scholarly journals Assessment of Postresuscitation Volume Status by Bioimpedance Analysis in Patients with Sepsis in the Intensive Care Unit: A Pilot Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Bram Rochwerg ◽  
Jason H. Cheung ◽  
Christine M. Ribic ◽  
Faraz Lalji ◽  
France J. Clarke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Pressure ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Volume Status ◽  
Bioimpedance Analysis ◽  
Consent Rate ◽  
Icu Patients ◽  
Unit Increase

Background. Bioimpedance analysis (BIA) is a novel method of assessing a patient’s volume status.Objective. We sought to determine the feasibility of using vector length (VL), derived from bioimpedance analysis (BIA), in the assessment of postresuscitation volume status in intensive care unit (ICU) patients with sepsis.Method. This was a prospective observational single-center study. Our primary outcome was feasibility. Secondary clinical outcomes included ventilator status and acute kidney injury. Proof of concept was sought by correlating baseline VL measurements with other known measures of volume status.Results. BIA was feasible to perform in the ICU. We screened 655 patients, identified 78 eligible patients, and approached 64 for consent. We enrolled 60 patients (consent rate of 93.8%) over 12 months. For each 50-unit increase in VL, there was an associated 22% increase in the probability of not requiring invasive mechanical ventilation (IMV) (p=0.13). Baseline VL correlated with other measures of volume expansion including serum pro-BNP levels, peripheral edema, and central venous pressure (CVP).Conclusion. It is feasible to use BIA to predict postresuscitation volume status and patient-important outcomes in septic ICU patients.Trial Registration. This trial is registered with clinicaltrials.govNCT01379404registered on June 7, 2011.

Association of opioid exposure during intensive care unit stays with post-discharge opioid use: A retrospective study and literature review

2021 ◽  
Vol 17 (6) ◽  
pp. 511-516
Author(s):  
Yoonsun Mo, MS, PharmD, BCPS, BCCCP ◽  
John Zeibeq, MD ◽  
Nabil Mesiha, MD ◽  
Abou Bakar, PharmD ◽  
Maram Sarsour, PharmD ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Hospital Discharge ◽  
Invasive Mechanical Ventilation ◽  
High Dose ◽  
Opioid Use ◽  
Electronic Health Record Data ◽  
Icu Patients ◽  
Mechanically Ventilated

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation. Design: A retrospective, observational study.Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.Participants: This study included mechanically ventilated patients requiring continuous opioid infusion from April 25, 2017 to May 16, 2019. Patients were excluded if they received chronic opioid therapy at home or expired during this hospital admission. Eligible patients were identified using an electronic health record data query.Main outcome measure(s): The proportion of ICU patients who continued to require opioids upon ICU and hospital discharge. Results: A total of 196 ICU patients were included in this study. Of these, 22 patients were transferred to a regular floor while receiving a fentanyl transdermal patch. However, the fentanyl patch treatment was continued only for three patients (2 percent) at hospital discharge.Conclusions: This retrospective study suggested that high-dose use of opioids in mechanically ventilated, opioid-naive ICU patients was not associated with continued opioid use upon hospital discharge.

scholarly journals Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Keith Killu ◽  
Victor Coba ◽  
Dionne Blyden ◽  
Semeret Munie ◽  
Darlene Dereczyk ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Scoring System ◽  
Venous Pressure ◽  
Tertiary Care ◽  
Bedside Ultrasound ◽  
Volume Status ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Volume Score

Objective. The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. Methods. A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient’s intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher’s exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy. Results. 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was −4 in 14 (66.7%) patients, −3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p<0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p<0.001). 22 (36.1% of total) patients diagnosed with hypervolemia, and their ultrasound volume score was +4 in 4 (18.2%) patients, +3 in 15 (68.2%) patients, and  + 1 in 1 (4.6%) patient (p<0.001). We found a strong association between standard measures and the ultrasound score (p<0.001). Conclusion. Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of −4 to −2 more likely represents hypovolemia, −1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.

scholarly journals CLINICAL CHARACTERISTICS OF 28 PATIENTS WITH DIABETES AND COVID-19 IN WUHAN, CHINA

