Medication Changes and Diagnosis of New Chronic Illnesses in COVID-19 Intensive Care Unit Survivors

Background Currently, there is limited literature on the impact of the COVID-19 infection on medications and medical conditions in COVID-19 intensive care unit (ICU) survivors. Our study is, to our knowledge, the first multicenter study to describe the prevalence of new medical conditions and medication changes at hospital discharge in COVID-19 ICU survivors. Objective To determine the number of medical conditions and medications at hospital admission compared to at hospital discharge in COVID-19 ICU survivors. Methods Retrospective multicenter observational study (7 ICUs) evaluated new medical conditions and medication changes at hospital discharge in patients with COVID-19 infection admitted to an ICU between March 1, 2020, to March 1, 2021. Patient and hospital characteristics, baseline and hospital discharge medication and medical conditions, ICU and hospital length of stay, and Charlson comorbidity index were collected. Descriptive statistics were used to describe patient characteristics and number and type of medical conditions and medications. Paired t-test was used to compare number of medical conditions and medications from hospital discharge to admission. Results Of the 973 COVID-19 ICU survivors, 67.4% had at least one new medical condition and 88.2% had at least one medication change. Median number of medical conditions (increased from 3 to 4, P < .0001) and medications (increased from 5 to 8, P < .0001) increased from admission to discharge. Most common new medical conditions at discharge were pulmonary disorders, venous thromboembolism, psychiatric disorders, infection, and diabetes. Most common therapeutic categories associated with medication change were cardiology, gastroenterology, pain, hematology, and endocrinology. Conclusion and Relevance Our study found that the number of medical conditions and medications increased from hospital admission to discharge. Our results provide additional data to help guide providers on using targeted approaches to manage medications and diseases in COVID-19 ICU survivors after hospital discharge.

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Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Medicinski pregled ◽

10.2298/mpns2104112p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 112-116

Author(s):

Marina Pandurov ◽

Izabella Fabri-Galambos ◽

Andjela Opancina ◽

Anna Uram-Benka ◽

Goran Rakic ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infections ◽

Hospital Length Of Stay ◽

Surgical Intensive Care Unit ◽

Negative Consequences ◽

Surgical Intensive Care ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

The Impact

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

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

Annals of Pharmacotherapy ◽

10.1177/10600280211043278 ◽

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.

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The impact of delirium in the intensive care unit on hospital length of stay

Intensive Care Medicine ◽

10.1007/s00134-001-1132-2 ◽

2001 ◽

Vol 27 (12) ◽

pp. 1892-1900 ◽

Cited By ~ 619

Author(s):

E. Ely ◽

S. Gautam ◽

R. Margolin ◽

J. Francis ◽

L. May ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

The Impact

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

Journal of Intensive Care Medicine ◽

10.1177/0885066617726942 ◽

2017 ◽

Vol 33 (7) ◽

pp. 383-393 ◽

Cited By ~ 33

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.

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Clinical presentation of paediatric patients with COVID-19 admitted to a single paediatric intensive care unit (PICU) in Iran

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000715 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000715

Author(s):

Amir Saeed ◽

Eslam Shorafa ◽

Anahita Sanaeidashti ◽

Mohammad Rahim Kadivar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Paediatric Intensive Care Unit ◽

Clinical Presentation ◽

Medical Condition ◽

Paediatric Intensive Care ◽

Chronic Medical Condition ◽

Chronic Medical Conditions ◽

Medical Conditions ◽

Paediatric Patients

ObjectivesTo describe the clinical characteristics of paediatric patients admitted to a single paediatric intensive care unit (PICU) in Iran with COVID-19.MethodsA cross-sectional study of paediatric patients who were admitted to a COVID-19-dedicated PICU from 16 March 2020 to 21 April 2020 with COVID-19.ResultsSix children had confirmed COVID-19 and four had suspected COVID-19. Six had pre-existing chronic medical conditions. Nine had respiratory failure and needed ventilation. Five children, of whom four had chronic medical conditions, died. Four had cardiac arrhythmias. Clinical presentation included fever and cough.ConclusionCOVID-19 can be fatal in paediatric patients, especially in those with a chronic medical condition.

