Platelet Transfusions in a Medical- Surgical Intensive Care Unit.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3637-3637
Author(s):  
Donald M. Arnold ◽  
Laura A. Molnar ◽  
Mark A. Crowther ◽  
Christopher Sigouin ◽  
Julie Carruthers ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Critically Ill Patients ◽  
Platelet Transfusion ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Bleeding Severity ◽  
Platelet Transfusions

Abstract Background: The benefits and harms of platelet transfusions in critically ill patients are unclear. Objectives: To describe the frequency of, indications for, and effects of platelet transfusions in patients admitted to a medical- surgical intensive care unit (ICU). Design: Single center cohort study (January 2001 to January 2002). Methods: We identified all patients who developed thrombocytopenia (platelet count <150 x 109/l) during their ICU admission from a prospective study which enrolled consecutive adults admitted to ICU with an expected length of stay ≥72 hours, and which excluded patients with trauma, orthopedic surgery, cardiac surgery, pregnancy, or receiving palliative care. Retrospectively, using a priori criteria, bleeding severity and the indications for platelet transfusions were assessed; 23.7% of bleeding events and 89.5% of transfusion indications were reviewed in duplicate independently. Initial agreement was calculated using Cohen’s unweighted kappa and all assessments of bleeding severity and transfusion indications were adjudicated by third person. Results: Of 261 ICU patients, 118 (45.2%) had thrombocytopenia. Initial agreement between primary reviewers for assessments of bleeding severity was good (k= 0.69), and for indications for platelet transfusions was poor (k=0.35); consensus was achieved in all cases. One third of thrombocytopenic patients had major bleeding (37/118, 31.4%), and one fifth had minor bleeding (24/118, 20.3%). Among thrombocytopenic patients, 27/118 (22.9%) received a total of 76 platelet transfusions, 24 (31.6%) of which were administered to treat bleeding, and 52 (68.4%) of which were to prevent bleeding. Of the prophylactic platelet transfusions, 18/52 (34.6%) preceded invasive procedures. The mean ± SD platelet count prior to therapeutic platelet transfusions was 54 ± 40 x109/l; for peri-procedural transfusions, 55 ± 38 x109/l; and for other prophylactic platelet transfusions, 37 ± 21 x109/l. Most transfusions (69/76, 91%) were administered as pools of 5.2 ± 1.2 random donor platelets, and few (7/76, 9.2%) were apheresis platelets. A single platelet transfusion (pool of 5 random donor units or 1 apheresis unit) resulted in a platelet increment of 14 ± 29 x109/l at 6.6 ± 5.9 hours following transfusion. No rise in platelet count was observed following 17 transfusions given to 13 patients. Conclusions: Platelet transfusions are frequently administered to thrombocytopenic critically ill patients, and, although the indication is not always clear, the most common reason is to prevent bleeding. Nearly half of transfused ICU patients were refractory to one or more platelet transfusion. Further prospective studies are needed on the indications for, and effects of, platelet transfusions in the ICU setting.

The Use Of Platelet Transfusions In The Intensive Care Unit and Impact On Platelet Count: A 30,000 Patient Registry Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1154-1154
Author(s):  
Shuoyan Ning ◽  
Rebecca Barty, MLT ◽  
Yang Liu ◽  
Nancy Heddle ◽  
Donald Arnold
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Research Funding ◽  
Platelet Transfusion ◽  
Large Cohort ◽  
Clinical Effects ◽  
Icu Patients ◽  
Icu Admission ◽  
Platelet Transfusions

