Blood Glucose Variability is Associated with Mortality in the Surgical Intensive Care Unit

2008 ◽  
Vol 74 (8) ◽  
pp. 679-685 ◽  
Author(s):  
Lesly A. Dossett ◽  
Hanqing Cao ◽  
Nathan T. Mowery ◽  
Marcus J. Dortch ◽  
John M. Morris ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Insulin Dose ◽  
Standard Of Care ◽  
Glucose Variability ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Blood Glucose Variability ◽  
Surgical Icu

Intensive insulin therapy has widely and rapidly been adopted as the standard of care for the treatment of hyperglycemia in the intensive care unit (ICU). Variability in blood glucose is increasingly recognized as an important factor in outcomes in the chronic diabetic in addition to hemoglobin A1C. We tested the hypothesis that measures of blood glucose variability would be associated with mortality in the surgical ICU. A retrospective analysis of a cohort of ventilated, critically ill surgical and trauma ICU patients placed on an automated insulin protocol was performed. Blood glucose (BG) variability was measured by comparing standard deviation, percentile values, successive changes in blood glucose, and by calculating the triangular index for various glucose-related indices. Eight hundred and fifty-eight patients had 46,474 blood glucose and insulin dose data points. One hundred and twenty-one patients died for an overall mortality rate of 14 per cent. Several measures of blood glucose variability (maximum successive change in BG and the triangular index) were different between the groups despite similar mean BG between survivors (117 mg/dL) and nonsurvivors (118 mg/dL). Increased blood glucose variability is associated with mortality in the surgical ICU. Further studies should focus on the demographic, clinical, and genetic factors responsible for this observation and identify strategies to minimize BG variability.

scholarly journals A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards

2018 ◽  
Vol 3 (1) ◽  
pp. e000180 ◽  
Author(s):  
Erin I Duffy ◽  
Jonah Garry ◽  
Lillian Talbot ◽  
David Pasternak ◽  
Ashley Flinn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Eye Tracking ◽  
Tertiary Care ◽  
Basic Needs ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Head Nodding ◽  
Surgical Icu

BackgroundMechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing.MethodsThis was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of −1 to +1, without cognitive impairment, were eligible. We asked patients four yes-or-no questions to assess basic needs regarding presence of pain, need for endotracheal suction, satisfactory room temperature, and position comfort. Patients were then asked if there was anything else that they wanted to communicate. All responses were confirmed by head nodding.ResultsThe median accuracy of the CB (100% (IQR 100%–100%)) for basic needs communication (yes/no questions) was comparable with that of the ETD (100% (IQR 68.8%–100%); p=0.14) in the 12 enrolled patients. Notably, 83% of patients desired to communicate additional information, ranging from spiritual (eg, desire for prayer/chaplain), emotional (eg, frustration, desire for comfort), physical/environmental (eg, television), to physiological (eg, thirst/hunger) needs.DiscussionThe majority of patients desired to communicate something other than basic needs. Unless specifically assessed via an assistive communication device (eg, CB or ETD), some of these other needs would have been difficult to discern.Level of evidenceIV therapeutic care/management.

scholarly journals Monitoring of Blood Glucose Level in Surgical Intensive Care Unit Patients with Sepsis

2019 ◽  
Vol 87 (9) ◽  
pp. 2977-2981
Author(s):  
ABDULLAH N. EL-ORABY, M.Sc.; SOHAIR M. SOLIMAN, M.D. ◽  
AHMED A. EL-DABA, M.D.; WAIL E. MESBAH, M.D.
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Essay: Celebrating New Life in a Neuro-Surgical ICU

2014 ◽  
Vol 18 (3) ◽  
pp. 65-66
Author(s):  
Marlienne Goldin,
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Real Time ◽  
Nursing Staff ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Grand Mal ◽  
Surgical Icu ◽  
New Mother ◽  
First Time

Caritas nurses cultivate the soul and spirit of their patients, as well as attend to their emotional and physical needs. This exemplar of caritas nursing shows how the nursing staff in a neuro-surgical intensive care unit (ICU), where a new mother had been admitted after having grand mal seizures during delivery, used technology to bring mother and baby together. Using iPhones and Facetime, the ICU nurses arranged for the mother to see her baby boy in the newborn nursery for the very first time, in real time. This caring moment exemplifies many of Watson’s caritas processes. Participating in these caring moments is the greatest reward of nursing.