2020 ◽  
Vol 26 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Feng Wang ◽  
Yan Yang ◽  
Kun Dong ◽  
Yongli Yan ◽  
Shujun Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Clinical Characteristics ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Icu Patients ◽  
Patients With Diabetes

Objective: Previous studies on coronavirus disease 2019 (COVID-19) were based on information from the general population. We aimed to further clarify the clinical characteristics of diabetes with COVID-19. Methods: Twenty-eight patients with diabetes and COVID-19 were enrolled from January 29, 2020, to February 10, 2020, with a final follow-up on February 22, 2020. Epidemiologic, demographic, clinical, laboratory, treatment, and outcome data were analyzed. Results: The average age of the 28 patients was 68.6 ± 9.0 years. Most (75%) patients were male. Only 39.3% of the patients had a clear exposure of COVID-19. Fever (92.9%), dry cough (82.1%), and fatigue (64.3%) were the most common symptoms, followed by dyspnea (57.1%), anorexia (57.1%), diarrhea (42.9%), expectoration (25.0%), and nausea (21.4%). Fourteen patients were admitted to the intensive care unit (ICU). The hemoglobin A1c level was similar between ICU and non-ICU patients. ICU patients had a higher respiratory rate, higher levels of random blood glucose, aspartate transaminase, bilirubin, creatine, N-terminal prohormone of brain natriuretic peptide, troponin I, D-dimers, procalcitonin, C-reactive protein, ferritin, interleukin (IL)-2R, IL-6, and IL-8 than non-ICU patients. Eleven of 14 ICU patients received noninvasive ventilation and 7 patients received invasive mechanical ventilation. Twelve patients died in the ICU group and no patients died in the non-ICU group. Conclusion: ICU cases showed higher rates of organ failure and mortality than non-ICU cases. The poor outcomes of patients with diabetes and COVID-19 indicated that more supervision is required in these patients. Abbreviations: COVID-19 = coronavirus disease 2019; ICU = intensive care unit; MERS-CoV = middle East respiratory syndrome-related coronavirus; 2019- nCoV = 2019 novel coronavirus; NT-proBNP = N-terminal prohormone of brain natriuretic peptide; SARS-CoV = severe acute respiratory syndrome-related coronavirus

scholarly journals Acute kidney injury incidence and acute renal replacement modality in intensive care unit patients in Indonesia: A result from Southeast Asia-Acute Kidney Injury Study

2020 ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Southeast Asia ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Three Stages

Abstract Background : Currently, there is limited data of large databases of acute kidney injury (AKI) epidemiology from Southeast Asia, especially in Indonesia, the biggest countries in. Therefore, we aimed to provide demographic data of intensive care unit (ICU) patients with AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : We collected demographic and clinical data from 952 ICU patients. Patients were classified into AKI and non-AKI. AKI was classified according to the Kidney Disease Improving Global Outcome (KDIGO) criteria in three stages. We then assess the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI patients. RRT modalities were listed down by the number of procedures conducted. Results : Overall incidence of AKI was 43%, distributed among three stages: 18.5 % stage 1, 33% stage 2, 48.5 % stage 3. Patients developing AKI need mechanical ventilation more often in comparison with non-AKI. Patients with AKI have an average APACHE score of 16.5, while non-AKI patients have an average score of 9.9. Among AKI patients, 24.6% requires RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions: This study showed that AKI is a common problem in Indonesian ICU with containing a high mortality rate. We strongly believe that identification the risk factor of AKI will provide the opportunity to develop the predictability score for AKI prevention and finally improve AKI outcome.

Outcomes of Prophylactic Pantoprazole in Adult Intensive Care Unit Patients Receiving Dialysis: Results of a Randomized Trial

2019 ◽  
Vol 50 (4) ◽  
pp. 312-319 ◽  
Author(s):  
Joerg C. Schefold ◽  
Mette Krag ◽  
Søren Marker ◽  
Anders Perner ◽  
Jørn Wetterslev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Kidney Injury ◽  
Statistical Analysis Plan ◽  
Gi Bleeding ◽  
Icu Patients ◽  
Once Daily ◽  
Adult Intensive Care Unit ◽  
Icu Discharge ◽  
Ulcer Prophylaxis

