scholarly journals Intensive care unit admission protocol controlled by intensivists can reduce transfer delays from the emergency department in critically ill patients

2018 ◽  
Vol 26 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Ji Eun Kim ◽  
Seul Lee ◽  
Jinwoo Jeong ◽  
Dong Hyun Lee ◽  
Jin-Heon Jeong
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Before And After

Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher in-hospital mortality and increased hospital length of stay. Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients. Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention. Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3–1665.3) min to 392.0 (279.3–686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0–11.8) days to 5.0 (3.0–10.0) days (p = 0.015). Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

scholarly journals Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255005
Author(s):  
Anwar Hassan ◽  
William Lai ◽  
Jennifer Alison ◽  
Stephen Huang ◽  
Maree Milross
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Gas Exchange ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Pulmonary Atelectasis ◽  
Respiratory Outcomes

Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respiratory failure leading to ventilatory support are a common occurrence in critically ill patients. Intrapulmonary percussive ventilation (IPV) is used to improve gas exchange and promote airway clearance in these patients. The current evidence regarding the effectiveness of intrapulmonary percussive ventilation in critical care settings remains unclear. This systematic review aims to summarise the evidence of the effectiveness of intrapulmonary percussive ventilation on intensive care unit length of stay (ICU-LOS) and respiratory outcomes in critically ill patients. Research question In critically ill patients, is intrapulmonary percussive ventilation effective in improving respiratory outcomes and reducing intensive care unit length of stay. Methods A systematic search of intrapulmonary percussive ventilation in intensive care unit (ICU) was performed on five databases from 1979 to 2021. Studies were considered for inclusion if they evaluated the effectiveness of IPV in patients aged ≥16 years receiving invasive or non-invasive ventilation or breathing spontaneously in critical care or high dependency units. Study titles and abstracts were screened, followed by data extraction by a full-text review. Due to a small number of studies and observed heterogeneities in the study methodology and patient population, a meta-analysis could not be included in this review. Outcomes of interest were summarised narratively. Results Out of 306 identified abstracts, seven studies (630 patients) met the eligibility criteria. Results of the included studies provide weak evidence to support the effectiveness of intrapulmonary percussive ventilation in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate. Interpretation Based on the findings of this review, the evidence to support the role of IPV in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate is weak. The therapeutic value of IPV in airway clearance, preventing pneumonia, and treating pulmonary atelectasis requires further investigation.

scholarly journals Factors contributing to delay intensive care unit admission of critically ill patients from the adult emergency Department in Tikur Anbessa Specialized Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Helen Teklie ◽  
Hywet Engida ◽  
Birhanu Melaku ◽  
Abdata Workina
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Transfer Time ◽  
Multivariate Logistic Regression ◽  
Icu Admission ◽  
Specialized Hospital

Abstract Background The transfer time for critically ill patients from the emergency department (ED) to the Intensive care unit (ICU) must be minimal; however, some factors prolong the transfer time, which may delay intensive care treatment and adversely affect the patient’s outcome. Purpose To identify factors affecting intensive care unit admission of critically ill patients from the emergency department. Patients and methods A cross-sectional study design was conducted from January 13 to April 12, 2020, at the emergency department of Tikur Anbesa Specialized Hospital. All critically ill patients who need intensive care unit admission during the study period were included in the study. A pretested structured questionnaire was adapted from similar studies. The data were collected by chart review and observation. Then checked data were entered into Epi-data version 4.1 and cleaned data was exported to SPSS Version 25 for analysis. Descriptive statistics, bivariate and multivariate logistic regression were used to analyze the data. Result From the total of 102 critically ill patients who need ICU admission 84.3% of them had prolonged lengths of ED stay. The median length of ED stay was 13.5 h with an IQR of 7–25.5 h. The most common reasons for delayed ICU admission were shortage of ICU beds 56 (65.1%) and delays in radiological examination results 13(15.1%). On multivariate logistic regression p < 0.05 male gender (AOR = 0.175, 95% CI: (0.044, 0.693)) and shortage of ICU bed (AOR = 0.022, 95% CI: (0.002, 0.201)) were found to have a significant association with delayed intensive care unit admission. Conclusion there was a delay in ICU admission of critically ill patients from the ED. Shortage of ICU bed and delay in radiological investigation results were the reasons for the prolonged ED stay.

The Impact of Continuous Infusion Compared to Intravenous Bolus Administration of Pantoprazole on Length of Intensive Care Unit Stay in Critically Ill Patients

2021 ◽  
pp. 089719002110360
Author(s):  
Katelynn Callaway ◽  
Mrinmayee Lakkad ◽  
Jacob T Painter ◽  
Lindsey Dayer ◽  
Allison K Oswalt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Continuous Infusion ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intravenous Bolus ◽  
Gi Bleeding ◽  
Icu Length Of Stay

Purpose: To determine if intravenous (IV) bolus pantoprazole increases intensive care unit (ICU) length of stay compared to IV infusion pantoprazole for treatment of gastrointestinal (GI) bleeding in critically ill patients. Methods: This retrospective cohort study included adult patients admitted to the ICU with GI bleeds. Patients treated with IV pantoprazole from January 1, 2017 to December 31, 2017 were analyzed in the continuous infusion group, and patients treated from March 1, 2018 to February 28, 2019 were analyzed in the bolus only group. Patients with pregnancy, variceal bleeds, or lower GI bleeds were excluded. Intensive care unit length of stay was compared between the two cohorts using the Mann Whitney U test. Adjusted analysis was conducted using the generalized linear model with gamma log link to estimate the effect of type of infusion on ICU length of stay. Results: A total of 145 patients were included in the analysis, with 72 patients in the continuous infusion group and 73 patients in the bolus only group. The median ICU length of stay was 70.5 hours for continuous infusion and 64 hours for bolus only pantoprazole ( P-value = .577). In the adjusted analysis, there was no difference in ICU length of stay between the continuous infusion and bolus only groups (RR, 1.06; 95% CI, .76–1.47). Conclusion: Intensive care unit length of stay was not prolonged with the use of IV bolus only compared to continuous infusion pantoprazole. Intravenous bolus only pantoprazole may be used in critically ill patients for treatment of upper GI bleeding.

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