Immediate Hemodynamic Responses to Transcutaneous Electrical Diaphragmatic Stimulation in Critically Ill Elderly Patients

Background. Critically ill patients admitted to intensive care units (ICUs) may develop diaphragmatic dysfunction, especially when artificial airways are used. Positive effects have been observed when using the transcutaneous electrical diaphragmatic stimulation (TEDS) technique in different clinical conditions. However, no study has evaluated the safety of TEDS in patients admitted to ICUs. This study is aimed at evaluating the influence of TEDS on the hemodynamic and vital parameters of critically ill elderly patients under invasive mechanical ventilation (IMV). Methods. Forty-seven patients aged >60 years under IMV were evaluated for hemodynamic variables before and after TEDS. The procedure lasted 30 minutes and was performed once. Results. The sample consisted of 33 men and 14 women with a mean age of 69.9 ± 7.64 years. The mean systolic blood pressures pre-TEDS and post-TEDS were 126.6 ± 23.7 and 122.9 ± 25.9 , respectively ( p = 0.467 ). The mean diastolic blood pressures pre-TEDS and post-TEDS were 71.1 ± 12.2 and 67.7 ± 14.2 , respectively ( p = 0.223 ). No significant differences in the mean arterial pressure or heart rate were found between the pre-TEDS and post-TEDS time points ( p = 0.335 and p = 0.846 , respectively). Conclusion. Our findings suggest that TEDS does not have clinically relevant impacts on hemodynamic or vital parameters in critically ill elderly patients. These findings point to the possible safety of TEDS application in this population.

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Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

Journal of the Intensive Care Society ◽

10.1177/1751143719900100 ◽

2020 ◽

pp. 175114371990010 ◽

Cited By ~ 1

Author(s):

Raymond Dominic Savio ◽

Rajalakshmi Parasuraman ◽

Daphnee Lovesly ◽

Bhuvaneshwari Shankar ◽

Lakshmi Ranganathan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Prone Position ◽

Supine Position ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Apache Ii ◽

Apache Ii Score ◽

The Mean

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

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Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

Italian Journal of Medicine ◽

10.4081/itjm.2010.105 ◽

2013 ◽

pp. 105-110

Author(s):

Carlo Frondini ◽

Maria L. Lunardelli

Keyword(s):

Elderly Patients ◽

Hip Fractures ◽

The Elderly ◽

Public Hospitals ◽

Preliminary Results ◽

Positive Effects ◽

Management Protocol ◽

Care Models ◽

The Mean ◽

Orthopedic Ward

Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary results obtained with an orthogeriatric model in one of these centers, a large teaching hospital in Bologna. Materials and methods: Beginning in February 2008, all patients older than 75 years admitted to the University of Bologna’s Sant’Orsola-Malpighi Hospital for hip fractures were cared for in an orthogeriatric unit. The unit consisted of 10 beds in the orthopedic ward that were managed by a geriatric specialist and a multidisciplinary team, which met daily and included an orthopedic surgeon, a physiatrist, a nurse case-manager, staff nurses, a physical therapist, and a social worker. The management protocol included a thorough geriatric work-up to identify comorbidities and risk factors, systematic assessment and prevention of pain and acute disorientation, early verticalization and moblization, postacute rehabilitation therapy, family support, and regular follow-up after discharge. Preliminary results were compared with those achieved in the same orthopedic ward prior to the creation of the Orthogeriatric Unit. Results: During 2008, 226 elderly patients (mean age 86.2 + 5.5 years), 73.4% of whom were women, were admitted to the Orthogeriatric Unit for hip fractures. The mean Charlson comorbidity index of this cohort was 3.0 + 1.8). Half the patients had Activity of Daily Living scores < 4, and cognitive impairment was common (mean score on Short Portable Mental Status Questionnaire: 5.9 + 3.2). Compared with figures obtained in the hospital’s orthopedic ward prior to 2008, in-hospital mortality dropped from 5.98% to 3.98%. The mean overall length of hospitalization was not significantly reduced, but the mean stay in the Orthogeriatric unit decreased by almost 2 days (to 10.46 days from 12.44 days in the traditional orthopedic unit). Discussion: Compared with traditional care models, the orthogeriatric model may allow better integration of the health-care resources available for the management of hip fractures in the elderly, and this improvement may have positive effects on the outcome of these cases.

