Provider-Documented Anxiety in the ICU: Prevalence, Risk Factors, and Associated Patient Outcomes

2020 ◽  
pp. 088506662095656
Author(s):  
Andrew D. May ◽  
Ann M. Parker ◽  
Ellen S. Caldwell ◽  
Catherine L. Hough ◽  
Jennifer E. Jutte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Abuse ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Chart Review ◽  
Severity Of Illness ◽  
Surgical Intensive Care Unit ◽  
Icu Patients ◽  
Icu Stay ◽  
History Of

Purpose: To determine the prevalence of provider-documented anxiety in critically ill patients, associated risk factors, and related patient outcomes. Method: Chart review of 100 randomly sampled, adult patients, with a length of stay ≥48 hours in a medical or trauma/surgical intensive care unit (ICU). Provider-documented anxiety was identified based on a comprehensive retrospective chart review of the ICU stay, searching for any acute episode of anxiety (e.g., documented words related to anxiety, panic, and/or distress). Results: Of 100 patients, 45% (95% confidence interval: 35%-55%) had documented anxiety, with similar prevalence in medical vs. trauma/surgical ICU. Patients with documented anxiety more frequently had history of anxiety (22% vs. 4%, p = .004) and substance abuse (40% vs. 22%, p = .048). In the ICU, they had greater severity of illness (median (IQR) Acute Physiology Score 16(13,21) vs. 13(8,19), p = .018), screened positive for delirium at least once during ICU stay, (62% vs. 31%, p = .002), benzodiazepines and antipsychotics use (87% vs. 58%, p = .002; 33% vs. 13%, p = .013, respectively), and mental health consultation (31% vs. 18%, p = .132). These patients also had longer ICU and hospital lengths of stay (6(4,11) vs. 4(3,6), p<.001 and 18(10,30) vs. 10(6,16) days, p<.001, respectively) and less frequent discharge back to home (27% vs. 44%, p = .079). Conclusions: Documented anxiety, occurring in almost half of ICU patients with length of stay ≥48 hours, was associated with a history of anxiety and/or substance abuse, and greater ICU severity of illness, delirium, psychiatric medications, and length of stay. Increased awareness along with more standardized protocols for assessment of anxiety in the ICU, as well as greater evaluation of non-pharmacological treatments for anxiety symptoms in the ICU are warranted.

scholarly journals Prediction Algorithm for ICU Mortality and Length of Stay Using Machine Learning

2021 ◽  
Author(s):  
Shinya IWASE ◽  
Taka-aki Nakada ◽  
Tadanaga Shimada ◽  
Takehiko Oami ◽  
Takashi Shimazui ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Length Of Stay ◽  
Predictive Value ◽  
Predictive Accuracy ◽  
Supervised Machine Learning ◽  
Icu Patients ◽  
Icu Stay ◽  
Precise Prediction ◽  
Length Of Icu Stay

Abstract Background: Machine learning can predict outcomes and determine variables contributing to precise prediction, and can thus classify patients with different risk factors of outcomes. This study aimed to investigate the predictive accuracy for mortality and length of stay in intensive care unit (ICU) patients using machine learning, and to identify the variables contributing to the precise prediction or classification of patients.Methods: Patients (n=12,747) admitted to the ICU at Chiba University Hospital were randomly assigned to the training and test cohorts. After learning using the variables on admission in the training cohort, the area under the curve (AUC) was analyzed in the test cohort to evaluate the predictive accuracy of the supervised machine learning classifiers, including random forest (RF) for outcomes (primary outcome, mortality; secondary outcome, and length of ICU stay). The rank of the variables that contributed to the machine learning prediction was confirmed, and cluster analysis of the patients with risk factors of mortality was performed to identify the important variables associated with patient outcomes.Results: Machine learning using RF revealed a high predictive value for mortality, with an AUC of 0.945. In addition, RF showed high predictive value for short and long ICU stays, with AUCs of 0.881 and 0.889, respectively. Lactate dehydrogenase (LDH) was identified as a variable contributing to the precise prediction in machine learning for both mortality and length of ICU stay. LDH was also identified as a contributing variable to classify patients into sub-populations based on different risk factors of mortality.Conclusion: The machine learning algorithm could predict mortality and length of stay in ICU patients with high accuracy. LDH was identified as a contributing variable in mortality and length of ICU stay prediction and could be used to classify patients based on mortality risk.

Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

2013 ◽  
Vol 34 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Cecile Aubron ◽  
Allen C. Cheng ◽  
David Pilcher ◽  
Tim Leong ◽  
Geoff Magrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Extracorporeal Membrane Oxygenation ◽  
Unit Length ◽  
Severity Of Illness ◽  
Infectious Complications ◽  
Hospital Length ◽  
Interquartile Range ◽  
Hospital Length Of Stay ◽  
Membrane Oxygenation

Objectives.To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.Design.Retrospective observational survey from 2005 through 2011.Participants and Setting.Patients who required ECMO in an Australian referral center.Methods.Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.Results.A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.Conclusion.The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

Abstract 13811: Cognitive and Psychological Outcomes of Patients 6 Months After Cardiac Arrest or Intensive Care Stay

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Matthew R Potter ◽  
Marco Mion ◽  
Eleni A Nikolopoulou ◽  
Neil Magee ◽  
Kelly Farrell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cognitive Impairment ◽  
Length Of Stay ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Icu Patients ◽  
Icu Stay ◽  
Sf 36 ◽  
Significant Difference

Background: The neuropsychological and cognitive consequences of an ICU stay can cause a large burden on many patients. In this study, we assessed the outcomes of a group of patients attending a newly set up, multi-disciplinary outpatient clinic focused on assessing neuropsychological and cognitive outcomes following a significant (>72 hours) ICU stay, and compared patients whose ICU was post-OHCA (out of hospital cardiac arrest), and those non-OHCA. Methods: Between 2016 and 2019, 152 patients were assessed within the Care after REsuscitation (CARE) / ICU follow up clinic, 6 months following hospital discharge, using the SF-36, HADS, PTSS-14 and MoCA. The OHCA group were compared to other non-OHCA, ICU patients (>72 hour stay). Results: No significant differences (p<0.05) were found between the groups outcomes, however we found that 6 months post-discharge, the non-OHCA group experience significantly more pain, are older, and required a longer length of stay (p<0.05). However, we found compared to normative data of the SF-36, over half of the OHCA group (on 6 out of the 8 subscales) and the non-OHCA (on 7 out of the 8) were below population norms, especially Role-Physical (66.7% OHCA and 71.6% non-OHCA) and Energy/ fatigue (66.7% OHCA and 61.4% non-OHCA). Anxiety was observed in 33.3% of the OHCA group, and 35.2% of the non-OHCA group had an abnormal total HADS score. PTSD was seen in 12.7% of the OHCA group and 10.2% of the non-OHCA group. Cognitive impairment was observed in 61.9% of OHCA and 59.1% of non-OHCA patients. Age and hospital length of stay had no significant effect on outcomes on our OHCA population, however females had significantly worse health related quality of life (HRQoL) on 6 out of the 8 subscales (p<0.05). Conclusion: Despite the OHCA and non-OHCA groups having no significant difference between their outcomes, there is a great disease burden upon many individuals following ICU stay, with many experiencing poor HRQoL, mood disorders, PTSD and cognitive impairment. The factors contributing to poor outcome following both ICU related illness and cardiac arrest should be further studied. The creation and validation of new assessment tools is imperative to ensure we fully appreciate the extent of the morbidity in this group to improve care for all ICU patients.

scholarly journals The independent risk factors of early diarrhoea in enteral nutrition for ICU patients

2019 ◽  
Vol 47 (10) ◽  
pp. 4929-4939 ◽  
Author(s):  
Weiting Chen ◽  
Hehao Wang ◽  
Yingzi Chen ◽  
Danqin Yuan ◽  
Renhui Chen
Keyword(s):  
Risk Factors ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Early Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Severity Of Illness ◽  
Icu Patients ◽  
Feeding Method ◽  
Prokinetic Agents ◽  
Independent Risk Factors

Objective To investigate the prevalence of and factors associated with diarrhoea in the early stage of enteral nutrition in critically ill patients in intensive care units (ICUs). Methods This prospective, multicentre, observational study enrolled consecutive patients who were newly admitted to ICUs and received enteral nutrition treatment. Events were observed continuously for 7 days or until patients were transferred out of the ICU after enteral nutrition. Demographic and clinical data, enteral nutrition data, diarrhoea-related data and outcomes were recorded. A multivariate logistic regression analysis was used to analyse the risk factors for diarrhoea. Results The study included 533 patients, of whom 164 (30.8%) developed diarrhoea. Diarrhoea was most commonly observed on the first to third days after starting enteral nutrition treatment. The median (interquartile range) duration of diarrhoea was 2 (1–3) days. The administration of gastrointestinal prokinetic agents, the increase in acute physiological and chronic health scores and the pyloric posterior feeding method were independent risk factors for diarrhoea. Conclusion The increased severity of illness, the administration of gastrointestinal prokinetic agents and the pyloric posterior feeding method were independent risk factors for diarrhoea in critically ill ICU patients undergoing enteral nutrition treatment.

