A prospective, observational, longitudinal cohort study of sedation practices in SGH intensive care units

Background: Critically ill patients require sedation for patient comfort and ventilator synchrony. Despite the extensive use of sedation, to date there is no consensus on the best sedation practices. We attempt to investigate our local sedation practices. Method: This was a single-centre prospective, observation cohort study in medical and surgical intensive care unit (ICU) patients who were ventilated and sedated for more than 24 hours. Baseline demographics were obtained and patients followed-up for 28 days or to ICU discharge. Details on sedatives, ventilation duration, vasopressors and renal replacement therapy use, hospital/ICU length of stay, mortality, delirium, and sedation depth were collected and analysed. Results: From March to July 2012, 58 patients were recruited with a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 20.2 ±8.5. Hospital mortality rates were 32.8%. Patients were followed-up for 387 ICU patient-days. In the early period (first 48 h), the most popular sedative used was propofol (74.1%), followed by morphine (29.3%). In the subsequent period (>48 h), most patients were not sedated (47.6%); morphine became the most popular sedation drug (32.5%) followed by propofol (31%). Ketamine, haloperidol and diazepam were not given. In total, 1994 Richmond Agitation and Sedation Score (RASS) assessments were performed over 387 ICU patient-days; 11.1% of RASS assessments were prescribed a sedation target, and 86% of them met the prescribed targets. Delirium was observed in 22.4% of patients. Compared with medical patients, surgical patients were more likely to be prescribed a sedation target (14.2% vs. 7.4%, p<0.01), require lower doses of sedation, have a RASS score of between −2 to 1 (84.8% vs. 72.3%, p<0.01) and have fewer incidences of delirium (4.1% vs. 12.1%, p=0.01). Conclusion: Propofol and morphine were the most commonly prescribed sedatives. Different sedation practices between units may contribute to a reduction in delirium incidence.

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Incidence of pressure injuries and risk factors in a paediatric surgical intensive care unit: a prospective cohort study

British Journal of Nursing ◽

10.12968/bjon.2021.30.sup20.s28 ◽

2021 ◽

Vol 30 (Sup20) ◽

pp. S28-S32

Author(s):

Jeiel Carlos Lamônica Crespo ◽

Silvia Regina Secoli ◽

Ticiane Carolina Gonçalves Faustino Campanili ◽

Ana Carolina Coelho Duarte ◽

Renata Eloah de Lucena Ferretti-Rebustini ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Icu Length Of Stay ◽

Stage 1

Objectives: The aim of the study was to evaluate the incidence of, and risk factors for, the occurrence of pressure injuries (PIs) in a paediatric surgical intensive care unit (ICU). Method: This is a prospective cohort study of 153 children in the postoperative period. Patients were assessed daily by physical examination and data were collected. All independent variables were included in a logistic regression. Results: The mean age of the cohort was 2 years, and the incidence of PI was 15.7%. According to the Braden Q Scale, 58.2% of patients were at high risk of developing PI; 79.3% of PIs were related to immobility and 69.0% were at stage 1. Risk factors were ICU length of stay and the number of medical devices used. Conclusion: The incidence of PI was high because patients were mostly at a considerable risk of developing a PI. PI was associated with several factors, especially length of ICU stay and number of devices, both of which are indirect indicators of the severity of patient condition and healthcare costs.

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Incidence and outcomes of acute lung injury in the surgical intensive care unit of a tertiary care hospital in Bangkok, Thailand

Asian Biomedicine ◽

10.5372/1905-7415.1004.501 ◽

2017 ◽

Vol 10 (4) ◽

pp. 379-385

Author(s):

Onuma Chaiwat ◽

Worawan Suwannasri ◽

Jedsadayoot Sak-aroonchai ◽

Sawita Kanavitoon ◽

Annop Piriyapathsom ◽

...

