scholarly journals Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

2017 ◽  
Vol 19 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Heyman Luckraz ◽  
Na’ngono Manga ◽  
Eshan L Senanayake ◽  
Mahmoud Abdelaziz ◽  
Shameer Gopal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
National Health Service ◽  
Ventilator Associated Pneumonia ◽  
Significant Morbidity ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
The Cost ◽  
Post Cardiac Surgery

Background Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Methods Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. Results There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Conclusion Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

scholarly journals Health-care associated infections in children after cardiac surgery in a pediatric cardiac intensive care unit (PCICU)

2011 ◽  
Vol 5 (10) ◽  
pp. 748-750 ◽  
Author(s):  
Naveed -ur-Rehman Siddiqui ◽  
Fatima Mir ◽  
Omair Shakil ◽  
Muneer Amanullah ◽  
Anwarul Haque
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Full Text ◽  
Cardiac Intensive Care Unit ◽  
Health Care Associated Infections ◽  
Cardiac Intensive Care

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Cost Implications of Using Inhaled Nitric Oxide Compared with Epoprostenol for Pulmonary Hypertension

1995 ◽  
Vol 11 (4) ◽  
pp. 163-166 ◽  
Author(s):  
Andy J Petros ◽  
Sean C Turner ◽  
Anthony J Nunn
Keyword(s):  
Nitric Oxide ◽  
Intensive Care Unit ◽  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Intensive Care ◽  
Congenital Heart ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
The Cost ◽  
Inhaled No

Objective: To compare the cost of using intravenous epoprostenol with that of inhaled nitric oxide (NO) for treating episodes of pulmonary hypertension in children with congenital heart disease. Design: An analysis of the cost of epoprostenol and NO use over the previous 18 months was performed. Three 6-month periods were identified, two in which epoprostenol was used and the third in which inhaled NO was introduced for the treatment of pulmonary hypertension. Setting: A 10-bed pediatric cardiac intensive care unit, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, England. Subjects: Children with congenital heart disease and persistently elevated pulmonary artery pressure following cardiac surgery. Main Outcome Measures: The total duration of use of epoprostenol and inhaled NO was documented. The costs per hour for epoprostenol and inhaled NO were calculated and the annual cost of each agent was estimated. Results: In the two 6-month periods prior to the introduction of inhaled NO, epoprostenol was used on 14 occasions (5 in the first period, 3 in the second). In the last 6-month period, nine children required pulmonary vasodilator therapy on 14 occasions. All nine children were treated successfully with inhaled NO; none were given or needed epoprostenol, as NO always was effective in providing pulmonary vasodilatation. For resistant pulmonary hypertension, increasing the concentration of NO would have been the next therapeutic option. The cost for the two 6-month periods using epoprostenol was $19,483.48 for the drug and $283.25 for equipment costs (total cost $19,766.73). There was no expenditure on epoprostenol in the final 6-month period. The cost of NO was $465. However, the total expenditure, including the delivery and monitoring system, was $4,722.85. Conclusions: Using inhaled NO in our pediatric cardiac intensive care unit abolished the use of epoprostenol during the reported monitoring period. The cost savings were significant, amounting to 12% of the annual drug budget for the unit. The cost of setting up the inhaled NO delivery system is recouped rapidly. The ease of delivery and measurement of inhaled NO also may have contributed to its increased clinical use.

scholarly journals Rhizopus rhizopodiformis: emerging etiological agent of mucormycosis

1979 ◽  
Vol 9 (4) ◽  
pp. 530-537
Author(s):  
E J Bottone ◽  
I Weitzman ◽  
B A Hanna
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Mount Sinai Hospital ◽  
Etiological Agent ◽  
Invasive Potential ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Mount Sinai ◽  
Systemic Infections

Mucormycosis is caused principally by members of the genus Rhizopus, especially R arrhizus and R. oryzae. Infection attributable to R. rhizopodiformis has rarely been documented. Of 13 cases of mucormycosis diagnosed during a 4-year period (1974 to 1978) at The Mount Sinai Hospital, 6 cases, occurring within 9 months, were caused by R. rhizopodiformis. The six isolates were identified mainly by: growth at 50 degrees C; production of short, sometimes branched, sporangiophores arising from opposite rhizoids; elongated columellae; and small spherical-to-elliptical, smooth-to-finely striated sporangiospores. The possibility that this explosive occurrence of R. rhizopodiformis at our institution was because of nosocomial acquisition was strongly supported by the recovery of this same mycotic agent from adhesive bandages used in the cardiac intensive care unit, where a patient developed subcutaneous R. rhizopodiformis infection after cardiac surgery. The invasive potential of R. rhizopodiformis was manifested by the extensive subcutaneous and systemic infections in each of the six patients, three of whom developed antibody against this mucormycotic agent.

scholarly journals Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric Cardiac Intensive Care Unit Survey

2019 ◽  
Vol 39 (2) ◽  
pp. e1-e7 ◽  
Author(s):  
Matthew J. Nordness ◽  
Ashly C. Westrick ◽  
Heidi Chen ◽  
Mark A. Clay
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Years Of Experience ◽  
Cardiac Intensive Care Unit ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Cardiac Intensive Care ◽  
Intensive Care Unit Nurses

BACKGROUND Low cardiac output syndrome is a transient constellation of signs and symptoms that indicate the heart’s inability to supply sufficient oxygen to tissues and end-organs to meet metabolic demand. Because the term lacks a standard clinical definition, the bedside diagnosis of this syndrome can be difficult. OBJECTIVE To evaluate concordance among pediatric cardiac intensive care unit nurses in their identification of low cardiac output syndrome in pediatric patients after cardiac surgery. METHODS An anonymous survey was distributed to 69 pediatric cardiac intensive care unit nurses. The survey described 10 randomly selected patients aged 6 months or younger who had undergone corrective or palliative cardiac surgery at a freestanding children’s hospital in a tertiary academic center. For each patient, data were presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours postoperatively). The respondent was asked to indicate whether the patient had low cardiac output syndrome (yes or no) at each time point on the basis of the data presented. RESULTS The response rate was 46% (32 of 69 nurses). The overall Fleiss k value was 0.30, indicating fair agreement among raters. When the results were analyzed by years of experience, agreement remained only slight to fair. CONCLUSIONS Regardless of years of experience, nurses have difficulty agreeing on the presence of low cardiac output syndrome. Further research is needed to determine whether the development of objective guidelines could improve recognition and facilitate communication between the pediatric cardiac intensive care unit nurse and the medical team.

scholarly journals Tissue oximetry during cardiac surgery and in the cardiac intensive care unit: A prospective observational trial

2018 ◽  
Vol 21 (4) ◽  
pp. 371 ◽  
Author(s):  
BenjaminJ Heller ◽  
Pranav Deshpande ◽  
JoshuaA Heller ◽  
Patrick McCormick ◽  
Hung-Mo Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Observational Trial ◽  
Cardiac Intensive Care ◽  
Tissue Oximetry
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