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.

Survey of Physiotherapy Practice in Ontario Cardiac Surgery Intensive Care Units

2021 ◽  
pp. e20200069
Author(s):  
Anastasia N.L. Newman ◽  
Michelle E. Kho ◽  
Jocelyn E. Harris ◽  
Alison Fox-Robichaud ◽  
Patricia Solomon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Critically Ill ◽  
Outcome Measures ◽  
Median Number ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Physiotherapy Practice

Purpose: This article describes current physiotherapy practice for critically ill adult patients requiring prolonged stays in critical care (> 3 d) after complicated cardiac surgery in Ontario. Method: We distributed an electronic, self-administered 52-item survey to 35 critical care physiotherapists who treat adult cardiac surgery patients at 11 cardiac surgical sites. Pilot testing and clinical sensibility testing were conducted beforehand. Participants were sent four email reminders. Results: The response rate was 80% (28/35). The median (inter-quartile range) reported number of cardiac surgeries performed per week was 30 (10), with a median number of 14.5 (4) cardiac surgery beds per site. Typical reported caseloads ranged from 6 to 10 patients per day pe therapist, and 93% reported that they had initiated physiotherapy with patients once they were clinically stable in the intensive care unit. Of 28 treatments, range of motion exercises (27; 96.4%), airway clearance techniques (26; 92.9%), and sitting at the edge of the bed (25; 89.3%) were the most common. Intra-aortic balloon pump and extracorporeal membrane oxygenation appeared to limit physiotherapy practice. Use of outcome measures was limited. Conclusions: Physiotherapists provide a variety of interventions with critically ill cardiac surgery patients. Further evaluation of the limited use of outcome measures in the cardiac surgical intensive care unit is warranted.

scholarly journals Telemedicine coverage for post-operative ICU patients

2016 ◽  
Vol 23 (2) ◽  
pp. 360-364 ◽  
Author(s):  
Tara Ann Collins ◽  
Matthew P Robertson ◽  
Corinna P Sicoutris ◽  
Michael A Pisa ◽  
Daniel N Holena ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Service ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surge Capacity ◽  
Icu Patients ◽  
Critical Care Service ◽  
Surgical Critical Care

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47–69) versus 58 (IQR 44–70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7–14) versus 15 (IQR 11–21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /–9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.

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

Biodebridement in the Surgical Intensive Care Unit: Unique Therapy for Unique Patients

2020 ◽  
pp. 000313482094311
Author(s):  
Christopher J. McLaughlin ◽  
Jeffrey M. Fornadley ◽  
Kim Fields ◽  
Scott Armen ◽  
Lacee Laufenberg
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Acute Care ◽  
Chronic Wounds ◽  
Acute Care Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Care Surgery ◽  
Unique Therapy

Acute care surgery has evolved to encompass the advanced management of complex nonhealing wounds. Biodebridement has the potential to improve the care of chronic wounds for acute care surgery patients, particularly for patients in the surgical intensive care unit (SICU) with hospital-acquired pressure injuries. A case report of biodebridement using larval maggot therapy in the SICU is presented to illustrate real-world application and progression in wound healing. A review of current research involving biodebridement was conducted. A septuagenarian gentleman sustained a fall resulting in cervical spine fractures with neurological deficits. The patient had a prolonged hospital course in the SICU, complicated by myocardial infarction, respiratory failure requiring tracheostomy, and development of a Stage IV sacral pressure ulcer. The wound base was sharply debrided several times and became refractory to conventional mechanical/chemical debridement techniques. The patient had a prohibitively high risk for the operating room but remained too sensate for further effective bedside debridement. Biodebridement was utilized to create a viable wound base, with improved appearance noted within 2 weeks. A review of the current literature shows biodebridement has numerous benefits in the management of chronic wounds. Biodebridement is a unique therapy that possesses great value for select patients in the SICU. In particular, patients who are too high risk for further operative intervention, but too sensate for ongoing bedside debridement and dressing changes, benefit significantly from this underutilized approach. Further research is needed to solidify the place of biodebridement in the surgical management of chronic nonhealing wounds.

Redesigning Orientation in an Intensive Care Unit Using 2 Theoretical Models

2015 ◽  
Vol 26 (3) ◽  
pp. 204-214 ◽  
Author(s):  
Elizabeth Kozub ◽  
Maribel Hibanada-Laserna ◽  
Gwen Harget ◽  
Laurie Ecoff
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Theoretical Models ◽  
Surgical Intensive Care Unit ◽  
Turnover Rates ◽  
Theoretical Frameworks ◽  
Surgical Intensive Care ◽  
Orientation Program ◽  
Before And After

Background: To accommodate a higher demand for critical care nurses, an orientation program in a surgical intensive care unit was revised and streamlined. Two theoretical models served as a foundation for the revision and resulted in clear clinical benchmarks for orientation progress evaluation. Purpose: The purpose of the project was to integrate theoretical frameworks into practice to improve the unit orientation program. Methods: Performance improvement methods served as a framework for the revision, and outcomes were measured before and after implementation. Results: The revised orientation program increased 1- and 2-year nurse retention and decreased turnover. Critical care knowledge increased after orientation for both the preintervention and postintervention groups. Conclusion: Incorporating a theoretical basis for orientation has been shown to be successful in increasing the number of nurses completing orientation and improving retention, turnover rates, and knowledge gained.

Long-term follow-up of ICU patients

1992 ◽  
Vol 1 (2) ◽  
pp. 115-117 ◽  
Author(s):  
BC Friedman ◽  
W Boyce ◽  
CE Bekes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Practical Method ◽  
Future Research ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Long Term Follow Up

Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.

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.

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