Transesophageal Echocardiography Performed by Intensivist and Emergency Physicians—A 5-Year, Single-Center Experience

Purpose: Data on the use of transesophageal echocardiography (TEE) by intensivist physicians (IP) and emergency physicians (EP) are limited. This study aims to characterize the use of TEE by IPs and EPs in critically ill patients at a single center in the United States. Materials and Methods: Retrospective chart review of all critical care TEEs performed from January 1, 2016 to January 31, 2021. The personnel performing the exams, location of the exams, characteristics of exams, complications, and outcome of the patients were reviewed. Results: A total of 396 examinations was reviewed. TEE was performed by IPs (92%) and EPs (9%). The location of TEE included: intensive care unit (87%), emergency department (11%), and prehospital (2%) settings. The most common indications for TEE were: hemodynamic instability/shock (44%), cardiac arrest (23%), and extracorporeal membrane oxygenation (ECMO) facilitation, adjustment, or weaning (21%). The most common diagnosis based on TEE were: normal TEE (25%), left ventricular dysfunction (19%), and vasodilatory shock (15%). A management change resulted from 89% of exams performed. Complications occurred in 2% of critical care TEEs. Conclusion: TEE can be successfully performed by IPs and EPs on critically ill patients in multiple clinical settings. TEE frequently informed management changes with few complications.

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Feasibility of cardiac output measurements in critically ill patients by medical students

The Ultrasound Journal ◽

10.1186/s13089-020-0152-5 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Geert Koster ◽

Thomas Kaufmann ◽

Bart Hiemstra ◽

Renske Wiersema ◽

Madelon E. Vos ◽

...

Keyword(s):

Cardiac Output ◽

Critical Care ◽

Medical Students ◽

Critically Ill ◽

Critically Ill Patients ◽

Left Ventricular ◽

Percentage Error ◽

Poor Agreement ◽

Cardiac Output Measurements

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

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Tracheostomy

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0117 ◽

2019 ◽

pp. 850-854

Author(s):

Saba Ghorab ◽

David G. Lott

Keyword(s):

United States ◽

Mechanical Ventilation ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

The United States ◽

Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

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Safety of Transesophageal Echocardiography Performed by Intensivists and Emergency Physicians in Critically Ill Patients With Coagulopathy and Thrombocytopenia: A Single-Center Experience

Journal of Intensive Care Medicine ◽

10.1177/0885066619887693 ◽

2019 ◽

Vol 36 (1) ◽

pp. 123-130

Author(s):

Trenton C. Wray ◽

Kristin Schmid ◽

Darren Braude ◽

Keith Azevedo ◽

Todd Dettmer ◽

...

Keyword(s):

High Risk ◽

Transesophageal Echocardiography ◽

Critically Ill ◽

Critically Ill Patients ◽

Risk Group ◽

Group Versus ◽

High Risk Group ◽

Emergency Physicians ◽

Artificial Airway ◽

Esophageal Bleeding

Introduction: The use of transesophageal echocardiography (TEE) by intensivist physicians (IPs) and emergency physicians (EPs) in critically ill patients is increasing in the intensive care unit, emergency department, and prehospital environments. Coagulopathy and thrombocytopenia are common in critically ill patients. The risk of performing TEE in these patients is unknown. The goal of this study was to assess whether TEE is safe when performed by IPs or EPs in critically ill patients with high bleeding risk (HBR). Methods: All TEEs performed by an IP or EP between January 1, 2016, and July 31, 2019, were reviewed as part of a quality assurance database. A TEE performed on a patient was deemed HBR if the patient met at least one of the following criteria: undergoing therapeutic anticoagulation, had an INR > 2, activated partial thromboplastin time >40 seconds, fibrinogen <150 mg/dL, and/or platelet count <50 000/μL. The medical record was reviewed on each patient to determine whether upper esophageal bleeding, oropharyngeal bleeding, esophageal perforation, or dislodgement of an artificial airway occurred during or after the TEE. Results: A total of 228 examinations were reviewed: 80 in the high-risk group and 148 in the low-risk group (LBR). There were complications potentially attributable to TEE in 8 (4%) of the 228 exams. Total complications were not different between groups: 4 (5%) in the HBR group versus 4 (3%) in the LBR group (odds ratio [OR] = 1.89 [0.34-10.44], P =.368). Upper esophageal bleeding occurred in 5 total examinations (2%), which was not different between groups: 3 (4%) in the HBR group and 2 (1%) in the LBR group (OR = 2.84 [0.31-34.55], P = .238). There were no deaths attributable to TEE in either group. Conclusion: Transesophageal echocardiography can be safely performed by IPs and EPs in critically ill patients at high risk of bleeding with minimal complications.