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Pulmonary Hypertension at Admission predicts ICU Mortality in Elderly Critically ill with Severe COVID-19 Pneumonia: retrospective cohort study

10.21203/rs.3.rs-1247509/v1 ◽

2022 ◽

Author(s):

Marko Kurnik ◽

Helena Božič ◽

Anže Vindišar ◽

Petra Kolar ◽

Matej Podbregar

Keyword(s):

Elderly Patients ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Predictor ◽

Strong Predictor ◽

Invasive Mechanical Ventilation ◽

Icu Mortality ◽

Non Invasive ◽

Icu Stay

Abstract BackgroundPoint-of-care ultrasound (POCUS) is a useful diagnostic tool for non-invasive assessment of critically ill patients. Mortality of elderly patients with COVID-19 pneumonia is high and there is still scarcity of definitive predictors. Aim of our study was to assess the prediction value of combined lung and heart POCUS data on mortality of elderly critically ill patients with severe COVID-19 pneumonia.MethodsThis was a retrospective observational study. Data of patients older than 70 years, with severe COVID-19 pneumonia admitted to 25-bed mixed, level 3, intensive care unit (ICU) was analyzed retrospectively. POCUS was performed at admission; our parameters of interest were pulmonary artery systolic pressure (PASP) and presence of diffuse B-line pattern (B-pattern) on lung ultrasound.ResultsBetween March 2020 and February 2021, 117 patients aged 70 years or more (average age 77±5 years) were included. Average length of ICU stay was 10.7±8.9 days. High-flow oxygenation, non-invasive ventilation and invasive mechanical ventilation were at some point used to support 36/117 (31%), 39/117 (33%) and 75/117 (64%) patients respectively. ICU mortality was 50.9%. ICU stay was shorter in survivors (8.8±8.3 vs 12.6±9.3 days, p=0.02). PASP was lower in ICU survivors (32.5±9.8 vs. 40.4±14.3 mmHg, p=0.024). B-pattern was more often detected in non-survivals (35/59 (59%) vs. 19/58 (33%), p=0.005). PASP and B-pattern at admission were both univariate predictors of mortality. PASP at admission was an independent predictor of ICU (OR 1.0683, 95%CI: 1.0108-1.1291, p=0.02) and hospital (OR 1.0813, 95%CI 1.0125-1.1548, p=0.02) mortality. Ventilator associated pneumonia (VAP) was a strong predictor of ICU and hospital mortality.ConclusionsPASP at admission is an independent predictor of ICU and hospital mortality of elderly patients with severe COVID-19 pneumonia. During ICU stay development of VAP was a strong predictor of ICU and hospital mortality.

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279. Clinical Characteristics of Critically Ill Patients with COVID-19 and Invasive Pulmonary Aspergillosis: A Case Series From Mexico City

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.481 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S245-S245

Author(s):

Patricia Galindo-Lopez ◽

Benjamin Valente-Acosta ◽

Francisco Moreno-Sanchez ◽

Luis Espinosa-Aguilar ◽

Irma Hoyo-Ulloa ◽

...

Keyword(s):

Critically Ill ◽

Mexico City ◽

Critically Ill Patients ◽

Medical Center ◽

Invasive Mechanical Ventilation ◽

Invasive Pulmonary Aspergillosis ◽

Case Series ◽

Global Public Health ◽

Pulmonary Aspergillosis ◽

The Mean

Abstract Background COVID-19 has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in case series of critically ill patients. However, the criteria for CAPA diagnosis has been inconsistent among most of the reports. Mexico has been widely affected by SARS-CoV-2. We present a series of CAPA cases at a teaching hospital in Mexico City. Methods We performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from May 1st, 2020, to May 1st, 2021. Including only those with critical COVID-19 who required invasive mechanical ventilation (IMV). Patients with a diagnosis of CAPA were analyzed. We followed the 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika). Results Among the 230 admitted patients who required IMV, we identified 49 (21.3%) cases of CAPA, 46 probable CAPA and 3 proven CAPA. Nineteen (38%) of those died in the hospital. The mean age was 64.5 ± 12.6 years and 11 were female. Proven CAPA was diagnosed with culture in three cases (one A. niger, one A. terreus and one A. fumigatus). Probable CAPA was diagnosed by a positive serum GP in 27 (55.1%) patients and by a positive bronchoalveolar lavage (BAL) GP in 29 (59.2%) cases. Seven patients had both serum and BAL positive GP. Forty-six (93.9%) patients received corticosteroids, and 22 (49.9%) were treated with tocilizumab before CAPA diagnosis. All but one received isavuconazole as CAPA treatment. We detected 35 (71.4%) patients who had a bacterial co-infection. Eighteen of those died (51.4%) compared to only one dead in the subgroup without coinfections (7.1%). The mean time from hospital admission to CAPA diagnosis was 6.2 days (SD 7.1) among those who survived compared to 13.2 (SD 6.3) days in those who died p< 0.01. Conclusion CAPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality when it occurs with other bacterial coinfections and when it is diagnosed late from admission. Disclosures All Authors: No reported disclosures

