◽  
Vol 1 (1) ◽  
pp. 8-17
Author(s):  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Mirza Nazim Uddin ◽  
UH Shahera Khatun ◽  
Md Abdul Mannan ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Positive Impact ◽  
Delayed Diagnosis ◽  
Outcome Data ◽  
Surviving Sepsis Campaign ◽  
Sepsis Bundles ◽  
Impact On Survival ◽  
The Impact

Objective: To assess compliance of Intensive Care Units (ICUs) of Bangladesh to the components of resuscitation & management bundles of Surviving Sepsis Campaign (SSC). Secondary objective was to assess the impact of compliance on mortality and to determine how its compliance & mortality compared with other Asian and Western countries. Design: Prospective Cohort study. Setting: 14 ICUs of Bangladesh. Participants: 65 adult patients with severe sepsis admitted into these ICUs in July 2009. The organizational characteristics of the participating centers, the patients’ baseline characteristics, the achievement of target within the resuscitation & management bundle & outcome data were recorded. Outcome: Compliance with the Surviving Sepsis Campaign’s resuscitation (6 hrs) & management (24 hrs) bundles. Results: Hospital mortality in ICU patients of Bangladesh suffering from severe sepsis was 49·2%. It was significantly higher than countries reported. Compliance to entire components of both resuscitation & management bundles were reported to be zero in ICUs of Bangladesh. Compliance of individual components of the bundles did not predict improved survival. Conclusion: In ICUs of Bangladesh, high mortality of severe sepsis and failure of compliance of SSC bundle guidelines to have positive impact on survival were presumably attributed to delayed diagnosis, poor adherence to & delayed application of SSC guidelines on sepsis bundles. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14359 Bangladesh Crit Care J March 2013; 1: 8-17

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