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Why MICAS?

Irish Journal of Paramedicine ◽

10.32378/ijp.v3i2.131 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

David Menzies ◽

Anna Marie Murphy

Keyword(s):

Critical Care ◽

Adverse Events ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Chart Review ◽

Hub And Spoke ◽

Local Staff ◽

Care Services ◽

Hospital Transport ◽

Clinical Records

IntroductionThe Mobile Intensive Care Ambulance Service (MICAS) was initiated in 1996 to assess, stabilise and transfer critically ill patients from a referring hospital to a receiving hospital to meet their clinical needs. Critically ill patients are transferred throughout Ireland to an increased level of care, repatriation for continuity of care following specialist treatment, specialist critical care services or in some instances, are considered too unstable to be transported by local staff. In 2015, it was estimated that approximately 1000 ICU patients are transported per annum (Murphy, Dwyer). These numbers are likely to increase as a result of the reorganisation of health services, the development of hospital groups, the establishment of the hub and spoke critical care services and introduction of trauma centres. This increases the requirement of inter hospital transfers throughout the country.AimsThe aim of this audit was to establish the rationale for a critical care retrieval service and to evaluate the adverse events for inter hospital transport of critically ill patients in Ireland over a 3 year periodMethodsA retrospective chart review of all patients transported by MICAS between January 2015 and December 2017 was undertaken. Clinical records were reviewed for acuity and for adverse events. Results339 patients were transported in this timeframe with 7% experiencing an adverse event overall.ConclusionThe MICAS data shows an increasing number of critically ill patients transferred by MICAS within the timeframe. The rationale for MICAS includes the provision by a specialist team with transport specific equipment with reduced adverse events.

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SINGLE CENTER CRITICAL CARE EXPERIENCE WITH A FOCUS ON VENTILATOR SETTINGS IN 32 CRITICALLY ILL PATIENTS WITH COVID-19

CHEST Journal ◽

10.1016/j.chest.2020.09.219 ◽

2020 ◽

Vol 158 (4) ◽

pp. A2633

Author(s):

Jyotirmayee Lenka ◽

Mamta Chhabria ◽

Naman Sharma ◽

Bryan E-Xin Tan ◽

Leela Krishna Teja Boppana ◽

...

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Single Center ◽

Care Experience ◽

Ventilator Settings

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Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

Current Diabetes Reviews ◽

10.2174/1573399814666180119142254 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-140 ◽

Cited By ~ 1

Author(s):

Ghada El Khoury ◽

Hanine Mansour ◽

Wissam K. Kabbara ◽

Nibal Chamoun ◽

Nadim Atallah ◽

...

Keyword(s):

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Center ◽

Descriptive Analysis ◽

Tertiary Care ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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Operation of a hyperbaric oxygen therapy center in Korea: Report of our experience from a setting in its nascent stages

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2019.6 ◽

2019 ◽

pp. 135-143

Author(s):

Yoon Seop Kim ◽

Yoonsuk Lee ◽

Sun Ju Kim ◽

Sung Oh Hwang ◽

Yong Sung Cha ◽

...

