Survival, Outcomes, and Use of Acuity Scoring Systems Following Tracheotomy in Veteran Patients

Objectives: To determine whether established prognosis tools used in the general population of critically ill patients will accurately predict tracheotomy-related outcomes and survival outcomes in critically ill patients undergoing tracheotomy. Methods: Retrospective chart review of 94 consecutive critically ill patients undergoing isolated tracheotomy. Results: Logistic Organ Dysfunction System (LODS) and sepsis-related organ failure assessment (SOFA) scores, 2 validated measures of acuity in critically ill patients, were calculated for all patients. The only tracheotomy-related outcome of significance was the finding that patients with an LODS score ≤6 were more likely to become ventilator independent ( P < .015). Higher LODS or SOFA scores were associated with in-house death (LODS, P = .001, SOFA, P = .008) and death within 90 days (LODS, P = .009, SOFA, P = .031), while death within 180 days was associated only with a higher LODS score (LODS, P = .018). When controlling for age, there was an association between both LODS ( P = .015) and SOFA ( P = .019) scores and death within 90 days of tracheotomy. Conclusions: The survival outcome for critically ill patients undergoing tracheotomy seems accurately predicted based on scoring systems designed for use in the general population of critically ill patients. Logistic Organ Dysfunction System may also be useful to predict the likelihood of the tracheotomy-related outcome of ventilator independence. This suggests that LODS scores may be helpful to palliative care clinicians as part of a shared decision-making aid in critically ill, ventilated patients for whom tracheotomy is being considered.

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Calibration and discrimination by daily Logistic Organ Dysfunction scoring comparatively with daily Sequential Organ Failure Assessment scoring for predicting hospital mortality in critically ill patients*

Critical Care Medicine ◽

10.1097/00003246-200209000-00009 ◽

2002 ◽

Vol 30 (9) ◽

pp. 2003-2013 ◽

Cited By ~ 79

Author(s):

Jean-François Timsit ◽

Jean-Philippe Fosse ◽

Gilles Troché ◽

Arnaud de Lassence ◽

Corinne Alberti ◽

...

Keyword(s):

Hospital Mortality ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Logistic Organ Dysfunction ◽

Failure Assessment

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Intensive Care Unit Scoring Systems

Critical Care Nurse ◽

10.4037/ccn2021613 ◽

2021 ◽

Vol 41 (4) ◽

pp. 54-64

Author(s):

Tiffany Purcell Pellathy ◽

Michael R. Pinsky ◽

Marilyn Hravnak

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Scoring Systems ◽

Multiple Organ Dysfunction Score ◽

Severity Scoring ◽

Logistic Organ Dysfunction

Background Illness severity scoring systems are commonly used in critical care. When applied to the populations for whom they were developed and validated, these tools can facilitate mortality prediction and risk stratification, optimize resource use, and improve patient outcomes. Objective To describe the characteristics and applications of the scoring systems most frequently applied to critically ill patients. Methods A literature search was performed using MEDLINE to identify original articles on intensive care unit scoring systems published in the English language from 1980 to 2020. Search terms associated with critical care scoring systems were used alone or in combination to find relevant publications. Results Two types of scoring systems are most frequently applied to critically ill patients: those that predict risk of in-hospital mortality at the time of intensive care unit admission (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score, and Mortality Probability Models) and those that assess and characterize current degree of organ dysfunction (Multiple Organ Dysfunction Score, Sequential Organ Failure Assessment, and Logistic Organ Dysfunction System). This article details these systems’ differing features and timing of use, score calculation, patient populations, and comparative performance data. Conclusion Critical care nurses must be aware of the strengths, limitations, and specific characteristics of severity scoring systems commonly used in intensive care unit patients to effectively employ these tools in clinical practice and critically appraise research findings based on their use.

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Serial evaluation of the Multiple Organ Dysfunction Score, Sequential Organ Failure Assessment and Logistic Organ Dysfunction scores to predict ICU mortality in mixed critically ill patients

Critical Care ◽

10.1186/cc6756 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P535

Author(s):

B Khwannimit

Keyword(s):

Sequential Organ Failure Assessment ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Icu Mortality ◽

Multiple Organ Dysfunction Score ◽

Logistic Organ Dysfunction ◽

Failure Assessment ◽

Serial Evaluation

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Evaluation of the logistic organ dysfunction system for the assessment of organ dysfunction and mortality in critically ill patients

Intensive Care Medicine ◽

10.1007/s001340100888 ◽

2001 ◽

Vol 27 (6) ◽

pp. 992-998 ◽

Cited By ~ 26

Author(s):

P.G.H. Metnitz ◽

J.-R. Le Gall ◽

H. Steltzer ◽

C.-G. Krenn ◽

T. Lang ◽

...

