Admission to the Regular Ward is Safe Following Uncomplicated Craniosynostosis Surgery: A Retrospective Study

FACE ◽  
2021 ◽  
pp. 273250162110279
Author(s):  
Deseray Sileo ◽  
Frank Walch ◽  
Brooke M. French ◽  
Krista Greenan ◽  
Sarah Graber ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Chart Review ◽  
Primary Outcome ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Icu Admission ◽  
Duration Of Hospitalization ◽  
Secondary Outcomes ◽  
Length Of Hospitalization ◽  
Type Of Surgery

Background: At our craniofacial center patients are routinely admitted to a regular ward, or floor, rather an intensive care unit (ICU) after uncomplicated craniosynostosis surgery. In this study, we review the safety of our postoperative placement policy, examining the rate of transfer from floor to ICU. Methods: The charts of patients who underwent craniosynostosis surgery from 2009 through 2017 at a single children’s hospital were reviewed. Postoperative hospital courses were characterized as preoperatively-planned ICU admission, perioperatively-planned ICU admission, or primary floor admission. The primary outcome was transfer from floor to ICU. Secondary outcomes included duration of hospitalization. Results: Chart review yielded 420 patients. Three hundred sixty-eight (88%) were admitted directly to the floor and 52 (12.0%) directly to an ICU. Of patients admitted to the floor, 2 (0.5%) were transferred to an ICU. Twenty-four patients with syndromic and 20 patients with multisutural craniosynostosis were admitted to the floor. Only 1 patient from each group (the same patient; 4.2% and 5.0%, respectively), was transferred to an ICU. Thirty-two ICU admissions were preoperatively planned and 20 were perioperatively planned. Reasons for preoperatively planned ICU admission included significant comorbidities and type of surgery. Reasons for perioperatively planned ICU admissions included significant intraoperative adverse events, excessive blood loss, and failure of clearance from the post-anesthesia care unit (PACU). Patients admitted to the ICU had a statistically significant longer mean length of hospitalization (4.8 days vs 2.7 days) than did patients admitted to the floor. Conclusions: Most postoperative craniosynostosis surgery patients—including patients with syndromic and/or multisutural synostosis—are managed safely on the floor at our center. Some patients still need postoperative ICU admission, but are easily identified preoperatively, intraoperatively, or in the PACU. Our findings should be applicable to other large craniofacial centers.

scholarly journals Persistently higher serum sCD40L levels are associated with outcome in septic patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yingjian Liang ◽  
Chengrui Zhu ◽  
Yini Sun ◽  
Zhiliang Li ◽  
Liang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Odds Ratio ◽  
Cd40 Ligand ◽  
Surgical Patients ◽  
Soluble Cd40 Ligand ◽  
Icu Admission ◽  
Time Changes ◽  
And Control ◽  
Type Of Surgery

Abstract Background Soluble CD40 ligand (sCD40L) exhibits proinflammatory and procoagulant effects. Recent data indicated that sCD40L plays a significant role in septic patients. The aim of the present study was to determine sCD40L changes in surgical patients without sepsis (SWS) and surgical sepsis patients (SS) during the first 3 days after intensive care unit (ICU) admission and to observe the association between sCD40L and mortality. Methods Time changes in sCD40L levels were assessed for 3 days after ICU admission in 49 patients with SS and compared with those in 19 SWS patients. Serum sCD40L concentration was detected by ELISA. Survival at 28 days served as the endpoint. Results SS had significantly higher sCD40L levels than SWS and control patients. We observed an association between sCD40L levels ≥1028.75 pg/mL at day 2 and 28-day mortality (odds ratio = 7.888; 95% confidence interval = 1.758 to 35.395; P = 0.007). We could not discover any significant differences in sex, presence of septic shock, site of infection, length of stay in the ICU, PaO2/FiO2 ratio, incidence of AKI, ARDS, or type of surgery between nonsurvivors and survivors. Conclusions Septic patients show persistently higher circulating sCD40L levels in the first 3 days after ICU admission, and serum sCD40L levels are associated with the mortality of patients with sepsis. Thus, serum sCD40L may be used as a reliable biomarker and therapeutic target in sepsis.

