Critical Care Practice and Resource Utilization in a LMIC Setting: A Prospective Cohort Study from Ethiopia

Sugar-containing beverages (SCBs) are a major source of sugar intake in children. Early life intake of SCBs may be a strong predictor of SCB intake later in life. The primary objective of this study was to evaluate if SCB intake (defined as 100% fruit juice, soda, and sweetened drinks) in early childhood (≤2.5 years of age) was associated with SCB intake in later childhood (5–9 years of age). A prospective cohort study was conducted using data from the TARGet Kids! primary care practice network (n = 999). Typical daily SCB intake was measured by parent-completed questionnaires. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression. A total of 43% of children consumed ≥0.5 cups/day of SCBs at ≤2.5 years and this increased to 64% by 5–9 years. Daily SCB intake, compared to no daily intake, at ≤2.5 years was significantly associated with SCB intake at 5–9 years (adjusted OR: 4.03; 95% CI: 2.92–5.55) and this association was much stronger for soda/sweetened drinks (adjusted OR: 12.83; 95% CI: 4.98, 33.0) than 100% fruit juice (OR: 3.61; 95% CI: 2.63–4.95). Other early life risk factors for SCB intake at 5–9 years were presence of older siblings, low household income, and shorter breastfeeding duration. Daily intake of SCBs in early childhood was strongly associated with greater SCB intake in later childhood. Early life may be an important period to target for population prevention strategies.

Download Full-text

Multimorbidity and its relationship with long-term outcomes following critical care discharge: a prospective cohort study

CHEST Journal ◽

10.1016/j.chest.2021.05.069 ◽

2021 ◽

Author(s):

Joanne McPeake ◽

Tara Quasim ◽

Philip Henderson ◽

Alastair H. Leyland ◽

Nazir I. Lone ◽

...

Keyword(s):

Critical Care ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Long Term Outcomes

Download Full-text

Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study

Critical Care ◽

10.1186/s13054-021-03561-1 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Céline Gélinas ◽

Mélanie Bérubé ◽

Kathleen A. Puntillo ◽

Madalina Boitor ◽

Melissa Richard-Lalonde ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Cohort Study ◽

Intensive Care ◽

Pain Intensity ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Data Set ◽

Icu Patients ◽

Brain Injured

Abstract Background Pain assessment in brain-injured patients in the intensive care unit (ICU) is challenging and existing scales may not be representative of behavioral reactions expressed by this specific group. This study aimed to validate the French-Canadian and English revised versions of the Critical-Care Pain Observation Tool (CPOT-Neuro) for brain-injured ICU patients. Methods A prospective cohort study was conducted in three Canadian and one American sites. Patients with a traumatic or a non-traumatic brain injury were assessed with the CPOT-Neuro by trained raters (i.e., research staff and ICU nurses) before, during, and after nociceptive procedures (i.e., turning and other) and non-nociceptive procedures (i.e., non-invasive blood pressure, soft touch). Patients who were conscious and delirium-free were asked to provide their self-report of pain intensity (0–10). A first data set was completed for all participants (n = 226), and a second data set (n = 87) was obtained when a change in the level of consciousness (LOC) was observed after study enrollment. Three LOC groups were included: (a) unconscious (Glasgow Coma Scale or GCS 4–8); (b) altered LOC (GCS 9–12); and (c) conscious (GCS 13–15). Results Higher CPOT-Neuro scores were found during nociceptive procedures compared to rest and non-nociceptive procedures in both data sets (p < 0.001). CPOT-Neuro scores were not different across LOC groups. Moderate correlations between CPOT-Neuro and self-reported pain intensity scores were found at rest and during nociceptive procedures (Spearman rho > 0.40 and > 0.60, respectively). CPOT-Neuro cut-off scores ≥ 2 and ≥ 3 were found to adequately classify mild to severe self-reported pain ≥ 1 and moderate to severe self-reported pain ≥ 5, respectively. Interrater reliability of raters’ CPOT-Neuro scores was supported with intraclass correlation coefficients > 0.69. Conclusions The CPOT-Neuro was found to be valid in this multi-site sample of brain-injured ICU patients at various LOC. Implementation studies are necessary to evaluate the tool’s performance in clinical practice.

Download Full-text

Epidemiology of acute kidney injury in Canadian critical care units: a prospective cohort study

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-012-9761-1 ◽

2012 ◽

Vol 59 (10) ◽

pp. 934-942 ◽

Cited By ~ 20

Author(s):

Ayodele Odutayo ◽

Neill K. J. Adhikari ◽

James Barton ◽

Karen E. A. Burns ◽

Jan O. Friedrich ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Kidney Injury ◽

Critical Care Units

Download Full-text

Hospital Mortality and Resource Implications of Hospitalisation with COVID-19 in London, UK: A Prospective Cohort Study

Critical Care Research and Practice ◽

10.1155/2021/8832660 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Savvas Vlachos ◽

Adrian Wong ◽

Victoria Metaxa ◽

Sergio Canestrini ◽

Carmen Lopez Soto ◽

...

Keyword(s):

Critical Care ◽

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Clinical Decision Making ◽

Hospital Admissions ◽

Resource Utilisation ◽

Hospital Level ◽

Care Services

Background. Coronavirus disease 2019 (COVID-19) had a significant impact on the National Health Service in the United Kingdom (UK), with over 35 000 cases reported in London by July 30, 2020. Detailed hospital-level information on patient characteristics, outcomes, and capacity strain is currently scarce but would guide clinical decision-making and inform prioritisation and planning. Methods. We aimed to determine factors associated with hospital mortality and describe hospital and ICU strain by conducting a prospective cohort study at a tertiary academic centre in London, UK. We included adult patients admitted to the hospital with laboratory-confirmed COVID-19 and followed them up until hospital discharge or 30 days. Baseline factors that are associated with hospital mortality were identified via semiparametric and parametric survival analyses. Results. Our study included 429 patients: 18% of them were admitted to the ICU, 52% met criteria for ICU outreach team activation, and 61% had treatment limitations placed during their admission. Hospital mortality was 26% and ICU mortality was 34%. Hospital mortality was independently associated with increasing age, male sex, history of chronic kidney disease, increasing baseline C-reactive protein level, and dyspnoea at presentation. COVID-19 resulted in substantial ICU and hospital strain, with up to 9 daily ICU admissions and 41 daily hospital admissions, to a peak census of 80 infected patients admitted in the ICU and 250 in the hospital. Management of such a surge required extensive reorganisation of critical care services with expansion of ICU capacity from 69 to 129 beds, redeployment of staff from other hospital areas, and coordinated hospital-level effort. Conclusions. COVID-19 is associated with a high burden of mortality for patients treated on the ward and the ICU and required substantial reconfiguration of critical care services. This has significant implications for planning and resource utilisation.

Download Full-text