Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital

2021 ◽  
pp. 105477382110515
Author(s):  
Graziela Argenti ◽  
Gerson Ishikawa ◽  
Cristina Berger Fadel ◽  
Ricardo Zanetti Gomes
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Public Hospital ◽  
Icu Length Of Stay ◽  
Hospital Acquired

A retrospective cohort study of hospital-acquired pressure injuries (HAPI) reported an incidence rate of 34.3% based on 582 medical records of adult patients admitted to the intensive care unit (ICU) of a medium-complexity public hospital in 2017 and 2018. Sixty percent of the patients used respirators, 49.3% presented hypotension, and 48.1% used norepinephrine. The main individual predictors of HAPI in the ICU were “days of norepinephrine” with an odds ratio (OR) of 1.625 (95% CI: 1.473–1.792) and concordance statistic (AUC) of 0.818 (95% CI: 0.779–0.857), “days of mechanical ventilation” with an OR of 1.521 (1.416–1.634) and AUC of 0.879 (0.849–0.909), “ICU stay (days)” with an OR of 1.279 (1.218–1.342) and AUC of 0.846 (0.812–0.881), and “Braden’s sensory perception” with an OR of 0.345 (95% CI: 0.278–0.429) and AUC of 0.760 (0.722–0.799). The duration of mechanical ventilation, norepinephrine administration, and ICU length of stay presented significant discriminative capacity for HAPI prediction.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals Efficacy of tocilizumab in the intensive care unit patients with COVID-19: a retrospective cohort study

2020 ◽  
Vol 29 (4) ◽  
pp. 17-25
Author(s):  
S.V. Moiseev ◽  
S.N. Avdeev ◽  
E.A. Tao ◽  
M.Yu. Brovko ◽  
A.G. Yavorovsky ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort

To evaluate the efficacy of earlier and late tocilizumab (TCZ) infusion, that is, prior to and after initiation of mechanical ventilation, in reducing mortality in a cohort of patients with severe COVID-19 pneumonia who required support in the intensive care unit (ICU).

A Retrospective Comparison of the Effectiveness and Safety of Intravenous Olanzapine Versus Intravenous Haloperidol for Agitation in Adult Intensive Care Unit Patients

2021 ◽  
pp. 088506662098445
Author(s):  
Michelle Wang ◽  
Tuyen T. Yankama ◽  
George T. Abdallah ◽  
Ijeoma Julie Eche ◽  
Kristen N. Knoph ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Academic Medical Center ◽  
Icu Length Of Stay ◽  
Haloperidol Group

Objective: Intravenous (IV) olanzapine could be an alternative to first-generation antipsychotics for the management of agitation in intensive care unit (ICU) patients. We compared the effectiveness and safety of IV olanzapine to IV haloperidol for agitation management in adult patients in the ICU at a tertiary academic medical center. Methods: A retrospective cohort study was conducted. The primary outcome was the proportion of patients who achieved a Richmond Agitation Sedation Scale (RASS) score of < +1 within 4 hours of IV olanzapine or IV haloperidol administration. Secondary outcomes included the proportion of patients who required rescue medications for agitation within 4 hours of initial IV olanzapine or IV haloperidol administration, incidence of adverse events and ICU length of stay. Results: In the 192 patient analytic cohort, there was no difference in the proportion of patients who achieved a RASS score of < +1 within 4 hours of receiving IV olanzapine or IV haloperidol (49% vs. 42%, p = 0.31). Patients in the IV haloperidol group were more likely to receive rescue medications (28% vs 55%, p < 0.01). There was no difference in the incidence of respiratory events or hypotension between IV olanzapine and IV haloperidol. Patients in the IV olanzapine group experienced more bradycardia (11% vs. 3%, p = 0.04) and somnolence (9% vs. 1%, p = 0.02) compared to the IV haloperidol group. Patients in the IV olanzapine group had a longer median ICU length of stay (7.5 days vs. 5 days, p = 0.04). Conclusion: In this retrospective cohort study, there was no difference in the effectiveness of IV olanzapine compared to IV haloperidol for the management of agitation. IV olanzapine was associated with an increased incidence of bradycardia and somnolence.

Effects of Chlorhexidine Oral Decontamination on Respiratory Colonization during Mechanical Ventilation in Intensive Care Unit Patients

2012 ◽  
Vol 33 (5) ◽  
pp. 527-530
Author(s):  
Douwe F. Postma ◽  
Sanjay U. C. Sankatsing ◽  
Steven F. T. Thijsen ◽  
Henrik Endeman
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Differential Effect ◽  
Retrospective Cohort ◽  
Fungal Colonization ◽  
Before And After ◽  
Oral Decontamination

We conducted a retrospective cohort study to assess respiratory colonization before and after the use of chlorhexidine oral decontamination among a cohort of intensive care unit patients who received mechanical ventilation. We observed a decrease in the prevalence of Enterobacteriaceae and an increase in the incidence of fungal colonization. Chlorhexidine oral decontamination might have a differential effect on respiratory colonization.

scholarly journals The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

2022 ◽  
Vol 11 (2) ◽  
pp. 357
Author(s):  
Tokio Kinoshita ◽  
Yukihide Nishimura ◽  
Yasunori Umemoto ◽  
Yasuhisa Fujita ◽  
Ken Kouda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Small Sample ◽  
Icu Length Of Stay ◽  
The Mean ◽  
Mean Time