Keyword(s):

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Logistic Organ Dysfunction

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970: EVALUATION OF THE USE OF MODAFINIL IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE CHART REVIEW

Critical Care Medicine ◽

10.1097/01.ccm.0000810204.67709.5d ◽

2021 ◽

Vol 50 (1) ◽

pp. 482-482

Author(s):

Lindsey Branstetter ◽

Jolie Gallagher ◽

Kayla Nichols ◽

Subir Goyal ◽

Ayesha Mukhtar

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Chart Review ◽

Retrospective Chart Review

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Principles of care of critically ill patients

Current Surgical Guidelines ◽

10.1093/med/9780198794769.003.0016 ◽

2018 ◽

pp. 143-150

Author(s):

Abdullah Jibawi ◽

Mohamed Baguneid ◽

Arnab Bhowmick

Keyword(s):

High Risk ◽

Brain Stem ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Blood Gases ◽

Scoring Systems ◽

Perioperative Period ◽

Circulatory Shock ◽

Risk Patients

Surgeons should be competent in identifying and treating high-risk patients in the perioperative period, including ability to identify, assess, and initiate treatment for organ dysfunction and circulatory shock, obtain and interpret blood gases, use blood products and fluid composites, support nutrition, treat sepsis, and identify and diagnose brain stem death. The chapter tackles main issues in the diagnosis and treatment of such patients, defines criteria and scoring systems in use for critically ill patients, and summarize treatment principles and approaches recommendations.

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Documentation of Crucial Information Relating to Critically Ill Patients

Journal of Palliative Care ◽

10.1177/0825859717746273 ◽

2017 ◽

Vol 33 (1) ◽

pp. 5-8 ◽

Cited By ~ 1

Author(s):

Alexandria Bear ◽

Elizabeth Thiel

Keyword(s):

Decision Making ◽

Palliative Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Medical Decision ◽

Care Providers ◽

Significant Difference ◽

Review Study

Background: Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. Objective: This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation. Results: Three hundred two electronic medical records were reviewed. There was a significant difference in documentation between palliative care and primary teams for prognosis (83% vs 32%, P < .001), care options (82% vs 50%, P < .001), and care plan (82% vs 46%, P < .001). Conclusions: Our retrospective chart review study demonstrated a significant difference in documentation between primary and palliative care teams. We acknowledge that review of documentation cannot be extrapolated to the presence or absence of conversations between providers and patients and/or surrogates. Additional studies to evaluate this connection would be advantageous.

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Impact of an Extended Infusion Β-lactam Strategy on Outcomes in Critically Ill Patients with Pseudomonas Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.689 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S299-S299

Author(s):

Kenneth Klinker ◽

Veena Venugopalan ◽

Andrea Carnley ◽

Stacy Voils ◽

Jessica Cope ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Cure ◽

Chart Review ◽

Additional Data ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Drug Concentrations ◽

Secondary Endpoints ◽

Extended Infusion

Abstract Background Pseudomonas aeruginosa (PSA) is frequently associated with nosocomial infections resulting in significant morbidity and mortality. High MICs in MDR strains highlights the need to maximize antibiotic exposure with the goal of improving patient outcomes. For β-lactams, optimal efficacy is achieved when free drug concentrations are above the MIC for ~ 40–60% of the dosing interval. Unfortunately, due to significant pharmacokinetic variability in the critically ill, achieving this target with standard intermittent infusions (II) is challenging, resulting in preference for extended (EI) or continuous infusion strategies. Additional data in patients with PSA infections are needed to understand the association between infusion strategy and clinical outcome. Methods A single-center, retrospective chart review. Adult patients with positive respiratory or blood cultures for PSA treated with cefepime or piperacillin/tazobactam managed in an ICU from January 2012 to May 2016 were included. Primary endpoint was clinical cure (CC) at end of therapy (EOT) between patients receiving EI or II. Secondary endpoints included microbiologic eradication (ME), 28-day mortality, length of ICU and hospital stay, and effect of baseline kidney function on clinical cure. Results Eighty-three patients were included in the analysis. Patient characteristics were well matched except for a higher frequency of malignancy in the EI arm (P = 0.02). CC was achieved in an overwhelming majority of EI patients compared with II (89.2% vs. 69.6%, P = 0.031). Further, patients with normal renal function (CrCL ≥ 60; P = 0.02) or APACHE II ≥ 17 (P = 0.04) receiving II experienced higher failure rates. In multivariate analysis, use of II associated with 4-fold higher incidence of clinical failure (OR 4.5 [1.3–16.3]). For other secondary endpoints, ME was observed in 73% of EI vs. 65% of II (P = 0.44) and 28-day mortality was observed in 13% of patients in both arms (P = 0.94). No significant differences were observed with other secondary variables. Conclusion Use of an EI strategy in critically ill patients with PSA infections improves CC. Further, EI benefitted those patients with normal to augmented renal clearance suggesting that improved exposure may play a role in clinical outcomes. Disclosures K. Klinker, The Medicines Company: Scientific Advisor, Consulting fee.

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