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Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

10.1101/2021.05.26.21257894 ◽

2021 ◽

Author(s):

Sylvia EK Sudat

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Length Of Stay ◽

Mortality Reduction ◽

Sepsis Screening ◽

The Impact

Objective: The objective of this study was to examine the impact of timely treatment and identification of sepsis on patient outcomes at Sutter Health, a mixed-payer healthcare system in northern California, US. Methods: This observational, retrospective analysis considered electronic health record (EHR) data for individuals who presented with sepsis during 2016-17 at any of Sutter Health's 22 emergency departments (ED). Impacts were assessed for the timing of broad-spectrum antibiotic and intravenous (IV) fluid initiation, first vital signs, sepsis screening, and lactate results. Outcomes were in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) hours for patients discharged alive. Results: The final sample size was 35,847 (N=9,638 severe sepsis, N=5,309 septic shock). Early fluid initiation had the largest estimated impacts: a mortality reduction of 2.85%[2.03%,3.68%] overall and 2.94%[1.44%,4.48%] for severe sepsis (within 1 hour of sepsis presentation), and 14.66%[9.23%,20.07%] for septic shock (within 3 hours); reduced LOS (days) 1.39[1.08,1.71] overall, 2.30[1.31,3.21] severe sepsis, 3.07[1.21,4.94] septic shock; and fewer ICU hours 25.93[16.95,34.66] overall, 35.06[14.7,56.99] severe sepsis, 41.99[15.70,70.68] septic shock (within 3 hours). Sepsis screening within 30 minutes was also associated with mortality reductions (3.88%[2.96%,4.90%] overall, 1.74%[0.08%,3.50%] severe sepsis, 6.78%[3.12%,10.33%] septic shock). The greatest improvement opportunity was estimated for joint initiation of antibiotics and IV fluids, with a modest additional mortality reduction of 0.80%[0.47%,1.17%] overall, 0.77%[0.34%,1.19%] severe sepsis, 2.94%[1.83%,3.97%] septic shock; LOS reduction of 0.37[0.28,0.46] overall, 0.29[0.17,0.43] severe sepsis, 0.25[0.01,0.51] septic shock (within 1 hour); ICU hours reduction of 4.85[3.26,6.57] overall, 5.07[2.55,7.67] severe sepsis, 3.85[1.69,6.24] septic shock (within 3 hours).

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Acute Adrenal Insufficiency May Affect Outcome in the Trauma Patient

The American Surgeon ◽

10.1177/000313480907500404 ◽

2009 ◽

Vol 75 (4) ◽

pp. 287-290 ◽

Cited By ~ 5

Author(s):

Oscar D. Guillamondegui ◽

Oliver L. Gunter ◽

Shivani Patel ◽

Sloan Fleming ◽

Bryan A. Cotton ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Patient ◽

Adrenal Insufficiency ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Acute Adrenal Insufficiency ◽

Stimulation Tests ◽

Cortisol Levels ◽

The Impact

Acute adrenal insufficiency in the trauma patient is underrecognized and the impact poorly understood. Our hypothesis was that the identification and treatment of acute adrenal insufficiency reduces mortality in trauma patients. Institutional Review Board approval for the retrospective review of a prospective database from a Level 1 trauma center for 2002 to 2004 was obtained. The study population included patients receiving a cosyntropin stimulation test (250 μg) and/or random Cortisol level based on our practice management guideline and an intensive care unit stay longer than 24 hours. Demographic, acuity, and outcome data were collected. The nonresponders had baseline Cortisol levels less than 20 μg/dL or poststimulation rise less than 9 μg/dL. Independent t tests and χ2 statistics were used. One hundred thirty-seven patients had cosyntropin stimulation tests performed. Eighty-two (60%) patients were nonresponders of which 66 were treated with hydrocortisone and 16 went untreated as a result of the discretion of the attending physician. The 55 (40%) responders showed no statistical differences in outcome variables whether or not they received hydrocortisone. The untreated adrenal-insufficient patients had significantly higher mortality, longer hospital length of stay, intensive care unit days, and ventilator-free days. Conclusions were: 1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and 2) acute adrenal insufficiency recognized by low random Cortisol levels or nonresponse to a stimulation tests should be considered for treatment.

