scholarly journals The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19

2020 ◽  
pp. 014556132096519
Author(s):  
Cecilia Botti ◽  
Francesca Lusetti ◽  
Stefano Peroni ◽  
Tommaso Neri ◽  
Andrea Castellucci ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Orotracheal Intubation ◽  
Optimal Timing ◽  
Prolonged Intubation ◽  
Day Range ◽  
The Individual

Objectives: Patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Indications and timing for performing tracheotomy in patients affected by severe COVID-19 pneumonia are still elusive. The aim of this study is to analyze the role of tracheotomy in the context of this pandemic. Moreover, we report the timing of the procedure and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to the intensive care unit (ICU) of the tertiary care center of Reggio Emilia (Italy). All patients underwent orotracheal intubation with invasive mechanical ventilation, followed by percutaneous or open surgical tracheotomy. Indications, timing of the procedure, and time needed to complete weaning and decannulation were reported. Results: Forty-four patients were included in the analysis. Median time from orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%) patients died during the follow-up period (median 22 days, range 8-68) after the intubation. Weaning from the ventilator was first attempted on median 25th day (range 13-43) from orotracheal intubation. A median of 35 (range 18-79) days was required to complete weaning. Median duration of ICU stay was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing tracheotomy, decision-making should be made on case-by-case basis. It should be adapted to the context of the pandemic, taking into account the availability of intensive care resources, potential risks for health care workers, and benefits for the individual patient.

scholarly journals The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary Intensive Care Unit of a tertiary care center in Nepal

2016 ◽  
Vol 20 (7) ◽  
pp. 417-420 ◽  
Author(s):  
Saurabh Pradhan ◽  
Ashish Ghimire ◽  
Balkrishna Bhattarai ◽  
Bashudha Khanal ◽  
Krishna Pokharel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
C Reactive Protein ◽  
Reactive Protein

Defining the role of the pediatric critical care nurse practitioner in a tertiary care center

2000 ◽  
Vol 28 (7) ◽  
pp. 2626-2630 ◽  
Author(s):  
Shari L. Derengowski ◽  
Sharon Y. Irving ◽  
Pamela V. Koogle ◽  
Robert M. Englander
Keyword(s):  
Critical Care ◽  
Nurse Practitioner ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Pediatric Critical Care ◽  
Care Nurse ◽  
Critical Care Nurse

Epidemiology of Nosocomial Outbreaks: 14-Year Experience at a Tertiary-Care Center

2000 ◽  
Vol 21 (8) ◽  
pp. 527-529 ◽  
Author(s):  
Luis Ostrosky-Zeichner ◽  
Rosa Baez-Martinez ◽  
M. Sigfrido Rangel-Frausto ◽  
Samuel Ponce-de-León
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Nosocomial Infections ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Common Organism ◽  
Overall Mortality

Twelve nosocomial outbreaks over 14 years at a tertiary-care center in Mexico are described. Overall mortality was 25.8%, one half due to pneumonia. The most common organism was Pseudomonas aeruginosa. Incidence was three outbreaks per 10,000 discharges; outbreak-related infections comprised 1.56% of all nosocomial infections. Incidence in the intensive care unit was 10-fold higher.

Predictive Value of Combination of D-dimer and Fibrinogen in Diagnosing Acute CVST

2021 ◽  
pp. 097275312110631
Author(s):  
Abhishek Pathak ◽  
Varun Kumar Singh ◽  
Anand Kumar ◽  
Vijaya Nath Mishra ◽  
Deepika Joshi ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Predictive Value ◽  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Cerebral Venous Sinus Thrombosis ◽  
Latex Agglutination ◽  
D Dimer ◽  
Latex Agglutination Assay

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke, and the role of D-dimer and fibrinogen in early diagnosis of CVST has been studied with varying results. The present study aims to study the role of the combination of D-dimer and fibrinogen in early diagnosis of acute CVST. Methods: Forty consecutive confirmed acute CVST cases admitted at a tertiary care center were recruited for the study. D-dimer and fibrinogen were assessed by a rapid semiquantitative latex agglutination assay. Results: Out of the 40 CVST patients, 21 (52.50%) were females. The mean age of the patients was 37.58 years ± 19.17 years. Common clinical features were headache ( N = 38 [95%]), papilloedema ( N = 15 [37.5%]), and seizures ( N = 12 [30%]). Although the sensitivity (75%) of the combination of D-dimer and fibrinogen assay was lower than that of D-dimer or fibrinogen alone, the specificity and positive predictive value (75% each) was higher. Conclusions: The combination of D-dimer and fibrinogen testing may aid in an early diagnosis of acute CVST and in better management.

Role of Office-Based Vaginoscopy in a Tertiary Care Center

2021 ◽  
Author(s):  
Rahul S. Patel ◽  
Alana L. Christie ◽  
Philippe E. Zimmern
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ashwat Dhillon ◽  
Kanhaiya Poddar ◽  
Murat Tuzcu ◽  
Eric Roselli ◽  
Lars Svensson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Troponin T ◽  
Coronary Revascularization ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Procedure

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.

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