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Association Between Awareness of Informal Caregivers and Falls in Elderly Patients with Uncontrolled Diabetes Mellitus

The Open Public Health Journal ◽

10.2174/1874944502013010658 ◽

2020 ◽

Vol 13 (1) ◽

pp. 658-666

Author(s):

Tossapon Chamnankit ◽

Parichat Ong-artborirak ◽

Jukkrit Wangrath

Keyword(s):

Diabetes Mellitus ◽

Elderly Patients ◽

Elderly People ◽

Informal Caregivers ◽

Multivariable Analysis ◽

P Value ◽

Uncontrolled Diabetes ◽

Risk Of Falls ◽

The Mean ◽

Falls In Elderly

Background: Elderly people with uncontrolled diabetes mellitus (DM) are at risk of falls, which can lead to injury and disability. Not much is known of informal caregivers’ awareness of falls in elderly patients with DM. Objective: This study aims to identify an association between caregiver’s awareness and falls in elderly patients with DM. Methods: A total of 136 pairs of DM patients and their respective family caregivers were recruited from a clinical service center at Chiang Mai University, Thailand. The questionnaire regarding the caregiver’s awareness of the risk of falls in elderly patients was given via a face-to-face interview. Each elderly patient was asked about their history of falls in the prior year, and the risk of falls was assessed by Time Up & Go (TUG) test. Logistic regression analysis was performed to determine association. Results: The mean age of the DM patients was 65.7 years. Sixty-two patients (45.6%) had fallen at least once in the prior year. The mean TUG test result was 12.67±1.83 second. Most caregivers demonstrated a high level of awareness regarding the risk of falls in elderly patients. The results of the multivariable analysis showed that three variables – balance problems, risk of falls assessed by TUG test, and scores of caregiver’s awareness of risk of falls – were significantly related to falls in the previous year among elderly patients with DM (p-value<0.05). Conclusion: The caregivers’ awareness of fall risk may influence fall occurrence among older adults with DM. An intervention program to improve awareness among informal caregivers should be considered for fall prevention in elderly people.

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Energy expenditure and oxygen uptake kinetics in critically ill elderly patients

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.2098 ◽

2021 ◽

Author(s):

Takeshi Ebihara ◽

Kentaro Shimizu ◽

Masahiro Ojima ◽

Yohei Nakamura ◽

Yumi Mitsuyama ◽

...

Keyword(s):

Energy Expenditure ◽

Oxygen Uptake ◽

Elderly Patients ◽

Critically Ill ◽

Oxygen Uptake Kinetics ◽

Uptake Kinetics

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Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽

10.1055/s-0041-1727121 ◽

2021 ◽

Vol 05 (02) ◽

pp. e134-e138

Author(s):

Anke Pape ◽

Jan T. Kielstein ◽

Tillman Krüger ◽

Thomas Fühner ◽

Reinhard Brunkhorst

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Randomized Trials ◽

Clinical Course ◽

Pharmacological Therapy ◽

The European Union ◽

Positive Effects ◽

Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

Annals of Intensive Care ◽

10.1186/s13613-021-00876-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ines Gragueb-Chatti ◽

Alexandre Lopez ◽

Dany Hamidi ◽

Christophe Guervilly ◽

Anderson Loundou ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Length Of Stay ◽

Critically Ill ◽

Invasive Mechanical Ventilation ◽

Blood Stream ◽

Hospital Length Of Stay ◽

Ventilator Associated Pneumonia ◽

Blood Stream Infections ◽

Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

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