scholarly journals Incidence and risk factors of delirium in surgical intensive care unit

2021 ◽  
Vol 6 (1) ◽  
pp. e000564
Author(s):  
Muhammad Asghar Ali ◽  
Madiha Hashmi ◽  
Waqas Ahmed ◽  
Syed Amir Raza ◽  
Muhammad Faisal Khan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Low Income ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care

BackgroundTo evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.MethodsWe conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for >24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors.ResultsThe average patient age was 43.29±17.38 and body mass index was 26.25±3.57 kg/m2. Delirium was observed in 19 of 87 patients with an incidence rate of 21.8%. Multivariable analysis showed chronic obstructive pulmonary disease, pain score >4 and hypernatremia were strong predictors of delirium. Midazolam (adjusted OR (aOR)=7.37; 95% CI 2.04 to 26.61) and propofol exposure (aOR=7.02; 95% CI 1.92 to 25.76) were the strongest independent predictors of delirium while analgesic exposures were not statistically significant to predict delirium in multivariable analysis.ConclusionDelirium is a significant risk factor of poor outcome in SICU. There was an independent association between pain, sedation, COPD, hypernatremia and fever in developing delirium.Level of evidenceIV.

Epidemiologic, Clinical, and Economic Evaluation of an Outbreak of Clonal Multidrug-ResistantAcinetobacter baumanniiInfection in a Surgical Intensive Care Unit

2007 ◽  
Vol 28 (11) ◽  
pp. 1247-1254 ◽  
Author(s):  
Lisa S. Young ◽  
Allison L. Sabel ◽  
Connie S. Price
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Significant Risk ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Duration Of Hospitalization ◽  
Tract Infections ◽  
Pulsatile Lavage

Objectives.To determine risk factors for acquisition of multidrug-resistant (MDR)Acinetobacter baumanniiinfection during an outbreak, to describe the clinical manifestations of infection, and to ascertain the cost of infection.Design.Case-control study.Setting.Surgical intensive care unit in a 400-bed urban teaching hospital and level 1 trauma center.Patients.Case patients received a diagnosis of infection due toA. baumanniiisolates with a unique pattern of drug resistance (ie, susceptible to imipenem, variably susceptible to aminoglycosides, and resistant to all other antibiotics) between December 1, 2004, and August 31, 2005. Case patients were matched 1 : 1 with concurrently hospitalized control patients. Isolates' genetic relatedness was established by pulsed-field gel electrophoresis.Results.Sixty-seven patients met the inclusion criteria. Case and control patients were similar with respect to age, duration of hospitalization, and Charlson comorbidity score. MDRA. baumanniiinfections included ventilator-associated pneumonia (in 56.7% of patients), bacteremia (in 25.4%), postoperative wound infections (in 25.4%), central venous catheter-associated infections (in 20.9%), and urinary tract infections (in 10.4%). Conditional multiple logistic regression was used to determine statistically significant risk factors on the basis of results from the bivariate analyses. The duration of hospitalization and healthcare charges were modeled by multiple linear regression. Significant risk factors included higher Acute Physiology and Chronic Health Evaluation II score (odds ratio [OR], 1.1 per point increase;P= .06), duration of intubation (OR, 1.4 per day intubated;P<.01), exposure to bronchoscopy (OR, 22.7;P= .03), presence of chronic pulmonary disease (OR, 77.7;P= .02), receipt of fluconazole (OR, 73.3;P<.01), and receipt of levofloxacin (OR, 11.5;P= .02). Case patients had a mean of $60,913 in attributable excess patient charges and a mean of 13 excess hospital days.Interventions.Infection control measures included the following: limitations on the performance of pulsatile lavage wound debridement, the removal of items with upholstered surfaces, and the implementation of contact isolation for patients with suspected MDRA. baumanniiinfection.Conclusions.This large outbreak of infection due to clonal MDRA. baumanniicaused significant morbidity and expense. Aerosolization of MDRA. baumanniiduring pulsatile lavage debridement of infected wounds and during the management of respiratory secretions from colonized and infected patients may promote widespread environmental contamination. Multifaceted infection control interventions were associated with a decrease in the number of MDRA. baumanniiisolates recovered from patients.

Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Song-I Lee ◽  
Younsuck Koh ◽  
Jin Won Huh ◽  
Sang-Bum Hong ◽  
Chae-Man Lim
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Medical Reason ◽  
Chronic Heart Disease

<b><i>Introduction:</i></b> An increase in age has been observed among patients admitted to the intensive care unit (ICU). Age is a well-known risk factor for ICU readmission and mortality. However, clinical characteristics and risk factors of ICU readmission of elderly patients (≥65 years) have not been studied. <b><i>Methods:</i></b> This retrospective single-center cohort study was conducted in a total of 122-bed ICU of a tertiary care hospital in Seoul, Korea. A total of 85,413 patients were enrolled in this hospital between January 1, 2007, and December 31, 2017. The odds ratio of readmission and in-hospital mortality was calculated by logistic regression analysis. <b><i>Results:</i></b> Totally, 29,503 patients were included in the study group, of which 2,711 (9.2%) had ICU readmissions. Of the 2,711 readmitted patients, 472 patients were readmitted more than once (readmitted 2 or more times to the ICU, 17.4%). In the readmitted patient group, there were more males, higher sequential organ failure assessment (SOFA) scores, and hospitalized for medical reasons. Length of stay (LOS) in ICU and in-hospital were longer, and 28-day and in-hospital mortality was higher in readmitted patients than in nonreadmitted patients. Risk factors of ICU readmission included the ICU admission due to medical reason, SOFA score, presence of chronic heart disease, diabetes mellitus, chronic kidney disease, transplantation, use of mechanical ventilation, and initial ICU LOS. ICU readmission and age (over 85 years) were independent predictors of in-hospital mortality on multivariable analysis. The delayed ICU readmission group (&#x3e;72 h) had higher in-hospital mortality than the early readmission group (≤72 h) (20.6 vs. 16.2%, <i>p</i> = 0.005). <b><i>Conclusions:</i></b> ICU readmissions occurred in 9.2% of elderly patients and were associated with poor prognosis and higher mortality.

scholarly journals A COMPARATIVE STUDY ON DRUG USE OF ANTIMICROBIAL AGENTS IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL.

2018 ◽  
Vol 11 (1) ◽  
pp. 310
Author(s):  
Nimin Paul ◽  
Santhosh Kumar V
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Total Drug ◽  
Surgical Intensive Care

 Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs.Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1st 2016 to March 1st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed.Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test.Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent’s usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.

scholarly journals Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

2016 ◽  
Vol 37 (5) ◽  
pp. 544-548 ◽  
Author(s):  
Anthony D. Harris ◽  
Sarah S. Jackson ◽  
Gwen Robinson ◽  
Lisa Pineles ◽  
Surbhi Leekha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Icu Admission ◽  
Clinical Culture ◽  
Culture Positive

OBJECTIVETo determine the prevalence of Pseudomonas aeruginosa colonization on intensive care unit (ICU) admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P. aeruginosa among those colonized and not colonized.METHODSWe conducted a cohort study of patients admitted to a medical or surgical intensive care unit of a tertiary care hospital. Patients had admission perirectal surveillance cultures performed. Risk factors analyzed included comorbidities at admission, age, sex, antibiotics received during current hospitalization before ICU admission, and type of ICU.RESULTSOf 1,840 patients, 213 (11.6%) were colonized with P. aeruginosa on ICU admission. Significant risk factors in the multivariable analysis for colonization were age (odds ratio, 1.02 [95% CI, 1.01–1.03]), anemia (1.90 [1.05–3.42]), and neurologic disorder (1.80 [1.27–2.54]). Of the 213 patients colonized with P. aeruginosa on admission, 41 (19.2%) had a subsequent clinical culture positive for P. aeruginosa on ICU admission and 60 (28.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization (ICU period and post-ICU period). Of these 60 patients, 49 (81.7%) had clinical infections. Of the 1,627 patients not colonized on admission, only 68 (4.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization. Patients colonized with P. aeruginosa were more likely to have a subsequent positive clinical culture than patients not colonized (incidence rate ratio, 6.74 [95% CI, 4.91–9.25]).CONCLUSIONSPrediction rules or rapid diagnostic testing will help clinicians more appropriately choose empirical antibiotic therapy for subsequent infections.Infect Control Hosp Epidemiol 2016;37:544–548

Sign in / Sign up

Export Citation Format

Share Document