System intervention in community pharmacy setting: Leading to better patient care through reducing harm associated with coprescribing benzodiazepines and opioids

2021 ◽  
Vol 17 (6) ◽  
pp. 445-453
Author(s):  
Angelina Vascimini, PharmD ◽  
Kevin Duane, PharmD ◽  
Stacey Curtis, PharmD
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Community Pharmacists ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Improvement Project ◽  
System Intervention ◽  
Secondary Outcomes ◽  
Pharmacy Setting

Objective: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death.Design: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020.Setting: Independent community pharmacy.Patients/participants: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status.Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up.Results: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance.Conclusion: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.

scholarly journals Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

2018 ◽  
Vol 35 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
George L. Anesi ◽  
Nicole B. Gabler ◽  
Nikki L. Allorto ◽  
Carel Cairns ◽  
Gary E. Weissman ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Primary Outcome ◽  
Resource Limited Setting ◽  
Icu Mortality ◽  
Icu Admission ◽  
Resource Limited ◽  
Limited Setting

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

scholarly journals Evaluation of Levetiracetam for Early Post-Traumatic Seizure Prophylaxis: A Level II Trauma Center Experience

2021 ◽  
Author(s):  
Timothy A. Amin ◽  
Steven F. Nerenberg ◽  
Osama A. Elsawy ◽  
Antai Wang ◽  
Jackie P. Johnston
Keyword(s):  
Trauma Center ◽  
Chart Review ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Ii ◽  
Post Traumatic ◽  
The Mean ◽  
Secondary Outcomes

Abstract Background: Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.Methods: A single-center, retrospective chart review of TBI patients > 18 years who received LEV for early PTS prophylaxis between August 2018 - July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).Results: Of the 137 included, mean age was 59±20 years and 69.3% were male. The mean admission GCS was 13±4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4-10) days and 13.9% met recommended 7-day duration. Those prescribed LEV > 7 days had more than twice the median LEV duration than those prescribed ≤ 7 days (10.25 (8.5-15.5) vs 4 (1.5-4.5) days, p < 0.0001). EEG-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1-7) and 7 (IQR 3-16) days, respectively. Conclusions: The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.

scholarly journals Use of Virtual Reality to Improve the Quality of the Hospital Stay for Patients in Neurosurgery

2021 ◽  
Vol 2 ◽  
Author(s):  
Pia Vayssiere ◽  
Paul E. Constanthin ◽  
Nalla Silva Baticam ◽  
Bruno Herbelin ◽  
Christine Degremont ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Statistical Difference ◽  
Primary Outcome ◽  
Pain Reduction ◽  
Anxiety Management ◽  
Positive Effects ◽  
Duration Of Hospitalization ◽  
Secondary Outcomes ◽  
Simple Spine

Background: Virtual Reality (VR) technologies have numerous beneficial applications for patients during hospitalization (through complete immersion in a virtual, distant place allowing to “escape” from the context of hospitalization). Their positive effects in pain and anxiety management, neurorehabilitation and psychotherapy have been demonstrated. Here, we evaluated the effects of VR on the quality of hospitalization and postoperative pain after neurosurgery.Methods: Patients hospitalized in our department between 2019 and 2020 were prospectively enrolled and divided into a group that received a personal, 30-minutes-long, VR session using an Oculus Go ™ VR headset (VR group) or not (non-VR group). Surgeries were classified in simple or complex spinal and simple or complex cranial. Patient‘s overall satisfaction was considered as primary outcome, with secondary outcomes encompassing duration of hospitalization, pain reduction and patients’ opinion regarding VR.Results: 161 patients were enrolled (77 in the VR group and 84 in the non-VR group). There was no statistical difference between the two groups regarding satisfaction. The VR group presented with a significantly longer duration of hospitalization and higher maximal pain. Interestingly, pain reduction during hospitalization was significantly higher in the VR group, particularly in simple surgeries and spine surgeries. A vast majority of the VR group patients appreciated their VR experience (89.2%) and advocated for its systematic use (83.8%).Conclusion: VR can improve pain reduction during hospitalization after neurosurgery, particularly for simple spine surgeries. Furthermore, patients experiencing VR appear to appreciate it and advocate for its systematic use in neurosurgery. Further research is warranted to identify patients for whom addition of VR during hospitalization might bring the most benefit.