Surgical Intensive Care Unit Mobility is Increased after Institution of a Computerized Mobility Order Set and Intensive Care Unit Mobility Protocol: A Prospective Cohort Analysis

2010 ◽  
Vol 76 (8) ◽  
pp. 818-822 ◽  
Author(s):  
Amy N. Hildreth ◽  
Toby Enniss ◽  
Robert S. Martin ◽  
Preston R. Miller ◽  
Donna Mitten-Long ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Cohort Analysis ◽  
Surgical Intensive Care Unit ◽  
Inclusion Criteria ◽  
Surgical Intensive Care ◽  
Surgical Icu ◽  
Baseline Characteristics ◽  
Order Set

In some populations, intensive care unit (ICU) mobility has been shown to be safe and beneficial. We gathered data on 50 nonintubated surgical patients in a 10-bed surgical ICU (SICU) who met physiologic inclusion criteria beginning in May 2008 (A group). In January 2009, we began mandatory entry of computerized mobility orders as part of a standardized ICU order set. We also created a mobility protocol for nurses in this ICU. We then collected data on 50 patients in this postintervention cohort (B group). Both groups had similar baseline characteristics. A group patients had some form of mobility orders entered in 29 patients (58%) versus 47 patients (82%) in the B group, P < 0.05. In the A group, 11 patients (22%) were mobilized; in the B group, 40 patients (80%) were mobilized, P < 0.05. In our SICU patient population, mandatory entry of computerized mobility orders as part of a standard SICU order set and establishment of an ICU mobility nursing protocol was associated with an increase in number of mobility orders entered as well as an increase in SICU patient activity. Further studies should focus on measurement of the effect of mobility interventions on patient outcomes.

scholarly journals Ramelteon for Decreasing Delirium in Surgical Intensive Care Unit Patients

2020 ◽  
Vol 11 ◽  
pp. 117955732095122
Author(s):  
Chelsea N Lopez ◽  
Amaris Fuentes ◽  
Atiya Dhala ◽  
Jonathan Balk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Median Number ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Objective ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Surgical Icu

In intensive care unit (ICU) patients, delirium contributes to prolonged hospitalization, long-term cognitive impairment and increased mortality. Sleep disturbance, a risk factor for delirium, has been attributed to impaired melatonin secretion in critically ill patients. Ramelteon, a synthetic melatonin receptor agonist, is indicated for insomnia; there is limited, but growing evidence, to support its use for the prevention of delirium. The primary objective of this study is to describe the use of ramelteon and the incidence of delirium, assessed by Confusion Assessment Method for the ICU (CAM-ICU) scores, in adult surgical ICU patients from May 22, 2016 to June 30, 2018. The primary endpoint is the number of delirium free days in the week prior to and post first ramelteon administration. A total of 231 patients were included in the study with 201 (87%) positive for delirium at least once during the study timeframe. The median number of CAM-ICU negative days in the week pre-ramelteon administration was 4 days (IQR 2-7 days) compared to 6 days (IQR 3-7 days) in the week post-first ramelteon administration ( P < .05). The time to CAM-ICU positive increased slightly to 3 days (IQR 1-7 days) following ramelteon initiation compared to 2 days (IQR 1-5 days) from initial ICU admission. Additionally, the median number of antipsychotic doses per patient decreased from 4 doses (IQR 1.25-14 doses) prior to ramelteon to 2 doses (IQR 1-4 doses) after ramelteon. Ramelteon administration was associated with a greater number of CAM-ICU negative days in surgical ICU patients. These findings describe a potential role for ramelteon in mitigating delirium in this patient population.

Is Methicillin-Resistant Staphylococcus Aureus More Contagious than Methicillin-Susceptible S. Aureus in a Surgical Intensive Care Unit?

2002 ◽  
Vol 23 (9) ◽  
pp. 491-494 ◽  
Author(s):  
Menno R. Vriens ◽  
Ad C. Fluit ◽  
Annet Troelstra ◽  
Jan Verhoef ◽  
Chris van der Werken
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Methicillin Resistance ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Methicillin Resistant ◽  
Active Screening ◽  
Screening Programs ◽  
Surgical Icu

