scholarly journals Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Channing Hui ◽  
Maria Cardinale ◽  
Balaji Yegneswaran
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Case Series ◽  
Life Threatening ◽  
Sedation And Analgesia ◽  
Clinically Significant ◽  
Dexmedetomidine Infusion ◽  
Community Teaching

Purpose. To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia. Materials and Methods. This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention. In all three cases, adjustments to therapy were required. Results. All three patients experienced significant bradycardia, with a heart rate less than 50 bpm, and one patient briefly developed asystole. In Case  1, the fentanyl infusion rate was reduced by 67% and the dexmedetomidine infusion rate was reduced by 25%. In Case  2, the sedation was changed to midazolam, and in Case  3, both fentanyl and dexmedetomidine were discontinued. In all three cases, there were no further incidences of significant bradycardia following intervention. Conclusions. Fentanyl used in combination with dexmedetomidine can result in clinically significant bradycardia. Further study is warranted to identify risk factors and elucidate the mechanisms that result in life-threatening bradycardia.

The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy

2014 ◽  
Vol 21 (6) ◽  
pp. 339-345 ◽  
Author(s):  
N Othman ◽  
Ck Chan ◽  
Fl Lau
Keyword(s):  
Risk Factors ◽  
Hong Kong ◽  
Emergency Departments ◽  
Multiple Logistic Regression Analysis ◽  
Case Series ◽  
Female Ratio ◽  
Intentional Ingestion ◽  
Accident And Emergency ◽  
Case Series Study ◽  
Clinically Significant

Objective To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning. Design Case series study. Setting Sixteen accident and emergency departments in Hong Kong. Patients Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012. Results 110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87). Conclusions Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)

scholarly journals Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu

2014 ◽  
Vol 6 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Raba Thapa ◽  
Deepak Man Joshi ◽  
Aparna Rizyal ◽  
Nhukesh Maharjan ◽  
Rajesh Dhoj Joshi
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Case Series ◽  
Systemic Hypertension ◽  
P Value ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Case Series Study ◽  
Systemic Problems ◽  
Clinically Significant

Introduction: Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal. Objectives: The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients. Materials and methods: A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients’ detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria. Main outcome measures: The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed. Results: A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004). Conclusion: The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection.   DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10760   Nepal J Ophthalmol 2014; 6 (2): 24-30

Hematogenous Candidiasis in Critically Ill Adult Patients: Epidemiology, Risk Factors and Management

1998 ◽  
Vol 11 (6) ◽  
pp. 437-451
Author(s):  
John Papadopoulos
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Amphotericin B ◽  
Critically Ill ◽  
Clinical Setting ◽  
Critically Ill Patients ◽  
Candida Species ◽  
Blood Cultures ◽  
The Past ◽  
Life Threatening

Hematogenous candidiasis is a life-threatening infection that occurs in critically ill patients. The incidence has increased dramatically over the past decade and Candida species are currently the fourth most common organism recovered from blood cultures in hospitalized patients. Numerous risk factors have been identified that predispose a patient to the development of hematogenous candidiasis. Diagnosis is often difficult in the clinical setting. Pharmacologic options for the management of hematogenous candidiasis includes amphotericin B, fluconazole, and flucytosine. Evidence from clinical trials indicate that fluconazole is as effective and better tolerated than amphotericin B for the management of hematogenous candidiasis in critically ill patients.

Neuroleptic Malignant Syndrome: A Review for Intensivists

1994 ◽  
Vol 9 (5) ◽  
pp. 227-234 ◽  
Author(s):  
Laura M. Prager ◽  
Frederick H. Millham ◽  
Stern A. Theodore
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Diagnostic Criteria ◽  
Neuroleptic Malignant Syndrome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Options ◽  
Accurate Diagnosis ◽  
Case Examples ◽  
Life Threatening

Neuroleptic malignant syndrome (NAIS) is arare, potentially life-threatening disorder that results from the use of neuroleptics, a class of drugs that is being used with increasing frequency in intensive care units (ICUs). Unfortunately, critically ill patients typically have coexisting conditions that make accurate diagnosis of NAIS difficult and complicate treatment decisions. Diagnostic criteria, risk factors, and treatment options for NMS are discussed; case examples are provided.

scholarly journals Incidence of Muscle Wasting in the Critically Ill: A Prospective Observational Cohort Study

2021 ◽  
Author(s):  
Ondrej Hrdy ◽  
Kamil Vrbica ◽  
Marek Kovar ◽  
Tomas Korbicka ◽  
Radka Stepanova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Patient Age ◽  
Patient Âgé ◽  
Secondary Outcomes ◽  
Clinically Significant

Abstract Background: Loss of muscle mass occurs rapidly during critical illness. It can often lead to weakness and fatigue, and it negatively affects quality of life. Despite the importance of understanding the incidence of clinically significant muscle wasting in critically ill patients, there have been few reports on this subject. This study aimed to assess the incidence of and identify risk factors associated with clinically significant loss of muscle mass in this patient population. Methods: This was a single-center observational study. Informed consent was obtained from all patients. We used ultrasound to determine the rectus femoris cross-sectional area (RFcsa) of each patient on their first and seventh days of treatment in the intensive care unit (ICU). The primary outcome of the study was the incidence of significant muscle wasting, which was defined as a greater or equal to 10% reduction in RFcsa from day 1 to day 7. SOFA score on day 7, length of artificial ventilation, ICU length of stay and twenty-eight-day mortality were evaluated as secondary outcomes. We used a logistic regression model to determine whether patient age, sex, BMI, frailty score, or medical history were significant risk factors for muscle wasting.Results: We screened an initial cohort of 1,293 patients and recruited 186 as study participants. Ultrasound measurements were completed in 104 patients. Sixty-two of these patients (59.6%) showed ≥10% decreases in RFcsa. Logistic regression analysis identified patient age as the sole risk factor associated with significant muscle wasting. While we detected no statistically significant differences associated with the secondary outcomes, the 28-day mortality rate almost doubled in the group of patients with significant wasting (30.6% versus 16.7%; p=0.165).Conclusions: Clinically significant muscle wasting was frequently observed in our cohort of critically ill adult patients. Patient age was identified as a risk factor for muscle wasting. The results of this study could be used to plan future studies that evaluate strategies to prevent muscle wasting and to improve the outcomes of critically ill patients.Trial registration: clinicaltrials.gov, NCT 03865095, date of registration: March 6, 2019.