Abstract Background Thrombocytopenia is a common complication of critical illness and an independent risk factor for bleeding and death in the intensive care unit (ICU). Platelet transfusions are commonly used to improve platelet counts; however, the expected platelet increment from a transfusion in this setting has not been established. The objective of this study was to describe the frequency of platelet transfusion administration and their effect on platelet count increments in a large cohort of non-oncology critically ill adults. Methods We performed an analysis of a registry database, which was developed to capture clinical and laboratory data on all blood transfusions administered in 3 academic hospitals in Hamilton, Ontario, Canada. We included all patients ≥18 years who received one or more platelet transfusion during an ICU admission. Data validation was done by integrity checks with medical records and laboratory information system performed by a biostatistician. Non-transfused ICU patients were used as controls. The absolute increment in platelet count was calculated for each single platelet transfusion using the closest platelet count taken within 24 hours before the transfusion and 4-24 hours after the transfusion. Results Between April 2006 and October 2012, 33,222 patients were admitted to ICU, including 29,511 (88.8%) who did not have a diagnosis of cancer. Of those, 4,502 (15.3%) received one or more platelet transfusion during any ICU admission (n=4,690); 31.9% were female and median age at the time of first admission was 69 years (IQR 59-77). Among the 25,009 non-transfused patients admitted to ICU during the same period, 38.1% were female and the median age was 65 years (IQR 52–76). Median pre-transfusion platelet count was 87 x109/L (IQR 59-131) and a single platelet transfusion resulted in a median platelet count increment of 21 x109/L (IQR 6-40) as measured 6.7 hours (IQR 5.1-9.8) after the transfusion. There were 277 (25.4%) transfusions that yielded a platelet count increment of 5 x109/L or less. ICU mortality was 562/4,690 (12.4%) for patients who received a platelet transfusion, compared with 2,251/33,033(6.8%) for patients who were not transfused during their ICU stay. Summary/Conclusion Among this large cohort of non-oncology ICU patients, platelet transfusions were commonly administered for thrombocytopenia that was generally mild. In this setting one platelet transfusion resulted in a median platelet count rise of 21 x109/L. Many transfusion episodes yielded no appreciable increase in platelet count. Further studies are needed to determine the clinical effects of platelet transfusion in this setting controlling for confounding. Disclosures: Heddle: CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees; Health Canada: Research Funding; Macopharma: Consultancy; ASH: Honoraria.

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

scholarly journals Telemedicine coverage for post-operative ICU patients

2016 ◽  
Vol 23 (2) ◽  
pp. 360-364 ◽  
Author(s):  
Tara Ann Collins ◽  
Matthew P Robertson ◽  
Corinna P Sicoutris ◽  
Michael A Pisa ◽  
Daniel N Holena ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Service ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surge Capacity ◽  
Icu Patients ◽  
Critical Care Service ◽  
Surgical Critical Care

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47–69) versus 58 (IQR 44–70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7–14) versus 15 (IQR 11–21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /–9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.

scholarly journals AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

2020 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Sebastian Hafner ◽  
Florian Balling ◽  
Eberhard Barth
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Acetylcholinesterase Activity ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Baseline Values

Abstract Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020

Bedside Videolaryngoscopic Assessment of Intubation Trauma

1989 ◽  
Vol 98 (8) ◽  
pp. 586-590 ◽  
Author(s):  
David M. Alessi ◽  
David G. Hanson ◽  
George Berci
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vocal Fold ◽  
Video Recording ◽  
Surgical Intensive Care Unit ◽  
Voice Rehabilitation ◽  
Surgical Intensive Care ◽  
Vocal Fold Paresis

Telescopic laryngoscopic examination was performed at the bedside after extubation in 29 consecutive surgical intensive care unit patients who required endotracheal intubation for more than 16 hours. The examinations were documented with a portable video recording system. The majority of patients exhibited evidence of acute endolaryngeal trauma. Vocal fold ulceration and vocal fold motion abnormalities were the most common lesions. Patients with abnormal larynges were followed up after discharge from the intensive care unit. Most of the identified injuries resolved without intervention. However, silent aspiration was identified frequently in patients with vocal fold paresis and was thought to be a significant factor in postoperative pulmonary complications. Early identification of significant laryngeal trauma and/or vocal fold paresis in critically ill patients is important for both postoperative pulmonary care and voice rehabilitation. This pilot study demonstrated that documentation of the laryngeal examination is feasible in critically ill patients in an intensive care unit setting.