scholarly journals Predictors of Carbapenem-Resistant Klebsiella pneumoniae Acquisition among Hospitalized Adults and Effect of Acquisition on Mortality

2007 ◽  
Vol 52 (3) ◽  
pp. 1028-1033 ◽  
Author(s):  
Mitchell J. Schwaber ◽  
Shiri Klarfeld-Lidji ◽  
Shiri Navon-Venezia ◽  
David Schwartz ◽  
Azita Leavitt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Functional Status ◽  
Group Versus ◽  
Severity Of Illness ◽  
Hospital Death ◽  
Case Group ◽  
Icu Stay ◽  
Carbapenem Resistant ◽  
Poor Functional Status

ABSTRACT Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging nosocomial pathogen. Little is known about its risk factors or mortality. We performed a case-case-control study to assess the risks for CRKP isolation and a retrospective cohort study to assess mortality in three groups of hospitalized adults: (i) patients from whom CRKP was isolated, (ii) patients from whom carbapenem-susceptible Klebsiella spp. (CSKS) were isolated, and (iii) controls from whom no Klebsiella spp. were isolated. After adjustment for length of stay (LOS), the demographics, comorbidities, and exposures of each case group were compared with those of the controls. Significant covariates were incorporated into LOS-adjusted multivariable models. In the mortality study, we evaluated the effect of CRKP on in-hospital death. There were 48 patients with CRKP isolation (21 died [44%]), 56 patients with CSKS isolation (7 died [12.5%]), and 59 controls (1 died [2%]). Independent risk factors for CRKP isolation were poor functional status (odds ratio [OR], 15.4; 95% confidence interval [CI], 4.0 to 58.6; P < 0.001); intensive care unit (ICU) stay (OR, 17.4; 95% CI, 1.5 to 201.9; P = 0.02); and receipt of antibiotics (OR, 4.4; 95% CI, 1.0 to 19.2; P = 0.05), particularly fluoroquinolones (OR, 7.2; 95% CI, 1.1 to 49.4; P = 0.04). CRKP was independently associated with death when patients with CRKP were compared with patients with CSKS (OR, 5.4; 95% CI, 1.7 to 17.1; P = 0.005) and with controls (OR, 6.7; 95% CI, 2.4 to 18.8; P < 0.001). After adjustment for the severity of illness, CRKP isolation remained predictive of death, albeit with a lower OR (for the CRKP group versus the CSKS group, OR, 3.9; 95% CI, 1.1 to 13.6; and P = 0.03; for the CRKP group versus the controls, OR, 5.0; 95% CI, 1.7 to 14.8; and P = 0.004). CRKP affects patients with poor functional status, an ICU stay, and antibiotic exposure and is an independent predictor of death.

Management of isolated calf vein thrombosis in cancer patients

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 64-69
Author(s):  
Anand S Brahmandam ◽  
Kirstyn Brownson ◽  
Laura Skrip ◽  
Terri Parker ◽  
Jeffrey Indes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Modalities ◽  
Vein Thrombosis ◽  
History Of ◽  
Calf Vein ◽  
History Of Cancer

The treatment of isolated calf vein thrombosis remains widely debated. This study highlights the characteristics of isolated calf vein thrombosis in cancer patients and compares to isolated calf vein thrombosis in patients without history of cancer. Between July 2013 and April 2014, a retrospective chart review of consecutive patients with isolated calf vein thrombosis was performed recording patient risk factors, ultrasound characteristics of the thrombus, treatment modalities, long-term recurrence of venous-thromboembolism, incidence of bleeding, and mortality. Of 131 patients with isolated calf vein thrombosis, 53 (40.1%) had history of cancer. Isolated calf vein thrombosis occurred at an older age in cancer patients (66.7 vs 58.5 years, p = 0.004). The anatomical characteristics of isolated calf vein thrombosis on ultrasound were comparable in both groups. Isolated calf vein thrombosis in cancer patients was less likely to be treated with anticoagulation (60.4% vs 80.8%, p = 0.018). However, a trend towards higher incidence of bleeding after initiation of anticoagulation for isolated calf vein thrombosis in cancer patients (11.3% vs 6.4%, p = 0.351) was noted. Mortality in cancer patients was higher (37.7% vs 9.00%, p < 0.001) but was unrelated to isolated calf vein thrombosis or its treatment. In conclusion, the risks of bleeding seem to exceed the benefits of anticoagulation in approximately 50% of cancer patients with isolated calf vein thrombosis. The management of isolated calf vein thrombosis does not seem to impact the survival of cancer patients.

scholarly journals Identifying factors associated with the discharge of male State patients from Weskoppies Hospital

