Impact of Volatile Anesthetics for Long-Term Sedation in Critically Ill Patients on Cognitive Impairment at 3-Months Follow-Up

2019 ◽  
Author(s):  
K.D. Walczak ◽  
V. Otero Castro ◽  
D. Grewal ◽  
A. Jerath ◽  
M. Wasowicz ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Volatile Anesthetics

scholarly journals Understanding terminology of delirium and long-term cognitive impairment in critically ill patients

2012 ◽  
Vol 26 (3) ◽  
pp. 267-276 ◽  
Author(s):  
A. Morandi ◽  
P.P. Pandharipande ◽  
J.C. Jackson ◽  
G. Bellelli ◽  
M. Trabucchi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Visfatin Serum Levels Predict Mortality in Critically Ill Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Alexander Koch ◽  
Ralf Weiskirchen ◽  
Alexander Krusch ◽  
Jan Bruensing ◽  
Lukas Buendgens ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Levels ◽  
Innate Immune ◽  
Medical Patients ◽  
Innate Immune Responses ◽  
Long Term Follow Up

The adipokine visfatin, also termed pre-B-cell colony-enhancing factor (PBEF), is mainly derived from adipose tissue but has been implicated in the regulation of innate immune responses. We hypothesized that visfatin could be a potential circulating biomarker in critical illness and sepsis. We therefore measured serum levels of visfatin in a cohort of 229 critically ill medical patients upon admission to the intensive care unit (ICU). In comparison to 53 healthy controls, visfatin levels were significantly elevated in medical ICU patients, especially in patients with sepsis. Visfatin serum concentrations were strongly associated with disease severity and organ failure but did not differ between patients with or without obesity or type 2 diabetes. Visfatin levels correlated with biomarkers of renal failure, liver dysfunction, and other adipokines (e.g., resistin, leptin, and adiponectin) in critically ill patients. High visfatin levels at ICU admission indicated an increased mortality, both at the ICU and during long-term follow-up of approximately two years. Our data therefore demonstrate that circulating visfatin is a valuable biomarker for risk and prognosis assessment in critically ill patients. Furthermore, visfatin seems to be involved in the pathogenesis of excessive systemic inflammation, supporting further research on visfatin as a therapeutic target.

Critically Ill Patients Requiring Acute Renal Replacement Therapy Are at an Increased Risk of Long-Term Renal Dysfunction, but Rarely Receive Specialist Nephrology Follow-Up

Nephron ◽  
2015 ◽  
Vol 129 (3) ◽  
pp. 164-170 ◽  
Author(s):  
Christopher J. Kirwan ◽  
Mark J. Blunden ◽  
Hamish Dobbie ◽  
Ajith James ◽  
Ambika Nedungadi ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Increased Risk

Delirium and long term cognition in critically ill patients

BMJ ◽  
2021 ◽  
pp. n1007
Author(s):  
M Elizabeth Wilcox ◽  
Timothy D Girard ◽  
Catherine L Hough
Keyword(s):  
Cognitive Impairment ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Severity Of Illness ◽  
Brain Dysfunction ◽  
Long Term Outcomes ◽  
Drug Treatments ◽  
Acute Brain Dysfunction

AbstractDelirium, a form of acute brain dysfunction, is very common in the critically ill adult patient population. Although its pathophysiology is poorly understood, multiple factors associated with delirium have been identified, many of which are coincident with critical illness. To date, no drug or non-drug treatments have been shown to improve outcomes in patients with delirium. Clinical trials have provided a limited understanding of the contributions of multiple triggers and processes of intensive care unit (ICU) acquired delirium, making identification of therapies difficult. Delirium is independently associated with poor long term outcomes, including persistent cognitive impairment. A longer duration of delirium is associated with worse long term cognition after adjustment for age, education, pre-existing cognitive function, severity of illness, and exposure to sedatives. Interestingly, differences in prevalence are seen between ICU survivor populations, with survivors of acute respiratory distress syndrome experiencing higher rates of cognitive impairment at early follow-up compared with mixed ICU survivor populations. Although cognitive performance improves over time for some ICU survivors, impairment is persistent in others. Studies have so far been unable to identify patients at higher risk of long term cognitive impairment; this is an active area of scientific investigation.

scholarly journals Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI

2017 ◽  
Vol 29 (3) ◽  
pp. 1011-1019 ◽  
Author(s):  
Melanie Meersch ◽  
Mira Küllmar ◽  
Christoph Schmidt ◽  
Joachim Gerss ◽  
Toni Weinhage ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
Early Stage ◽  
Early Initiation ◽  
Absolute Difference ◽  
Delayed Initiation ◽  
Major Adverse Kidney Events

Whether earlier initiation of RRT in critically ill patients with AKI can improve outcomes remains debated. We examined follow-up data from a large clinical trial to prospectively investigate the long-term outcomes associated with the timing of RRT initiation in such patients. We extended the follow-up of patients in the Early Versus Delayed Initiation of RRT in Critically Ill Patients with AKI (ELAIN) Trial from 90 days to 1 year after randomization for 230 (99.6%) patients. The primary outcome was a composite of major adverse kidney events (persistent renal dysfunction, dialysis dependence, and mortality) at 1 year. Secondary outcomes included inflammatory markers. Overall, 72 of 111 (64.9%) and 106 of 119 (89.1%) patients met the primary outcome in the early (stage 2 AKI) and delayed (stage 3 AKI) initiation groups, respectively (odds ratio [OR] with early initiation, 0.23; 95% confidence interval [95% CI], 0.11 to 0.45; P< 0.001). The early initiation group had a 1-year all-cause mortality rate (56 of 111 [50.2%]) significantly lower than that of the delayed initiation group (83 of 119 [69.8%]; absolute difference, −19.6%; 95% CI, −32.0% to −7.2%; P<0.01). After 1 year, 16 of 55 (29.1%) and 23 of 36 (63.9%) surviving patients in the early and delayed groups, respectively, failed to recover renal function (absolute difference, −34.8%; 95% CI, −54.6% to −15.0%; P=0.001). In conclusion, early initiation of RRT in these critically ill patients with AKI significantly reduced the occurrence of major adverse kidney events, reduced mortality, and enhanced renal recovery at 1 year.