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Impact of intensive care unit discharge delay after medical clearance on outcomes after liver transplantation

10.21203/rs.3.rs-157788/v1 ◽

2021 ◽

Author(s):

Shirin Salimi ◽

Keval Pandya ◽

Rebecca J Davis ◽

Michael Crawford ◽

Carlo Pulitano ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Outcomes ◽

Intensive Care Unit Discharge ◽

Deceased Donor ◽

Hospital Length Of Stay ◽

Resistant Organism ◽

No Donor ◽

Icu Discharge ◽

The Impact

Abstract Background For general intensive care unit (ICU) patients, ICU discharge delay (ICUDD) has been shown to be associated with increased hospital length of stay (LOS) and acquiring multi-resistant organism (MRO) infections. The impact of ICUDD in liver transplant (LT) recipients is unknown. Methods We retrospectively studied consecutive adults who underwent deceased-donor LT between 2011–2019. All patients went to ICU post-operatively then to a specific transplant ward. ICUDD was defined as > 8 hours between a patient being cleared by staff for discharge to ward and the patient leaving ICU. Results 550 received LT and survived to ward discharge. Median time between clearance for ward and the patient leaving ICU was 25.6 hours (interquartile range 6.6–38.6). The majority (68.4%) of patients experienced ICUDD. No donor or recipient variables were associated with ICUDD. However, patients cleared for discharge early in the week (Sunday-Tuesday) were more likely to experience ICUDD than those cleared on Wednesday-Saturday: 77.5% vs. 62.2% (P = 0.001), while patients cleared outside routine work hours were more likely to experience ICUDD than those cleared within working hours (93.6% vs. 66.2%, P < 0.001). The median hospital LOS were identical (18 days, P = 0.96) and there were no differences in other patient outcomes. Patients who became colonized with MRO in ICU spent longer time there compared to those who remained MRO-free (9 vs. 6 days, P < 0.001), however this was not due to ICUDD. Conclusions ICUDD post-LT is common and related to logistical factors. It does not prolong hospital LOS and is not associated with adverse patient outcomes or MRO colonization.

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Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102967 ◽

2021 ◽

pp. rapm-2021-102967

Author(s):

Jiabin Liu ◽

Haoyan Zhong ◽

Jashvant Poeran ◽

Peter K Sculco ◽

David H Kim ◽

...

Keyword(s):

Bariatric Surgery ◽

Intensive Care Unit ◽

Intensive Care ◽

Hip Arthroplasty ◽

Hospital Length Of Stay ◽

Major Complications ◽

Postoperative Intensive Care ◽

Second Surgery ◽

Total Knee ◽

The Impact

BackgroundPatients with morbid obesity may require both bariatric surgery and total knee/hip arthroplasty (TKA/THA). How to sequence these two procedures with better outcomes remains largely unstudied.MethodsThis cohort study extracted claims data on patients with an obesity diagnosis that received both bariatric surgery and TKA/THA surgery within 5 years of each other (Premier Healthcare database 2006–2019). Overall, 1894 patients received bariatric surgery before TKA or THA, while 1000 patients underwent TKA or THA before bariatric surgery. Main outcomes and measures include major complications (acute renal failure, acute myocardial infarction, other cardiovascular complications, sepsis/septic shock, pulmonary complications, pulmonary embolism, pneumonia, and central nervous system-related adverse events), postoperative intensive care unit utilization, ventilator utilization, 30-day readmission, 90-day readmission, 180-day readmission and total hospital length of stay after the second surgery. Regression models measured the association between the complications and sequence of TKA/THA and bariatric surgery.ResultsUndergoing TKA/THA before bariatric surgery (compared with the reverse) was associated with higher odds of major complications (7.0% vs 1.9%; adjusted OR 4.8, 95% CI 3.1, 7.6, p<0.001). Similar patterns were also observed for intensive care unit admission, ventilator use postoperatively, 30-day, and 90-day readmissions. Patients who received a second surgery within 6 months of their first surgery exhibited worse outcomes, especially among the TKA/THA first patient cohort. Major complication incidences occurred at 20.5%, 12.5%, 5.1%, 5.0%, 5.8% and 8.5% with time between TKA/THA and bariatric surgery at <6 months, 6 months–1 year, 1–2, 2–3, 3–4 and 4–5 years, respectively.ConclusionsPatients who require both bariatric surgery and TKA/THA should consider bariatric surgery before TKA/THA as it is associated with improved outcomes. Procedures should be staged beyond 6 months.

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