Abstract 345: Resuscitation Quality in the Intensive Care Unit- A Retrospective, Observational Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Lara L Roessler ◽  
Mathias J Holmberg ◽  
Rahul Pawar ◽  
Annmarie T Lassen ◽  
Ari Moskowitz
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Observational Study ◽  
Airway Device ◽  
Prior History ◽  
Arterial Line ◽  
Quality Metric ◽  
Device Placement ◽  
Illness Category

Background: Adherence to quality metrics during in-hospital cardiac arrest (IHCA) have been associated with improved outcomes, however, quality metric adherence in the intensive care unit (ICU) has not been well described. In this study, we assessed trends in adherence to time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of endotracheal airway device placement during IHCA in the ICU and identified potential predictors of adherence failure. Methods: This was an observational study using the Get With The Guidelines® - Resuscitation registry, a United-States based IHCA registry. Adult patients (>18 years) with an index cardiac arrest in adult ICUs between 2006 and 2018 in the US were included. Generalized estimation equations were used for the analyses. Results: We included 75668 patients. From 2006-2018, adherence to time to epinephrine ≤ 5 min increased from 93% (95%CI, 93%-94%) to 98% (95%CI, 97%-98%), time to defibrillation ≤ 2 min went from 71% (95%CI, 68%-75%) to 74% (95% CI, 71%-77%) and confirmation of airway device placement increased from 93% (95%CI, 91%-94%) to 97% (95% CI, 96%-98%). Significant predictors of defibrillation >2 min included a non-cardiac (RR, 1.35; 95%CI, 1.25-1.46) and traumatic (RR, 1.67; 95%CI, 1.34-2.09) illness category, a prior history of renal insufficiency (RR, 1.13; 95%CI, 1.06-1.22), no myocardial infarction (RR, 1.09; 95%CI, 1.00-1.19), no metabolic abnormality (RR, 1.10; 95%CI, 1.01-1.20), events occurring at nighttime (RR, 1.08; 95%CI, 1.01-1.14), an initial PVT as opposed to VF rhythm (RR, 1.10; 95%CI, 1.03-1.16), no arterial line in place at time of event (RR, 1.20; 95%CI, 1.09-1.32), and events occurring at a small hospital (RR, 1.17; 95%CI, 1.02-1.34). Conclusions: Overall, quality metric adherence was high in the ICU, with the exception of time to defibrillation ≤ 2 min. Predictors associated with defibrillation >2 min, included a non-cardiac and traumatic illness category and nighttime arrests.

scholarly journals Surviving cardiac arrest: What happens after admission to the intensive care unit?

2021 ◽  
Author(s):  
Raquel Menezes Fernandes ◽  
Daniel Nuñez ◽  
Nuno Marques ◽  
Cláudia Camila Dias ◽  
Cristina Granja
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care

scholarly journals The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
L. J. Delaney ◽  
E. Litton ◽  
K. L. Melehan ◽  
H.-C. C. Huang ◽  
V. Lopez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Moderate Level ◽  
Sleep Monitoring ◽  
Clinical Trial Registration ◽  
Wake Time ◽  
Intensive Care Patients

Abstract Background Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

scholarly journals Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients

PLoS ONE ◽  
2014 ◽  
Vol 9 (10) ◽  
pp. e110274 ◽  
Author(s):  
Barbara J. Drew ◽  
Patricia Harris ◽  
Jessica K. Zègre-Hemsey ◽  
Tina Mammone ◽  
Daniel Schindler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Alarm Fatigue

scholarly journals Contamination of Propofol Infusions in the Intensive Care Unit: Incidence and Clinical Significance

1998 ◽  
Vol 26 (2) ◽  
pp. 162-164 ◽  
Author(s):  
S. A. R. Webb ◽  
B. Roberts ◽  
F. X. Breheny ◽  
C. L. Golledge ◽  
P. D. Cameron ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Nosocomial Infection ◽  
Wound Infection ◽  
Clinical Significance ◽  
Low Grade ◽  
Clinical Infection ◽  
Icu Patients

Epidemics of bacteraemia and wound infection have been associated with the infusion of bacterially contaminated propofol administered during anaesthesia. We conducted an observational study to determine the incidence and clinical significance of administration of potentially contaminated propofol to patients in an ICU setting. One hundred patients received a total of 302 infusions of propofol. Eighteen episodes of possible contamination of propofol syringes were identified, but in all cases contamination was by a low-grade virulence pathogen. There were no episodes of clinical infection or colonization which could be attributed to the administration of contaminated propofol. During the routine use of propofol to provide sedation in ICU patients the risk of nosocomial infection secondary to contamination of propofol is extremely low.

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