scholarly journals Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Angelina Grest ◽  
Judith Kurmann ◽  
Markus Müller ◽  
Victor Jeger ◽  
Bernard Krüger ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Retrospective Study ◽  
Mean Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Cost ◽  
Cardiovascular Safety ◽  
Drug Infusion ◽  
Saps Ii

Purpose. The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery. Methods. 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages). Results. Patients receiving clonidine (n = 193) were younger (66 (57–73) vs 70 (63–77) years, p=0.003) and had a lower SAPS II (35 (27–48) vs 41 (31–54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75–100) vs 90 (80–105) bpm, p=0.028), MAP (70 (65–80) vs 70 (65–75) mmHg, p=0.093), and norepinephrine (0.05 (0.00–0.11) vs 0.12 (0.03–0.19) mcg/kg/min, p<0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (−0.04–0.02) mcg/kg/min) and decreased in the dexmedetomidine group (−0.03 (−0.10–0.02) mcg/kg/min, p=0.007). Conclusions. Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.

Predicting Need for Vasopressors in the Intensive Care Unit Using an Attention Based Deep Learning Model

2020 ◽  
Author(s):  
Gloria Hyunjung Kwak ◽  
Lowell Ling ◽  
Pan Hui
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Intensive Care ◽  
Deep Learning ◽  
Mean Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Class Imbalance ◽  
Vasopressor Therapy ◽  
Icu Admission

Abstract BackgroundPrevious models on prediction of shock mostly focused on septic shock and often required laboratory results in their models. Database analyses often report only limited data pre-processing which may introduce significant bias into machine classifiers. The purpose of this study was to use deep learning approaches to predict vasopressor requirement for critically ill patients within 24 hours of ICU admission using only vital signs. Performance bias from relative missing data and inadequate matching was assessed. MethodsWe used data from the Medical Information Mart for Intensive Care III database and the eICU Collaborative Research Database to develop a vasopressor prediction model. We performed systematic data pre-processing using matching of cohorts, oversampling and imputation to control for bias, class imbalance and missing data. After pre-processing we used bidirectional long short-term memory (Bi-LSTM), a multivariate time series model to predict the need for vasopressor therapy using serial physiological data collected 21 hours prior to prediction time. ResultsUsing data from 10,941 critically ill patients from 209 ICUs, our Bi-LSTM model achieved an initial area under the curve (AUC) of 0.96 (95%CI 0.96-0.96) to predict the need for vasopressor therapy in 2 hours within the first day of ICU admission. After matching to control class imbalance, the Bi-LSTM model had AUC of 0.83 (95%CI 0.82-0.83). Heart rate, respiratory rate and mean arterial pressure contributed most to the model amongst other serial physiological variables of systolic blood pressure, diastolic blood pressure, pulse oximetry and temperature. ConclusionsWe used Bi-LSTM to develop a model to predict the need for vasopressor for critically ill patients for the first 24 hours of ICU admission. With attention mechanism, respiratory rate, mean arterial pressure and heart rate were identified as key sequential determinants of vasopressor requirements. Although rigorous data pre-processing such as missing value analysis and class matching reduced predictive performance, it minimized bias in data and should be performed for database studies.

scholarly journals Can the cytokine adsorber CytoSorb® help to mitigate cytokine storm and reduce mortality in critically ill patients? A propensity score matching analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina Scharf ◽  
Ines Schroeder ◽  
Michael Paal ◽  
Martin Winkels ◽  
Michael Irlbeck ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Wilcoxon Test ◽  
Relative Reduction ◽  
Cytokine Storm ◽  
Saps Ii ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background A cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. However, it is questionable whether its use is actually beneficial in these patients. Methods Patients with an interleukin-6 (IL-6) > 10,000 pg/ml were retrospectively included between October 2014 and May 2020 and were divided into two groups (group 1: CS therapy; group 2: no CS therapy). Inclusion criteria were a regularly measured IL-6 and, for patients allocated to group 1, CS therapy for at least 90 min. A propensity score (PS) matching analysis with significant baseline differences as predictors (Simplified Acute Physiology Score (SAPS) II, extracorporeal membrane oxygenation, renal replacement therapy, IL-6, lactate and norepinephrine demand) was performed to compare both groups (adjustment tolerance: < 0.05; standardization tolerance: < 10%). U-test and Fisher’s-test were used for independent variables and the Wilcoxon test was used for dependent variables. Results In total, 143 patients were included in the initial evaluation (group 1: 38; group 2: 105). Nineteen comparable pairings could be formed (mean initial IL-6: 58,385 vs. 59,812 pg/ml; mean SAPS II: 77 vs. 75). There was a significant reduction in IL-6 in patients with (p < 0.001) and without CS treatment (p = 0.005). However, there was no significant difference (p = 0.708) in the median relative reduction in both groups (89% vs. 80%). Furthermore, there was no significant difference in the relative change in C-reactive protein, lactate, or norepinephrine demand in either group and the in-hospital mortality was similar between groups (73.7%). Conclusion Our study showed no difference in IL-6 reduction, hemodynamic stabilization, or mortality in patients with Cytosorb® treatment compared to a matched patient population.