Background: Intensive care unit (ICU) patients with acute kidney injury requiring renal replacement therapy (RRT) are considered at high risk of gastrointestinal (GI) bleeding and stress ulcer prophylaxis (SUP) is often prescribed. We aimed to assess the incidence of GI bleeding and effects of SUP in these patients. Methods: We assessed GI bleeding in ICU patients receiving RRT at baseline (and at any time in the ICU) and effects of prophylactic pantoprazole versus placebo in the international SUP in the ICU (SUP-ICU) trial. All analyses were conducted according to a published protocol and statistical analysis plan. Results: Data of 3,291 acutely admitted adult ICU patients with one or more risk factors for GI bleeding randomized to pantoprazole or placebo intravenously once daily during ICU stay (until ICU discharge, death, or a maximum of 90 days) were analyzed. Some 20 out of 258 (7.8%, 95% CI 4.5–11.1%) and 52 out of 568 (9.2%, 95% CI 6.8–11.6%) of the patients receiving RRT at baseline and at any time in ICU, respectively, developed clinically important GI bleeding in the ICU. We did not observe statistically significant differences in the intervention effect (pantoprazole vs. placebo) in the proportion of patients with clinically important GI bleeding, clinically important events, infectious adverse events, use of interventions to stop GI bleeding, or 90-day mortality in patients with versus without RRT at baseline. Conclusions: In adult ICU patients receiving RRT at baseline, we observed high incidences of clinically important GI bleeding, but did not observe effects of pantoprazole versus placebo in this subgroup.

scholarly journals Defining human mean circulatory filling pressure in the intensive care unit

2020 ◽  
Vol 129 (2) ◽  
pp. 311-316
Author(s):  
Marije Wijnberge ◽  
Jaap Schuurmans ◽  
Rob B. P. de Wilde ◽  
Martijn K. Kerstens ◽  
Alexander P. Vlaar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Pressure ◽  
Filling Pressure ◽  
Central Venous ◽  
Venous Compliance ◽  
Icu Patients ◽  
Mean Circulatory Filling Pressure ◽  
Arterial Blood

In a cohort of 311 intensive care unit (ICU) patients, median mean circulatory filling pressure (Pmcf) measured after cardiac arrest was 15 mmHg (interquartile range 12–18). In 48% of cases, arterial blood pressure remained higher than central venous pressure, but correction for arterial-to-venous compliance differences did not result in clinically relevant alterations of Pmcf. Fluid balance, use of vasopressors or inotropes, and being on mechanical ventilation were associated with a higher Pmcf.

scholarly journals Diameter dan Indeks Inferior Vena Cava (IVC) Berkorelasi dengan Central Venous Pressure (CVP) pada Pasien Kritis yang Menggunakan Ventilasi Mekanik di Intensive Care Unit (ICU)

2021 ◽  
Vol 13 (2) ◽  
pp. 88-98
Author(s):  
Buyung Hartiyo Laksono ◽  
Arie Zainul Fatoni ◽  
Vilda Prasastri Yuwono ◽  
Aswoco Andyk Asmoro
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Kidney Injury ◽  
Central Venous ◽  
Cross Sectional

Latar belakang: Pengukuran central venous pressure (CVP) merupakan salah satu metode guiding deresusitasi pada pasien dengan kasus tertentu. Kenaikan nilai CVP 1 mmHg dikaitkan dengan peningkatan angka kejadian acute kidney injury (AKI). Namun sebagai sebuah metode yang invasif, pemasangan CVP memiliki risiko yang perlu diperhatikan. Di sisilain, pengukuran diameter dan indeks IVC yang bermuara di atrium kanan dengan menggunakan ultrasonografi (USG) non-invasif dinilai mampu untuk memprediksi nilai CVP pada pasien. Namun beberapa penelitian hubungan antara CVP dengan diameter dan indeks IVC memberikan hasil yang kontroversial.Tujuan: Penelitian untuk mengetahui hubungan antara nilai CVP dengan diameter dan indeks IVC.Metode: Penelitian ini menggunakan metode cross-sectional pada 30 pasien yang dilakukan ventilasi mekanik dan pemasangan CVC di unit perawatan intensif. Parameter CVP, diameter minimum dan maksimum inferior vein cava (IVC mak, IVC min), distensibillity index (DI-index), dan aortacaval index (Cava/Ao index) diukur. Data dianalisis menggunakan uji korelasi pada SPPS 18.0 (p<0.05).Hasil: Didapatkan korelasi signifikan antara CVP dan semua variabel yang diuji (IVC mak, IVC min, DI-index, dan Cava/Ao index) (p<0.05), dengan korelasi terkuat antara CVP dan IVC min (R= 0,908). Korelasi bersifat positif, kecuali antara DI-index dan CVP.Kesimpulan: Parameter IVC min, IVC mak, Cava/Ao- index, dan DI-index signifikan berkorelasi kuat dengan CVP. Korelasi terjadi bersifat positif, kecuali antara DI-index dan CVP.