Keyword(s):

Intensive Care ◽

Acute Lung Injury ◽

Mortality Rate ◽

Lung Injury ◽

Tertiary Care ◽

Ventilatory Support ◽

Surgical Intensive Care Unit ◽

Apache Ii Score ◽

Care Hospital ◽

Surgical Intensive Care

Abstract Background Although the pathophysiology and treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well established, the incidence and outcomes of ALI have not been extensively reported. Variations in healthcare systems, demographics, socioeconomics, and levels of intensive care units (ICU) may explain remarkable differences in outcomes reported. Objectives To evaluate the incidence and outcomes of ALI/ARDS at the surgical ICU (SICU) at Siriraj Hospital of Mahidol University, Bangkok. Methods We included patients aged ≥18 years admitted to the general SICU between June 1, 2010 and May 31, 2013 in this prospective, cohort observational study. All patients required ≥24 h of ventilatory support. The study outcomes were the incidence of ALI/ARDS, SICU length of stay, and mortality rate. Results Of 2523 patients admitted to the SICU, 495 (20%) required ≥24 h ventilatory support, and 15 (3%) developed ALI/ARDS. ALI/ARDS occurred on day 2 of ventilatory support. ARDS was caused by sepsis and pneumonia. The patients who developed ALI/ARDS had a higher APACHE II score (P = 0.001) and end-stage renal disease (P = 0.01). Pneumonia and acute kidney injury were more severe in patients with ALI and ARDS (40% vs 9%, P = 0.002; 33% vs 10%, P = 0.02, respectively). Ventilatory support duration, SICU lengths of stay and hospital mortality were higher in the ALI/ARDS group. Conclusions The incidence of ALI/ARDS in the SICU was low, but the mortality rate was high. A larger sample size is necessary to identify independent risk factors for ALI/ARDS.

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Interrater Reliability of APACHE II Scores for Medical-Surgical Intensive Care Patients: A Prospective Blinded Study

American Journal of Critical Care ◽

10.4037/ajcc2007.16.4.378 ◽

2007 ◽

Vol 16 (4) ◽

pp. 378-383 ◽

Cited By ~ 18

Author(s):

Michelle E. Kho ◽

Ellen McDonald ◽

Paul W. Stratford ◽

Deborah J. Cook

Keyword(s):

Intensive Care ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Illness Severity ◽

Apache Ii ◽

Surgical Intensive Care Unit ◽

Apache Ii Score ◽

Surgical Intensive Care ◽

Chronic Health ◽

Severity Scores

Background Despite widespread use of the Acute Physiology and Chronic Health Evaluation II (APACHE II), its interrater reliability has not been well studied. Objective To determine interrater reliability of APACHE II scores among 1 intensive care nurse and 2 research clerks. Methods In a prospective, blinded, observational study, 3 raters collected APACHE II scores on 37 consecutive patients in a medical-surgical intensive care unit. One research clerk was blinded to the study’s start date to minimize observer bias. The nurse and the other research clerk were blinded to each other’s scores and did not communicate with the first research clerk about the study. The data analyst was blinded to the identity and source of all 3 raters’ scores. Intraclass correlation coefficients and 95% confidence intervals were assessed. Results Mean (standard deviation) APACHE II scores were 21.8 (9.2) for the nurse, 20.4 (7.7) for research clerk 1, and 20.5 (8.1) for research clerk 2. Among the 3 raters, the intraclass correlation coefficient (95% confidence interval) was 0.90 (0.84, 0.94) for the APACHE II total score. Within APACHE II score components, the highest reliability was for age (0.98 [0.97, 0.99]), with lower reliabilities for the Chronic Health Index (0.64 [0.50, 0.80]) and the verbal component of the Glasgow Coma Scale (0.40 [0.20, 0.60]). Results were similar between pairs of raters. Conclusions Use of trained nonmedical personnel to collect illness severity scores for clinical, research, and administrative purposes is reasonable. This method could be used to assess reliability of other illness severity scores.

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Similar Outcomes for Medical Patients Supported with VA-ECMO in the Cardiac Care Unit and Cardiac Surgical Intensive Care Unit

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2018.07.395 ◽

2018 ◽

Vol 24 (8) ◽

pp. S104-S105

Author(s):

Fathima F. Jahufar ◽

William Jakobleff ◽

Joshua Josephs ◽

Sandhya Murthy ◽

Stephen Forest ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Surgical Intensive Care Unit ◽

Cardiac Care ◽

Medical Patients ◽

Surgical Intensive Care ◽

Va Ecmo ◽

Cardiac Care Unit

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Lactate level and unplanned readmission to the surgical intensive care unit: a retrospective cohort study

Annals of Palliative Medicine ◽

10.21037/apm-20-291 ◽

2020 ◽

Vol 9 (6) ◽

pp. 20-20

Author(s):

Tak Kyu Oh ◽

Chami Im ◽

In-Ae Song

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Lactate Level ◽

Retrospective Cohort ◽

Surgical Intensive Care Unit ◽

Unplanned Readmission ◽

Surgical Intensive Care

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Obesity Does Not Affect Mortality after Trauma