scholarly journals Ramelteon for Decreasing Delirium in Surgical Intensive Care Unit Patients

2020 ◽  
Vol 11 ◽  
pp. 117955732095122
Author(s):  
Chelsea N Lopez ◽  
Amaris Fuentes ◽  
Atiya Dhala ◽  
Jonathan Balk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Median Number ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Objective ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Surgical Icu

In intensive care unit (ICU) patients, delirium contributes to prolonged hospitalization, long-term cognitive impairment and increased mortality. Sleep disturbance, a risk factor for delirium, has been attributed to impaired melatonin secretion in critically ill patients. Ramelteon, a synthetic melatonin receptor agonist, is indicated for insomnia; there is limited, but growing evidence, to support its use for the prevention of delirium. The primary objective of this study is to describe the use of ramelteon and the incidence of delirium, assessed by Confusion Assessment Method for the ICU (CAM-ICU) scores, in adult surgical ICU patients from May 22, 2016 to June 30, 2018. The primary endpoint is the number of delirium free days in the week prior to and post first ramelteon administration. A total of 231 patients were included in the study with 201 (87%) positive for delirium at least once during the study timeframe. The median number of CAM-ICU negative days in the week pre-ramelteon administration was 4 days (IQR 2-7 days) compared to 6 days (IQR 3-7 days) in the week post-first ramelteon administration ( P < .05). The time to CAM-ICU positive increased slightly to 3 days (IQR 1-7 days) following ramelteon initiation compared to 2 days (IQR 1-5 days) from initial ICU admission. Additionally, the median number of antipsychotic doses per patient decreased from 4 doses (IQR 1.25-14 doses) prior to ramelteon to 2 doses (IQR 1-4 doses) after ramelteon. Ramelteon administration was associated with a greater number of CAM-ICU negative days in surgical ICU patients. These findings describe a potential role for ramelteon in mitigating delirium in this patient population.

scholarly journals Efficacy of an 8-week Bedside Ultrasound Training Program for Surgical Residents in the Intensive Care Unit

2021 ◽  
Author(s):  
Kyoung Moo Im ◽  
Eun Young Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Training Program ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bedside Ultrasound ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Post Graduate ◽  
Surgical Residents

Abstract BackgroundBedside ultrasound has become one of the most important non-invasive and readily available diagnostic tools especially for critically ill patients. However, the current ultrasound training program is not standardized and is mostly unavailable to all surgical residents equally. The aim of this study was to assess and evaluate the effectiveness of our new training program in bedside ultrasound for surgical residents.MethodsPostgraduate residents (years 1 to 4) from the department of general surgery in a tertiary hospital attended the newly designed, 8-week training course in bedside ultrasound for critically ill patients at the surgical intensive care unit. Didactic and experimental lectures in basic ultrasound physics and machine usage were delivered, followed by daily hands-on ultrasound training to patients. Each participant prospectively documented their ultrasound findings and completed self-assessment of ultrasound skills using a Likert scale.Results44 residents were enrolled in the current study and only 36.4% of them were previously exposed to bedside ultrasound experience. Following the course completion, the proficiency levels and the objective structured assessment of ultrasound skill (OSAUS) scores showed significant improvement in all elements (P < 0.001). The mean differences in pre- and post-course score between post-graduate years were recorded, except for proficiency in peritoneal cavity (P = 0.163). Post-hoc analysis revealed that post-graduate year 2 residents showed a higher improvement in most elements. The training program showed improvement in post-course scores, whether or not residents had previous experience.ConclusionsOur results revealed that the knowledge and confidence of surgical residents in bedside ultrasound could be improved via short-term and impact training curriculum. The authors believe that such education should be encouraged for all surgical residents to enhance competency in performing bedside ultrasound evaluation of critically ill patients.

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