This retrospective cohort study aimed to examine the rehabilitation effect of patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU) under mechanical ventilation and included ICU patients from a university hospital who received rehabilitation under ventilator control until 31 May 2021. Seven patients were included, and three of them died; thus, the results of the four survivors were examined. The rehabilitation program comprised the extremity range-of-motion training and sitting on the bed’s edge. The Sequential Organ Failure Assessment score (median (25–75th percentiles)) at admission was 7.5 (5.75–8.5), and the activities of daily living (ADLs) were bedridden, the lowest in the Functional Independence Measure (FIM) and Barthel Index (BI) surveys. Data on the mean time to extubation, ICU length of stay, and ADLs improvement (FIM and BI) during ICU admission were obtained. Inferential analyses were not performed considering the small sample size. The mean time to extubation was 4.9 ± 1.1 days, and the ICU length of stay was 11.8 ± 5.0 days. ΔFIM was 36.5 (28.0–40.5), and the ΔBI was 22.5 (3.75–40.0). Moreover, no serious adverse events occurred in the patients during rehabilitation. Early mobilization of patients with COVID-19 may be useful in ADLs improvement during ICU stay.

scholarly journals Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study

2021 ◽  
Author(s):  
Kexin Huang ◽  
Tamryn F Gray ◽  
Santiago Romero-Brufau ◽  
James A Tulsky ◽  
Charlotta Lindvall
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Gradient Boosting ◽  
Short Term ◽  
Icu Length Of Stay

Abstract Objective Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods. Materials and Methods This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes. Results For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839). Discussion Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction. Conclusions Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians’ and nurses’ notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.

scholarly journals Using Machine Learning Algorithms to Predict Hospital Acquired Thrombocytopenia after Operation in the Intensive Care Unit: A Retrospective Cohort Study

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1614
Author(s):  
Yisong Cheng ◽  
Chaoyue Chen ◽  
Jie Yang ◽  
Hao Yang ◽  
Min Fu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Machine Learning Algorithms ◽  
Gradient Boosting ◽  
Test Set ◽  
Hospital Acquired

Hospital acquired thrombocytopenia (HAT) is a common hematological complication after surgery. This research aimed to develop and compare the performance of seven machine learning (ML) algorithms for predicting patients that are at risk of HAT after surgery. We conducted a retrospective cohort study which enrolled adult patients transferred to the intensive care unit (ICU) after surgery in West China Hospital of Sichuan University from January 2016 to December 2018. All subjects were randomly divided into a derivation set (70%) and test set (30%). ten-fold cross-validation was used to estimate the hyperparameters of ML algorithms during the training process in the derivation set. After ML models were developed, the sensitivity, specificity, area under the curve (AUC), and net benefit (decision analysis curve, DCA) were calculated to evaluate the performances of ML models in the test set. A total of 10,369 patients were included and in 1354 (13.1%) HAT occurred. The AUC of all seven ML models exceeded 0.7, the two highest were Gradient Boosting (GB) (0.834, 0.814–0.853, p < 0.001) and Random Forest (RF) (0.828, 0.807–0.848, p < 0.001). There was no difference between GB and RF (0.834 vs. 0.828, p = 0.293); however, these two were better than the remaining five models (p < 0.001). The DCA revealed that all ML models had high net benefits with a threshold probability approximately less than 0.6. In conclusion, we found that ML models constructed by multiple preoperative variables can predict HAT in patients transferred to ICU after surgery, which can improve risk stratification and guide management in clinical practice.

Impact of the Injectable Opioid Drug Shortage on Analgesia and Sedation Management in the Medical Intensive Care Unit: A Retrospective Cohort Study

2021 ◽  
pp. 001857872199980
Author(s):  
Kayla John ◽  
Kari Cape ◽  
Lauren Goodman ◽  
Jessica Elefritz
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Medical Intensive Care Unit ◽  
Drug Shortage ◽  
Icu Length Of Stay ◽  
Medical Intensive Care

Objectives: The purpose of this study was to assess the impact of the injectable opioid drug shortage on analgesia and sedation management in the medical intensive care unit (MICU). Methods: A single-center, retrospective cohort study was conducted of mechanically ventilated patients during the injectable opioid shortage. Outcomes were compared between a cohort of patients during the intravenous (IV) opioid shortage (01/01/18-03/31/18) and a control cohort (01/01/17-03/31/17). Total IV opioids and alternative sedative administration were assessed. Richmond Agitation Sedation Score (RASS) and Clinical Pain Observation Score (CPOT) assessments were also evaluated. The primary outcome was percentage of RASS within goal. Secondary outcomes included duration of mechanical ventilation, hospital/ICU length of stay, and mortality. Results: One hundred patients were included (50 patients per cohort). In the shortage cohort, 23.2% fewer IV opioids were used (40 501.8 vs 52 713.8 oral morphine equivalents [OME]). No statistical differences were found in percentage of patients within goal RASS between the shortage and control (median 63.7% vs 74.8%; P = .094) or CPOT (median 49.7% vs 47.7%; P = .575). More patients received enteral opioids and propofol on day 1 in the shortage cohort when compared to the control (22% vs 4%; P = .007 and 76% vs 56%; P = .035) but there were no differences in benzodiazepine, dexmedetomidine, or antipsychotic use. No differences in mechanical ventilation, hospital/ICU length of stay, or mortality were found. Conclusions: Use of less IV opioids during the injectable opioid shortage did not affect achievement of goal RASS and CPOT scores or increase prescribing of sedative medications such as benzodiazepines in the MICU.

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