scholarly journals Persistently higher serum sCD40L levels are associated with outcome in septic patients

2021 ◽  
Author(s):  
Yingjian Liang ◽  
Chengrui Zhu ◽  
Yini Sun ◽  
Zhiliang Li ◽  
Liang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Odds Ratio ◽  
Cd40 Ligand ◽  
Surgical Patients ◽  
Soluble Cd40 Ligand ◽  
Icu Admission ◽  
Time Changes ◽  
And Control ◽  
Type Of Surgery

Abstract Background: Soluble CD40 ligand (sCD40L) exhibits proinflammatory and procoagulant effects. Recent data indicated that sCD40L plays a significant role in septic patients. The aim of the present study was to determine sCD40L changes in surgical patients without sepsis (SWS) and surgical sepsis patients (SS) during the first three days after intensive care unit (ICU) admission and to observe the association between sCD40L and mortality.Methods: Time changes in sCD40L levels were assessed for 3 days after ICU admission in 49 patients with SS and compared with those in 19 SWS patients. Serum sCD40L concentration was detected by ELISA. Survival at 28 days served as the endpoint.Results: SS had significantly higher sCD40L levels than SWS and control patients. We observed an association between sCD40L levels ≥1028.75 pg/mL at day 2 and 28-day mortality (odds ratio=7.888; 95% confidence interval=1.758 to 35.395; P=0.007). We could not discover any significant differences in sex, presence of septic shock, site of infection, length of stay in the ICU, PaO2/FiO2 ratio, incidence of AKI, ARDS, or type of surgery between nonsurvivors and survivors.Conclusions: Septic patients show persistently higher circulating sCD40L levels in the first three days after ICU admission, and serum sCD40L levels are associated with the mortality of patients with sepsis. Thus, serum sCD40L may be used as a reliable biomarker and therapeutic target in sepsis.

scholarly journals Circulating bioactive adrenomedullin as a marker of sepsis, septic shock and critical illness

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Oscar H. M. Lundberg ◽  
Maria Lengquist ◽  
Martin Spångfors ◽  
Martin Annborn ◽  
Deborah Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Critical Illness ◽  
Organ Failure ◽  
Primary Outcome ◽  
Organ Support ◽  
Severity Of Disease ◽  
Therapeutic Value ◽  
Secondary Outcomes ◽  
Youden’S Index

Abstract Background Biomarkers can be of help to understand critical illness and to identify and stratify sepsis. Adrenomedullin is a vasoactive hormone, with reported prognostic and potentially therapeutic value in sepsis. The primary aim of this study was to investigate the association of circulating bioactive adrenomedullin (bio-ADM) levels at intensive care unit (ICU) admission with mortality in sepsis patients and in a general ICU population. Secondary aims included the association of bio-ADM with organ failure and the ability of bio-ADM to identify sepsis. Methods In this retrospective observational study, adult patients admitted to one of four ICUs during 2016 had admission bio-ADM levels analysed. Age-adjusted odds ratios (OR) with 95% CI for log-2 transformed bio-ADM, and Youden’s index derived cut-offs were calculated. The primary outcome was 30-day mortality, and secondary outcomes included the need for organ support and the ability to identify sepsis. Results Bio-ADM in 1867 consecutive patients were analysed; 632 patients fulfilled the sepsis-3 criteria of whom 267 had septic shock. The median bio-ADM in the entire ICU population was 40 pg/mL, 74 pg/mL in sepsis patients, 107 pg/mL in septic shock and 29 pg/mL in non-septic patients. The association of elevated bio-ADM and mortality in sepsis patients and the ICU population resulted in ORs of 1.23 (95% CI 1.07–1.41) and 1.22 (95% CI 1.12–1.32), respectively. The association with mortality remained after additional adjustment for lactate in sepsis patients. Elevated bio-ADM was associated with an increased need for dialysis with ORs of 2.28 (95% CI 2.01–2.59) and 1.97 (95% CI 1.64–2.36) for the ICU population and sepsis patients, respectively, and with increased need of vasopressors, OR 1.33 (95% CI 1.23–1.42) (95% CI 1.17–1.50) for both populations. Sepsis was identified with an OR of 1.78 (95% CI 1.64–1.94) for bio-ADM, after additional adjustment for severity of disease. A bio-ADM cut-off of 70 pg/mL differentiated between survivors and non-survivors in sepsis, but a Youden’s index derived threshold of 108 pg/mL performed better. Conclusions Admission bio-ADM is associated with 30-day mortality and organ failure in sepsis patients as well as in a general ICU population. Bio-ADM may be a morbidity-independent sepsis biomarker.