Background and Objective:In the Netherlands, the prevalence of methicillin resistance among Staphylococcus aureus isolates has been kept to less than 1% by using active screening programs and isolation. At the University Medical Center Utrecht (UMCU), an active screening program for methicillin-resistant S. aureus (MRSA) in the surgical intensive care unit (ICU) was implemented in 1986. Between 1992 and 2001, only 6 patients with MRSA were admitted to the surgical ICU. However, 4 of these 6 strains were able to spread to 23 other patients and 15 healthcare workers (HCWs). We were surprised by the epidemic behavior of these strains and wondered whether this was exceptional for S. aureus or whether methicillin-susceptible S. aureus (MSSA) was also spreading in the ICU.Design:A 2-month, prospective, observational study to investigate the incidence and spread of MSSA in the surgical ICU of UMCU and historical data collected during a 10-year period regarding MRSA.Setting:A 10-bed surgical ICU in a 1,042-bed teaching hospital.Results:Weekly swabs revealed the presence of MSSA in 11 (24%) of 45 patients and 16 (22%) of 72 HCWs. Of all 4,105 patient–HCW contacts, there were only 21 episodes in which both the patient and the HCW were found to carry MSSA. With the use of pulsed-field gel electrophoresis, no identical strains could be identified.Conclusion:In our surgical ICU, MRSA seems to spread more easily than MSSA, probably because of selection under antibiotic pressure or a still unknown intrinsic factor within MRSA.

Hypoglycemia in a Surgical Intensive Care Unit

2021 ◽  
pp. 000313482110249
Author(s):  
Emily Switzer ◽  
Morgan Schellenberg ◽  
Meghan Lewis ◽  
Natthida Owattanapanich ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Blood Glucose ◽  
High Risk ◽  
Soft Tissue ◽  
Surgical Intensive Care Unit ◽  
Subcutaneous Insulin ◽  
Surgical Intensive Care ◽  
Long Acting

Background Glycemic control is an important aspect of critical care because derangements are associated with morbidity and mortality. Patients at highest risk for hypoglycemia in the surgical intensive care unit (SICU) are incompletely described by existing literature. Our objective was to delineate this high-risk patient population in our SICU. Study Design In this single-center, retrospective, observational study, SICU patients admitted from June 1, 2019 to July 31, 2020 with ≥1 episode of hypoglycemia (blood glucose <60 mg/dL) were included. Results There were 41 hypoglycemic events in 27 patients, comprising an incidence of 1.5% among SICU patients. The most common admission diagnoses were cirrhosis (n = 13, 48%), polytrauma (n = 12, 44%), multisystem organ failure (n = 11, 41%), diabetes mellitus (n = 9, 33%), and soft tissue infection (n = 8, 30%). Four high-risk populations were identified: patients in multisystem organ failure (MSOF) (n = 11, 41%); those who were nil per os (NPO) (n = 10, 37%); patients receiving long acting subcutaneous insulin, for example, Lantus (n = 3, 11%); and those on continuous intravenous insulin infusions (n = 3, 11%). After multi-disciplinary peer review, most hypoglycemic events (n = 16, 59%) were deemed iatrogenic. Conclusions Hypoglycemia is rare in surgical critical care. When it does occur, patients are typically in MSOF, NPO, on long acting subcutaneous insulin or continuous insulin infusions, have soft tissue infections, or have acute or chronic liver failure. Increased vigilance with frequent blood glucose monitoring in these high-risk patients may reduce the risk of hypoglycemia in the SICU.

scholarly journals Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

2020 ◽  
Author(s):  
Yan-Juan Lin ◽  
Ling-Yu Lin ◽  
Yan-Chun Peng ◽  
Hao-Ruo Zhang ◽  
Liang-wan Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Standard Deviation ◽  
Aortic Dissection ◽  
Intensive Care Unit Stay ◽  
Postoperative Delirium ◽  
Acute Aortic Dissection ◽  
Glucose Variability ◽  
Blood Glucose Variability

Abstract Background: Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients.Methods: We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess.Results: A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in age, body mass index, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay (P<0.05). The median of the mean of blood glucose and the standard deviation of blood glucose were higher in the delirium group than in the non-delirium group, and the difference was statistically significant (P<0.05). In model 1, the adjusted hazard ratio of the standard deviation of blood glucose was 1.436 (P<0.05). In Model 2, the standard deviation of blood glucose (AHR=1.418, 95% CI=1.195-1.681, P<0.05) remained significant after adjusting for confounders (P<0.05). The area under the curve of the standard deviation of blood glucose was 0.763 (95% CI=0.704-0.821, P<0.01). The sensitivity was 81.6%, and the specificity was 57.8%. Conclusions: Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

Sign in / Sign up

Export Citation Format

Share Document