Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit

2021 ◽  
pp. 106002802110432
Author(s):  
Adrienne Darby ◽  
Kalynn Northam ◽  
C. Adrian Austin ◽  
Lydia Chang ◽  
Stacy Campbell-Bright
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Medical Intensive Care Unit ◽  
Severity Of Illness ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Poor Sleep ◽  
Medical Intensive Care ◽  
The Impact

Background: Evidence suggests that poor sleep increases risk of delirium. Because delirium is associated with poor outcomes, institutions have developed protocols to improve sleep in critically ill patients. Objective: To assess the impact of implementing a multicomponent sleep protocol. Methods: In this prospective, preimplementation and postimplementation evaluation, adult patients admitted to the medical intensive care unit (ICU) over 42 days were included. Outcomes evaluated included median delirium-free days, median Richards-Campbell Sleep Questionnaire (RCSQ) score, median optimal sleep nights, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and in-hospital mortality. Results: The preimplementation group included 78 patients and postimplementation group, 84 patients. There was no difference in median delirium-free days (1 day [interquartile range, IQR, = 0-2.5] vs 1 day [IQR = 0-2]; P = 0.48), median RCSQ score (59.4 [IQR = 43.2-71.6] vs 61.2 [IQR = 49.9-75.5]; P = 0.20), median optimal sleep nights (1 night [IQR = 0-2] vs 1 night [IQR = 0-2]; P = 0.95), and in-hospital mortality (16.7% vs 17.9%, P = 1.00). Duration of MV (8 days [IQR = 4-10] vs 4 days [IQR = 2-7]; P = 0.03) and hospital LOS (13 days [IQR = 7-22.3] vs 8 days [IQR = 6-17]; P = 0.05) were shorter in the postimplementation group, but both were similar between groups after adjusting for age and severity of illness. Conclusions and Relevance: This report demonstrates that implementation of a multicomponent sleep protocol in everyday ICU care is feasible, but limitations exist when evaluating impact on measurable outcomes. Additional evaluations are needed to identify the most meaningful interventions and best practices for quantifying impact on patient outcomes.

Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 33 (7) ◽  
pp. 383-393 ◽  
Author(s):  
Jing Chen ◽  
Dalong Sun ◽  
Weiming Yang ◽  
Mingli Liu ◽  
Shufan Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

Characteristics and Outcomes of Patients Discharged Directly Home From a Medical Intensive Care Unit: A Retrospective Cohort Study

2020 ◽  
pp. 088506662096063
Author(s):  
Preeyal M. Patel ◽  
Michele A. Fiorella ◽  
Ann Zheng ◽  
Lauren McDonnell ◽  
Mina Yasuoka ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Wait Time ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Urban University ◽  
Medical Intensive Care ◽  
Transfer Order

Objective: To evaluate the safety of directly discharging patients home from the medical intensive care unit (MICU). Materials and Methods: Single-center retrospective observational study of consecutive MICU direct discharges to home from an urban university hospital between June, 1, 2017, and June 30, 2019. Results: Of 1061 MICU discharges, 331 (31.2%) patients were eligible for analysis. Patients were divided into 2 groups based on duration of wait-time (< or ≥24 hours) between ward transfer order and ultimate hospital discharge. Most patients (68.2%) were discharged in <24 hours. Patients who waited for a floor bed for ≥24 hours prior to discharge had longer hospital length-of-stay (LOS, median 3.83 versus 2.00 days) and ICU LOS (median 3.51 versus 1.74 days). Overall, 44 (13.3%) direct MICU discharges were readmitted to the hospital within 30-days, but there was no difference in this outcome or in 30-day mortality when comparing the 2 wait-time groups. Conclusions: The practice of directly discharging MICU patients home does not negatively influence patient outcomes. Patients who overstay in the ICU after being deemed transfer-ready are unlikely to be benefiting from critical care, but impact hospital throughput and resource utilization. Prospective investigation into this practice may provide further confirmation of its feasibility and safety.

scholarly journals Blind Spots in Methods Based on Cultivation and Metagenomic Sequencing for Surface Microbiomes in a Medical Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s141-s142
Author(s):  
Jiaxian Shen ◽  
Alexander McFarland ◽  
Ryan Blaustein ◽  
Mary Hayden ◽  
Vincent Young ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Medical Intensive Care Unit ◽  
Metagenomic Sequencing ◽  
Whole Cell ◽  
Medical Intensive Care ◽  
The Impact ◽  
Blind Spots

Background: Cultivation of targeted pathogens has been long recognized as a gold standard for healthcare surveillance. However, there is an emergent need to characterize all viable microorganisms in healthcare facilities to understand the role that both clinical and nonclinical microorganisms play in healthcare-associated infections. Metagenomic sequencing allows detection of entire microbial communities, in contrast to targeted identification by cultivation. Widespread application of metagenomic sequencing has been impeded in part because the sensitivity and specificity are unknown, which inhibits our ability to interpret results for risk assessment. To assess the impact of sample preparation methods on sensitivity and specificity, we compared several pretreatment steps followed by metagenomic sequencing, and we performed culture-based analyses. Methods: We collected 120 surface swabs from the medical intensive care unit at Rush University Medical Center, which we aggregated to create a representative microbiome sample. We then subjected aliquots to different processing methods (DNA extraction methods, internal standard addition, propidium monoazide (PMA) treatment, and whole-cell serial filtration). We evaluated the effects of these methods based on DNA yields and metagenomic sequencing outcomes. We also compared the metagenomic results to the microbial identifications obtained by cultivation using environmental microbiology methods and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results: Our results demonstrate that bead-beating and heat lysis followed by liquid-liquid extraction is the optimal method for the identification of low-biomass surface-associated microbes, as opposed to widely used column-based and magnetic bead-based methods. For low-biomass surface-associated samples, ~590,000 reads per sample are sufficient for ≍90% coverage in metagenomic sequencing (Fig. 1). The ZymoBIOMICS microbial community standard is not appropriate for methods assessing membrane integrity. For the identification of putatively viable microorganisms, PMA treatment is promising, although elimination of signals from nonviable organisms will reduce the overall detectable signal. Combining PMA-treated metagenomic sequencing with cultivation yields the most comprehensive results, particularly for low-abundance taxa, despite high sequencing coverage (Fig. 2). To distribute more detection resources to bacteria, our target domain, we tried whole-cell filtration prior to extraction, attempting to isolate bacterial cells from eukaryotic cells and other particles. For low-biomass surface-associated samples, the sample loss and the difficulties in performing filtration outweigh the slight increase of bacterial signal. Conclusions: Despite optimization, we observed certain blind spots in both cultivation and metagenomic sequencing. This information is essential for informed risk assessment. Further research is needed to identify additional limitations to ensure that results from metagenomic sequencing can be interpreted in the context of healthcare-acquired infection prevention.Funding: This work was supported by the Centers for Disease Control and Prevention (BAA FY2018-OADS-01 Contract 02915).Disclosures: None

scholarly journals Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wanjak Pongsittisak ◽  
Kashane Phonsawang ◽  
Solos Jaturapisanukul ◽  
Surazee Prommool ◽  
Sathit Kurathong
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Medical Intensive Care Unit ◽  
Kidney Injury ◽  
The Elderly ◽  
University Hospital ◽  
Medical Intensive Care

Background. Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods. This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results. The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion. Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

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