Safety Profile and Risk Factors for Bleeding in Transbronchial Cryobiopsy Using a Two-Scope Technique for Peripheral Pulmonary Lesions

2021 ◽  
Author(s):  
Toshiyuki Nakai ◽  
Tetsuya Watanabe ◽  
Yuto Kaimi ◽  
Koichi Ogawa ◽  
Yoshiya Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diagnostic Yield ◽  
Multivariable Analysis ◽  
Bleeding Risk ◽  
Balloon Occlusion ◽  
Ground Glass ◽  
Pulmonary Lesions ◽  
Life Threatening ◽  
Peripheral Pulmonary Lesions ◽  
Clinically Significant

Abstract Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

scholarly journals 399. Risk Factors for Mortality in COVID-19 Patients in a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S268-S268
Author(s):  
Justin A Andrade ◽  
Karina Muzykovsky ◽  
James Truong
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Logistic Regression ◽  
Hospital Mortality ◽  
Teaching Hospital ◽  
Case Series ◽  
Advanced Age ◽  
Retrospective Case ◽  
Multivariable Logistic Regression ◽  
Community Teaching

Abstract Background As of May 2020, there were over 190,000 confirmed COVID-19 cases in New York City (NYC) with approximately 13,000 deaths. Previously published literature identified risk factors (advanced age, higher severity of illness and elevated d-dimer) for mortality in a cohort of patients from Wuhan, China and mechanical ventilation in a case series from NYC. Another case series from NYC evaluated clinical outcomes only. There are limited published studies assessing clinical characteristics, outcomes and risk factors for mortality in COVID-19 patients in NYC. The objective of this study was to assess the risk factors for mortality in patients with confirmed COVID-19 infections. Methods This study was a single center retrospective case-control at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients with confirmed COVID-19 infection, who received at least 24 hours of COVID-19 therapy were included. Endpoints assessed were risk factors for mortality in COVID-19 patients, increase in QTc, renal failure or renal replacement therapy, ventricular fibrillation or ventricular tachycardia. Baseline characteristics between survivor and non-survivors were analyzed utilizing Mann-Whitney U test/two-tailed t-tests for continuous data and Chi-square/Fisher’s exact test for categorical data. Univariable and multivariable logistic regression analyses were conducted to identify the risk factors for in-hospital mortality. Results Two-hundred and eighty six patients were included in this analysis, of whom 97 (33.9%) were non-survivors and 189 (66.1%) patients were survivors. Diabetes and coronary artery disease were more common in non-survivors compared to survivors (p = 0.003 and p &lt; 0.001, respectively). Multivariable logistic regression showed higher in-hospital mortality in patients with advanced age (odds ratio 5.779, 95 % confidence interval 1.369–24.407), vasopressor initiation (OR 28.301, 95 % CI 3.307–242.176), and development of renal failure (OR 30.927, 95 % CI 1.871–511.201). Conclusion Risk factors associated with mortality for COVID-19 patients in a community teaching hospital include advanced age, vasopressor therapy, and development of renal failure. Disclosures All Authors: No reported disclosures

scholarly journals Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Toshiyuki Nakai ◽  
Tetsuya Watanabe ◽  
Yuto Kaimi ◽  
Koichi Ogawa ◽  
Yoshiya Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diagnostic Yield ◽  
Multivariable Analysis ◽  
Bleeding Risk ◽  
Balloon Occlusion ◽  
Ground Glass ◽  
Pulmonary Lesions ◽  
Life Threatening ◽  
Peripheral Pulmonary Lesions ◽  
Clinically Significant

Abstract Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

scholarly journals QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection

2022 ◽  
Vol 27 ◽  
pp. 107424842110694
Author(s):  
Wasim S. El Nekidy ◽  
Khalid Almuti ◽  
Hazem ElRefaei ◽  
Bassam Atallah ◽  
Lana M. Mohammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Qt Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Factors Associated ◽  
Qt Interval Prolongation ◽  
History Of ◽  
Clinically Significant

Background: Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population. Methods: We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms). Results: Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation ( P = .004 for the likelihood-ratio test). Conclusion: The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.

Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients

2018 ◽  
pp. 187-191
Author(s):  
Miguel Cobas ◽  
Melissa Grillo
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multicenter Cohort Study ◽  
Hemodynamic Compromise ◽  
Potential Risk Factors ◽  
Independent Risk Factors ◽  
Clinically Significant ◽  
Ulcer Prophylaxis

The efficacy of stress ulcer prophylaxis for the prevention of gastrointestinal bleeding in the critically ill has led to its widespread use. Side effects and cost of prophylaxis necessitate targeting the therapy to those patients most likely to benefit. A prospective multicenter cohort study was conducted to evaluate potential risk factors for stress ulceration in patients admitted to intensive care units. Two strong independent risk factors for bleeding were identified: respiratory failure and coagulopathy. Since few critically ill patients have clinically significant gastrointestinal bleeding (defined as overt bleeding in association with hemodynamic compromise or the need for blood transfusion), prophylaxis can safely be withheld unless they require mechanical ventilation or have a coagulopathy.

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