Evaluating the impact of CPAP weaning procedures on total days on nasal CPAP: A retrospective chart review

2021 ◽  
pp. 1-10
Author(s):  
Z.B. Puthattayil ◽  
G.P. Moore ◽  
K. Tang ◽  
N. Huneault-Purney ◽  
S.L. Lawrence
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Retrospective Chart Review ◽  
Stability Criteria ◽  
Inclusion Criteria ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

BACKGROUND: There is no consensus on how to wean infants from Nasal Continuous Positive Airway Pressure (NCPAP). We hypothesized that ceasing NCPAP abruptly would decrease the duration required, compared with a gradual wean. METHODS: This retrospective chart review included preterm infants requiring NCPAP for over 48 hours. Cohort1 weaned NCPAP by cycling on and off, while cohort 2 ceased NCPAP abruptly. The primary outcome was total days on NCPAP. Secondary outcomes included rate of bronchopulmonary dysplasia, weight gain, duration of hospital stay, and compliance with the use of stability criteria. RESULTS: 81 infants met inclusion criteria in cohort one, and 89 in cohort two. Median days on NCPAP were 17.0 and 11.0 days, respectively, not significant. There was no significant difference in secondary outcomes. CONCLUSIONS: There was no significant association between the two NCPAP weaning protocols and the outcomes studied.

scholarly journals Admission criteria in critically ill COVID-19 patients: A physiology-based approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260318
Author(s):  
Samuele Ceruti ◽  
Andrea Glotta ◽  
Maira Biggiogero ◽  
Pier Andrea Maida ◽  
Martino Marzano ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mortality Rate ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Admission Criteria ◽  
Do Not Resuscitate ◽  
Intensive Monitoring ◽  
Icu Admission ◽  
Monitoring Protocol ◽  
Careful Management

Introduction The COVID-19 pandemic required careful management of intensive care unit (ICU) admissions, to reduce ICU overload while facing limitations in resources. We implemented a standardized, physiology-based, ICU admission criteria and analyzed the mortality rate of patients refused from the ICU. Materials and methods In this retrospective observational study, COVID-19 patients proposed for ICU admission were consecutively analyzed; Do-Not-Resuscitate patients were excluded. Patients presenting an oxygen peripheral saturation (SpO2) lower than 85% and/or dyspnea and/or mental confusion resulted eligible for ICU admission; patients not presenting these criteria remained in the ward with an intensive monitoring protocol. Primary outcome was both groups’ survival rate. Secondary outcome was a sub analysis correlating SpO2 cutoff with ICU admission. Results From March 2020 to January 2021, 1623 patients were admitted to our Center; 208 DNR patients were excluded; 97 patients were evaluated. The ICU-admitted group (n = 63) mortality rate resulted 15.9% at 28 days and 27% at 40 days; the ICU-refused group (n = 34) mortality rate resulted 0% at both intervals (p < 0.001). With a SpO2 cut-off of 85%, a significant correlation was found (p = 0.009), but with a 92% a cut-off there was no correlation with ICU admission (p = 0.26). A similar correlation was also found with dyspnea (p = 0.0002). Conclusion In COVID-19 patients, standardized ICU admission criteria appeared to safely reduce ICU overload. In the absence of dyspnea and/or confusion, a SpO2 cutoff up to 85% for ICU admission was not burdened by negative outcomes. In a pandemic context, the SpO2 cutoff of 92%, as a threshold for ICU admission, needs critical re-evaluation.

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