scholarly journals Protocol for a randomised trial of an interprofessional team-delivered intervention to support surrogate decision-makers in ICUs

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033521
Author(s):  
Taylor Lincoln ◽  
Anne-Marie Shields ◽  
Praewpannarai Buddadhumaruk ◽  
Chung-Chou H Chang ◽  
Francis Pike ◽  
...  
Keyword(s):  
Family Support ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Maslach Burnout Inventory ◽  
Skills Training ◽  
Icu Stay ◽  
Surrogate Decision ◽  
The Impact

IntroductionAlthough shortcomings in clinician–family communication and decision making for incapacitated, critically ill patients are common, there are few rigorously tested interventions to improve outcomes. In this manuscript, we present our methodology for the Pairing Re-engineered Intensive Care Unit Teams with Nurse-Driven Emotional support and Relationship Building (PARTNER 2) trial, and discuss design challenges and their resolution.Methods and analysisThis is a pragmatic, stepped-wedge, cluster randomised controlled trial comparing the PARTNER 2 intervention to usual care among 690 incapacitated, critically ill patients and their surrogates in five ICUs in Pennsylvania. Eligible subjects will include critically ill patients at high risk of death and/or severe long-term functional impairment, their main surrogate decision-maker and their clinicians. The PARTNER intervention is delivered by the interprofessional ICU team and overseen by 4–6 nurses from each ICU. It involves: (1) advanced communication skills training for nurses to deliver support to surrogates throughout the ICU stay; (2) deploying a structured family support pathway; (3) enacting strategies to foster collaboration between ICU and palliative care services and (4) providing intensive implementation support to each ICU to incorporate the family support pathway into clinicians’ workflow. The primary outcome is surrogates’ ratings of the quality of communication during the ICU stay as assessed by telephone at 6-month follow-up. Prespecified secondary outcomes include surrogates’ scores on the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the modified Patient Perception of Patient Centredness scale, the Decision Regret Scale, nurses’ scores on the Maslach Burnout Inventory, and length of stay during and costs of the index hospitalisation.We also discuss key methodological challenges, including determining the optimal level of randomisation, using existing staff to deploy the intervention and maximising long-term follow-up of participants.Ethics and disseminationWe obtained ethics approval through the University of Pittsburgh, Human Research Protection Office. The findings will be published in peer-reviewed journals.Trial registration numberNCT02445937

scholarly journals Clinical Outcomes and Independent Risk Factors for 90-day Mortality in Critically-ill Patients Infected With SARS CoV-2: a Multicenter Study in Turkish Intensive Care Units

2021 ◽  
Author(s):  
Kursat Gundogan ◽  
Ismail Hakki Akbudak ◽  
Pervin Hanci ◽  
Burcin Halacli ◽  
Sahin Temel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
Invasive Mechanical Ventilation ◽  
Positive Fluid Balance

Abstract Background: There are limited data on long-term outcome and mortality predictors of COVID-19 from different parts of the world. The aim of this study was to determine risk factors of 90-day mortality in critically-ill patients infected with SARS-CoV-2 in Turkish ICUs. Methods: This multicenter, retrospective study was performed in 26 ICUs in Turkey. All patients with confirmed SARS-CoV2 infection, requiring more than 24 hours of ICU follow-up were included in the study. Demographics, clinical characteristics, laboratory variables, respiratory support, treatment types, and survival data were recorded. Results: A total of 421 patients were included in the study. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. 90-day mortality rate was 55.1%. Factors independently associated with 90-day mortality were receiving invasive mechanical ventilation (HR 4.09 [95% CI: 2.20-7.63]), admission lactate level > 2 mmol/L (2.78 [1.93-4.01]), age ≥ 60 years (2.45 [1.48-4.06)]), having cardiac arrhythmia during ICU stay (2.01 [1.27-3.20]), receiving vasopressor treatment (1.94 [1.32-2.84]), positive fluid balance of ≥ 600 ml/per day during ICU follow-up (1.68 [1.21-2.34]), admission PaO2/FiO2 ratio of ≤ 150 mmHg (1.66 [1.18-2.32], and baseline ECOG score ≥ 1 (1.42 [1.00-2.02]. Conclusion: This study has shown that long-term mortality was high in critically-ill COVID-19 patients in Turkish ICUs. Invasive mechanical ventilation, high lactate level, older age, presence of cardiac arrhythmia, need for vasopressor treatment, positive fluid balance, severe hypoxemia and not having fully-active performance were related with mortality.

Follow-up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

2020 ◽  
Vol 86 (5) ◽  
Author(s):  
Martina Spaziante ◽  
Alessandra Oliva ◽  
Giancarlo Ceccarelli ◽  
Francesco Alessandri ◽  
Francesco Pugliese ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Cultures ◽  
Gram Negative
Sign in / Sign up

Export Citation Format

Share Document