The American Surgeon ◽

10.1177/000313480607201028 ◽

2006 ◽

Vol 72 (10) ◽

pp. 966-969 ◽

Cited By ~ 9

Author(s):

Rodrigo F. Alban ◽

Sergey Lyass ◽

Daniel R. Margulies ◽

M. Michael Shabot

Keyword(s):

Intensive Care Unit ◽

Risk Factor ◽

Intensive Care ◽

Adverse Outcomes ◽

Apache Ii ◽

Surgical Intensive Care Unit ◽

Apache Ii Score ◽

Surgical Intensive Care ◽

Significant Difference ◽

Nonobese Patients

Although obesity has been proposed as a risk factor for adverse outcomes after trauma, numerous studies report conflicting results. The objective of this study was to compare outcomes of obese and nonobese patients after trauma. The study population consisted of all trauma patients admitted to a surgical intensive care unit in a Level I trauma center from January 1999 to December 2002. Admission data, demographics, injury severity score (ISS), severity of illness, hospital course, complications, and outcomes were compared between obese (OB; body mass index [BMI] ≥ 30), and nonobese patients (NOB; BMI ≤ 29). A total of 918 patients was included in the study, 135 OB (14.7%) and 783 NOB (85.3%). There was no significant difference in demographic data, ISS, APACHE II score, and hospital stay. Intensive care unit stay was longer for OB patients (6.8 vs 4.8 days, P = 0.04). Overall mortality was 5.9 per cent for OB and 8.0 per cent for NOB patients (P = 0.48). Mortality by mechanism of injury was 3.4 per cent OB versus 7.4 per cent NOB (P = 0.26) for blunt and 10.6 per cent OB versus 10.2 per cent NOB (P = 0.9) for penetrating injury. The three most common complications associated with death were pulmonary, cardiovascular, and neurological deterioration. Using logistic regression analysis, age and ISS and APACHE II scores were associated with mortality, but BMI was not. We conclude that obesity does not appear to be a risk factor for adverse outcomes after blunt or penetrating trauma. Further research is warranted to uncover the reason for discrepant findings between centers.

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Interhospital Transfer: An Independent Risk Factor for Mortality in the Surgical Intensive Care Unit

The American Surgeon ◽

10.1177/000313481307900929 ◽

2013 ◽

Vol 79 (9) ◽

pp. 909-913 ◽

Cited By ~ 23

Author(s):

Katherine R. Arthur ◽

Rachel R. Kelz ◽

Angela M. Mills ◽

Caroline E. Reinke ◽

Mathew P. Robertson ◽

...

Keyword(s):

Risk Factor ◽

Intensive Care ◽

Independent Risk Factor ◽

Interquartile Range ◽

Apache Ii ◽

Surgical Intensive Care Unit ◽

Apache Ii Score ◽

Icu Mortality ◽

Surgical Intensive Care ◽

Interhospital Transfer

Interhospital transfer (IHT) is associated with mortality in medical and mixed intensive care units (ICUs), but few studies have examined this relationship in a surgical ICU (SICU) setting. We hypothesized that IHT is associated with increased mortality in SICU patients relative to ICU patients admitted within the hospital. We reviewed SICU and transfer center databases from a tertiary academic center over a 2-year period. Inclusion criteria included age 18 years or older and SICU admission 24 hours or greater. Demographic data, admission service, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were captured. The primary end point was ICU mortality. Univariate logistic regression was used to test the association between variables and mortality. Factors found to be associated with mortality at P < 0.1 were entered into a multivariable model. Of 4542 admissions, 416 arrived by IHT. Compared with the non-IHT group, the IHT group was older (age 58.3 years [interquartile range, 47.8 to 70.6] vs 57.8 years [interquartile range, 44.1 to 68.8] years, P = 0.036), sicker (APACHE II score 16.5 [interquartile range, 12 to 23] vs 14 [interquartile range, 10 to 20], P < 0.001), and more likely to be white (82% [n = 341] vs 69% [n = 2865], P < 0.001). Mortality rates in IHT patients were highest on the emergency surgery (18%), transplant surgery (16%), and gastrointestinal surgery (8%) services. After adjusting for age and APACHE II score, IHT remained a risk factor for ICU mortality (odds ratio, 1.60; 95% confidence interval, 1.04 to 2.45; P = 0.032) in SICU patients. Interhospital transfer is an independent risk factor for mortality in the SICU population; this risk is unevenly distributed through service lines. Further efforts to determine the cause of this association are warranted.

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