scholarly journals Vancomycin Serum Concentration after 48 h of Administration: A 3-Years Survey in an Intensive Care Unit

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 793
Author(s):  
Nicolas Perin ◽  
Claire Roger ◽  
Grégory Marin ◽  
Nicolas Molinari ◽  
Alexandre Evrard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Concentration ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Loading Dose ◽  
Duration Of Treatment ◽  
Icu Patients ◽  
Vancomycin Concentration ◽  
Serum Vancomycin

The present study assessed the proportion of intensive care unit (ICU) patients who had a vancomycin serum concentration between 20 and 25 mg/L after 24–48 h of intravenous vancomycin administration. From 2016 to 2018, adult ICU patients with vancomycin continuous infusion (CI) for any indication were included. The primary outcome was the proportion of patients with a first-available vancomycin serum concentration between 20–25 mg/L at 24 h (D2) or 48 h (D3). Of 3894 admitted ICU patients, 179 were included. A median loading dose of 15.6 (interquartile range (IQR) = (12.5–20.8) mg/kg) was given in 151/179 patients (84%). The median daily doses of vancomycin infusion for D1 and D2 were 2000 [(IQR (1600–2000)) and 2000 (IQR (2000–2500)) mg/d], respectively. The median duration of treatment was 4 (2–7) days. At D2 or D3, the median value of first serum vancomycin concentration was 19.8 (IQR (16.0–25.1)) with serum vancomycin concentration between 20–25 mg/L reported in 43 patients (24%). Time spent in the ICU before vancomycin initiation was the only risk factor of non-therapeutic concentration at D2 or D3. Acute kidney injury occurred significantly more when vancomycin concentration was supra therapeutic at D2 or D3. At D28, 44 (26%) patients had died. These results emphasize the need of appropriate loading dose and regular monitoring to improve vancomycin efficacy and avoid renal toxicity.

scholarly journals Microalbuminuria can predict the development of acute kidney injury in intensive care unit admission

2020 ◽  
Vol 7 (9) ◽  
pp. 1372
Author(s):  
Bharath G. ◽  
Prasanna Kumar ◽  
Mahendra S. V.
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Statistical Significance ◽  
Prognostic Significance ◽  
Kidney Injury ◽  
Common Finding ◽  
P Value ◽  
Icu Patients ◽  
Icu Stay

Background: Microalbuminuria, defined as 30–300 mg/day of albumin excretion in urine is a common finding in ICU patients and has shown not only as a predictor of organ failure but prolonged intensive care unit (ICU)  stay. Objective of the study was to determine the prediction of acute kidney injury using urine microalbuminuria and to determine the presence of urine microalbuminuria and relationship between ICU length of stay.Methods: The present study is conducted on patients admitted to Medical ICU in SDMCMSH, Dharwad from December 2016 to November 2017. 75 patients who met the inclusion and exclusion criteria were included in the study.Results: The present study included 75 patients, among which 50 were males and 25 were females. The mean age was 60.2years. AKI was developed more in non-diabetics than diabetics and non-hypertensives than hypertensives. The median urine microalbumin at admission in AKI was 80.9 and at 48 hr was130.1 predicted the AKI mean (1.79) in 59 patients with a p value of <0.001 using Mann Whitney test and P value statistically significant.Conclusions: Urine microalbuminuria at 48 hr has predicted AKI in 59 patients with median of 130.1 with statistical significance. Urine microalbuminuria of high value in AKI is directly proportional to prolonged ICU stay. At 48 hours of admission, increased levels of microalbuminuria compared at admission and 48 hour, indicates its prognostic significance among AKI and NON-AKI’s in ICU patients.

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