2017 ◽  
Vol 23 ◽  
Author(s):  
Riaan G. Prinsloo ◽  
Andre Swanepoel ◽  
Gian Lippi
Keyword(s):  
Substance Abuse ◽  
Substance Use ◽  
Length Of Stay ◽  
Substance Use Disorder ◽  
Physical Aggression ◽  
Hospital Data ◽  
Related Factors ◽  
Term Care ◽  
Factors Associated ◽  
History Of

Background: Designated psychiatric facilities are responsible for the care, treatment and reintegration of State patients. The necessary long-term care places a considerable strain on health-care resources. Resource use should be optimised while managing the risks that patients pose to themselves and the community. Identifying unique factors associated with earlier discharge may decrease the length of stay. Factors associated with protracted inpatient care without discharge could identify patients who require early and urgent intervention.Aim: We identify socio-economic, demographic, psychiatric and charge-related factors associated with the discharge of male State patients.Methods: We reviewed the files of discharged and admitted forensic State patients at Weskoppies Psychiatric Hospital. Data were captured in an electronic recording sheet. The association between factors and the outcome measure (discharged vs. admitted) was determined using chi-squared tests and Fischer’s exact tests.Results: Discharged State patients were associated with being a primary caregiver (p = 0.031) having good insight into illness (p = 0.025) or offence (p = 0.005) and having had multiple successful leaves of absences. A lack of substance abuse during admission (p = 0.027), an absence of a diagnosis of substance use disorder (p = 0.013) and the absence of verbal and physical aggression (p = 0.002 and p = 0.016) were associated with being discharged. Prolonged total length of stay (9–12 years, p = 0.031) and prolonged length of stay in open wards (6–9 years, p = 0.000) were associated with being discharged. A history of previous offences (p = 0.022), a diagnosis of substance use disorder (p = 0.023), recent substance abuse (p = 0.018) and a history of physical aggression since admission (p = 0.017) were associated with continued admission.Conclusion: Discharge of State patients is associated with an absence of substance abuse, lack of aggression, multiple successful leave of absences and length of stay in hospital.

scholarly journals Therapeutic Interventions are Important Risk Factors for Delirium in the ICU Setting ： A Multicenter Observational Study

2021 ◽  
Author(s):  
Ying Liu ◽  
Zhiyong Yuan ◽  
Shixia Cai ◽  
Xiaoning Han ◽  
Kai Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Observational Study ◽  
Univariate Analysis ◽  
Therapeutic Interventions ◽  
Physical Restraints ◽  
Icu Patients ◽  
Icu Stay ◽  
Increased Risk

Abstract Background Delirium is an important independent predictor of negative clinical outcomes in intensive care unit (ICU) patients. The purpose of this study was to investigate the territorial incidence of ICU delirium, its related risk factors, and short-term outcomes in Shandong Province, China, to provide precise information for territorial patient management. Methods A multicenter prospective observational study was conducted. Patients with delirium were defined as any patient with at least one positive CAM-ICU or ICDSC assessment. Demographics, admission clinical data, daily interventions provided to patients and environmental factors were collected. Results From May 1, 2018 to Jan 31, 2020, 536 noncomatose patients were ultimately eligible for the study. One hundred eighteen patients (22%) experienced delirium at least once. In the univariate analysis, age (p = 0.009), SOFA score (p = 0.006), a history of cerebrovascular disease (p = 0.044) and impaired renal function (p = 0.003) were risk factors for delirium. Most therapeutic interventions were linked to delirium in the univariate analysis, including enteral nutrition (p = 0.000), artificial airway (p = 0.021), nasogastric tube (p = 0.001), use of restraint straps (p = 0.000), and use of sedative medications, including midazolam (p = 0.003), propofol (p = 0.032) and butorphanol (p = 0.028). Among the patient’s vital signs and laboratory examinations performed on the day of assessment, body temperature, BUN levels and CRP levels were risk factors for delirium. Midazolam use, chronic renal insufficiency, physical restraints, nosogastric tube, enteral nutrition, and CRP and BUN levels were factors associated with an increased risk of delirium in the multivariate analysis. The durations of mechanical ventilation and ICU stay in patients with delirium was significantly higher than those in patients without delirium [8 (IQR: 4–14) vs 5 (IQR: 3–10) and 9 (IQR: 4–17) vs 6 (IQR: 4–12), p < 0.05]. Conclusions Delirium was associated with prolonged mechanical ventilation and a prolonged ICU stay. Based on the findings from this study, we should not only reduce the use of sedatives and analgesics but also minimize invasive operations, including the placement of nasogastric tubes, to recover eternal nutrition for ICU patients and avoid physical restraints as much as possible to prevent delirium. Trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR1900021360).

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