Keyword(s):

Critically Ill ◽

Hyperbaric Oxygen ◽

Critically Ill Patients ◽

Demographic Data ◽

Developed Countries ◽

The United States ◽

Medical Society ◽

Hyperbaric Medicine ◽

Therapy Center ◽

Hbo2 Therapy

Purpose: Hyperbaric medicine is nascent in Korea when compared to other developed countries, such as the United States and Japan. Our facility has been managed by physicians with certifications from the Undersea and Hyperbaric Medical Society (UHMS) and National Oceanic and Atmospheric Administration in diving and clinical diseases since October 2016. This study was conducted to share similar issues that are encountered during the establishment of a program in a new area through our experiences in the operation of a hyperbaric oxygen (HBO2) therapy center. Methods: In this retrospective observational study we collected data on HBO2 patients treated at our center between October 2016 and June 2018 after HBO2 was conducted by HBO2-certified physicians. We then compared demographic data of patients with data from January 2011 to September 2015 – before HBO2 operations were conducted by HBO2-certified physicians. Result: A total of 692 patients received 5,130 treatments. Twelve indicated diseases were treated using HBO2 therapy. Fifty-six critically ill patients with intubation received HBO2. Although two patients experienced seizure due to oxygen toxicity during the study period, certified physicians and inside attendant took immediate corrective action. Conclusion: After the establishment of the HBO2 center operated by physicians with certification, more patients, including critically ill patients, received HBO2 safely for various diseases. In order to improve the practice of hyperbaric medicine in Korea, the Korean Academy of Undersea and Hyperbaric Medicine (KAUHM), an advanced and well-organized academic society, should communicate often with HBO2 centers, with the aim to set Korean education programs at UHMS course levels and increase reimbursement for HBO2 therapy.

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Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

Intensive Care Medicine Experimental ◽

10.1186/s40635-019-0280-z ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

M. Ostermann ◽

A. Schneider ◽

T. Rimmele ◽

I. Bobek ◽

M. van Dam ◽

...

Keyword(s):

Blood Pressure ◽

Critical Care ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Future Research ◽

Knowledge Gaps ◽

Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

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The Efficacy of Convalescent Plasma Use in Critically Ill COVID-19 Patients

Medicina ◽

10.3390/medicina57030257 ◽

2021 ◽

Vol 57 (3) ◽

pp. 257

Author(s):

Livius Tirnea ◽

Felix Bratosin ◽

Iulia Vidican ◽

Bianca Cerbu ◽

Mirela Turaiche ◽

...

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Therapeutic Option ◽

White Blood Cells ◽

The United States ◽

Plasma Therapy ◽

Reactive Protein ◽

United States Food ◽

States Food

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.

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ABO blood types and sepsis mortality

Annals of Intensive Care ◽

10.1186/s13613-021-00844-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Theis S. Itenov ◽

Daniel I. Sessler ◽

Ashish K. Khanna ◽

Sisse R. Ostrowski ◽

Pär I. Johansson ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

The United States ◽

Endothelial Damage ◽

Blood Type ◽

Type B ◽

Blood Concentrations ◽

Soluble Thrombomodulin ◽

Blood Types

Abstract Background We aimed to determine if the ABO blood types carry different risks of 30-day mortality, acute kidney injury (AKI), and endothelial damage in critically ill patients with sepsis. This was a retrospective cohort study of three independent cohorts of critically ill patients from the United States and Scandinavia consisting of adults with septic shock. We compared the 30-day mortality across the blood types within each cohort and pooled the results in a meta-analysis. We also estimated the incidence of AKI and degree of endothelial damage, as measured by blood concentrations of soluble thrombomodulin and syndecan-1. Results We included 12,342 patients with severe sepsis. In a pooled analysis blood type B carried a slightly lower risk of 30-day all-cause mortality compared to non-blood type B (adjusted HR 0.88; 95%-CI 0.79–0.98; p = 0.02). There was no difference in the risk of AKI. Soluble thrombomodulin and syndecan-1 concentrations were lower in patients with blood type B and O compared to blood type A, suggesting less endothelial damage. Conclusion Septic patients with blood type B had less endothelial damage, and a small reduction in mortality. The exposure is, however, unmodifiable.

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