scholarly journals Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kevin Roedl ◽  
Dominik Jarczak ◽  
Andreas Drolz ◽  
Dominic Wichmann ◽  
Olaf Boenisch ◽  
...  
Keyword(s):  
Critically Ill ◽  
Liver Dysfunction ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
University Hospital ◽  
Severe Liver ◽  
Saps Ii ◽  
Severe Liver Dysfunction ◽  
Global Threat ◽  
The University

Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.

scholarly journals BEDSIDE LAPAROSCOPY AS DIAGNOSTIC TOOL REVIEW OF ABDOMINAL PATHOLOGIES IN CRITICALLY ILL PATIENTS: REVIEW

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Retrospective Study ◽  
Diagnostic Accuracy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Laboratory Tests ◽  
Diagnostic Laparoscopy ◽  
Delayed Diagnosis ◽  
Definite Diagnosis ◽  
Imaging Results ◽  
Increase Rate

Introduction: The diagnosis of abdominal pathologies in critically ill patients is often difficult because of inconclusive laboratory tests or imaging results, or the inability to safely transfer a patient to the radiology room. These causes give a delayed diagnosis of abdominal pathology in the intensive care unit (ICU) and increase rate of morbidity and mortality. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Aim: The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Materials and Methods: A  literature research was carried out including PubMed, Medline, Embase, Cochrane and Google Scholar databases to identify articles reporting on importance of diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Conclusions: Bedside diagnostic laparoscopy represents a safe and accurate technique for diagnosing intraabdominal pathology in an ICU setting and should be taken into consideration when patient transfer to radiology or the operating room is considered unsafe or when routine radiological examinations are not conclusive enough to reach a definite diagnosis. Keywords: Bedside laparoscopy, critically ill patients, ultrasonography (US), computed tomography (CT) , emergency surgery

scholarly journals Augmented Renal Clearance in Iranian Critically Ill Patients: Retrospective Study at Masih Daneshvari Hospital

2017 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Seyed Reza Saghebi ◽  
Behrooz Farzanegan ◽  
Payam Tabarsi ◽  
Rokhsaneh Zangooi ◽  
Batoul Khoundabi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Augmented Renal Clearance

Temporal patterns of heart rate and selected arrhythmias for 48 hours after cardiac surgery

1993 ◽  
Vol 2 (5) ◽  
pp. 359-370 ◽  
Author(s):  
SL Woods ◽  
L Felver ◽  
R Hoeksel
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Critically Ill ◽  
Longitudinal Design ◽  
Temporal Patterns ◽  
Temporal Variations ◽  
Individual Subject ◽  
Cosinor Analysis ◽  
Premature Ventricular Complexes ◽  
Critically Ill Adults

OBJECTIVE: To describe the temporal patterns of heart rate and arrhythmias in the immediate postoperative period following cardiac surgery. Six postoperative cardiac surgical patients with a mean age of 48.3 years were studied. DESIGN: Descriptive longitudinal design. SETTING: Cardiac surgical ICU. METHODS: Heart rate and arrhythmias were recorded continuously for 48 hours from a cardiac monitor using a Holter tape recorder. Environmental and treatment data were noted throughout data collection by trained nonparticipant observers. RESULTS: Mean heart rate and incidence of arrhythmias were different between the 2 study days; therefore, data were divided into two segments (A and B). These differences coincided with extubation in most cases. Individual subject cosinor analysis revealed 24-hour rhythms of heart rate in both segments in all subjects except segment B for one subject. Rhythms of shorter periods were also found. In segment A individual subjects' acrophases (peak times of fitted curves) occurred later than expected for subjects' prehospitalization sleep-wake schedule, whereas in segment B they occurred earlier. Cosinor analysis of arrhythmias revealed significant 24-hour rhythms in both segments in one of the three subjects with premature atrial complexes, two of the four subjects with premature ventricular complexes and both subjects with ventricular couplets. Four-hour rhythms were found in premature atrial complexes (n = 1), atrial tachycardia (n = 1) and premature ventricular complexes (n = 3). Acrophases for arrhythmias varied among patients. During segment B the 4-hour-rhythm acrophases in heart rate and arrhythmias were related to the timing of respiratory therapy. CONCLUSIONS: Temporal variations in heart rate could be identified in these six critically ill adults. Rhythm parameters changed during the first 48 hours after cardiac surgery. In those who had arrhythmias, some patients demonstrated temporal patterns in the incidence of selected arrhythmias. Further study is needed to describe the temporal patterns of heart rate and arrhythmias in varied groups of critically ill persons in a variety of settings.

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