Laboratory HIT Testing in Critically Ill Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 198-198
Author(s):  
Mark A. Crowther ◽  
Stephan Langevin ◽  
Jamie L Cooper ◽  
Peter Dodek ◽  
John Muscedere ◽  
...  
Keyword(s):  
Platelet Count ◽  
Venous Thrombosis ◽  
Critically Ill ◽  
Risk Score ◽  
Critically Ill Patients ◽  
Research Funding ◽  
Study Drug ◽  
Clinical Suspicion ◽  
Low Risk ◽  
Icu Patients

Abstract Abstract 198FN2 Introduction: Many critically ill patients are frequently suspected of having HIT because heparin exposure is nearly universal and up to 45% of medical-surgical ICU patients have a platelet count of less than 150 × 109. Methods: Our objectives were: (1) To estimate the incidence of suspected and objectively confirmed HIT; and (2) To evaluate whether a published clinical prediction rule (the 4T's score) reliably rules out HIT in ‘low risk' ICU patients. PROTECT was a multinational, concealed, stratified, randomized blinded trial enrolling medical-surgical critically ill patients to evaluate thromboprophylaxis with the low molecular weight heparin (LMWH) dalteparin 5,000U daily vs unfractionated heparin (UFH) 5,000 twice daily on the primary outcome of proximal leg deep vein thrombosis (DVT). Patients were evaluated for HIT and included in this HITEC Substudy if 1) their platelet count decreased to less than 50 × 109/L, 2) if there was an otherwise unexplained platelet count decrease to less than 50% of the patient's baseline (defined as the value found on the first platelet count after ICU admission as long as the count is >100 × 109/L), or 3) if venous thrombosis occurred, and 4) if HIT was otherwise suspected. There were 2 laboratory components to HIT testing (local and central). For local real-time clinical care, HIT was evaluated and treated as per local practice. Centrally, blood samples were analyzed at the laboratory of Dr Ted Warkentin at McMaster University. The 4Ts Score was completed by Research Coordinators (RCs) and by central adjudication. We defined HIT as a clinical suspicion of HIT and a positive serotonin release assay (SRA). Results: The PROTECT trial enrolled 3746 patients of whom 763 patients (397 allocated to UFH and 366 to LMWH) met HITEC enrollment criteria; 151 because of an absolute platelet count of less than 50×109, 253 because of a fall in their platelet count of greater than 50% from the time of ICU admission and 534 because venous thrombosis developed and 128 because of a clinical suspicion of HIT (categories are not mutually exclusive). Of these 763 patients, 475 had a central or local laboratory HIT test performed and were adjudicated. HIT was present in 15/3746 patients enrolled in the PROTECT study (0.4%, 95% CI 0.2% to 0.7%), and 15/475 (3.2%) with local or central testing, while 432 patients with RC 4Ts scores were matched to an adjudicated outcome. Using the 4Ts score, RCs and central adjudication classified patients as low risk (4Ts score of 3 or less) in 71.1% and 86.3% of cases, respectively, moderate risk (score or 4 or 5) in 25.7% and 12.0% of cases, and high risk (score of 6 or more) in 3.2% and 1.7% of cases. There was a good correlation between a low pretest probability according to the RCs' scores and the absence HIT (prevalence of adjudication confirmed HIT 1.6% (95% CI 0.5 to 3.7%).There was a moderate correlation between a low pretest probability according to central adjudication and the absence HIT (prevalence of adjudication confirmed HIT 2.6% (1.3 to 4.7%). Discussion: HIT occured in less than 1% of medical-surgical critically ill patients, and in 3% of patients who had at least one criterion to suspect HIT. We failed to confirm our pre-specified criteria for successful implementation of the 4T's score (that the upper boundary the 95% confidence interval about the proportion of patients with confirmed HIT and a low 4Ts score was less than 3%) and thus we conclude that use of the 4Ts score does not rule out the presence of platelet-activating antibodies in medical surgical critically ill patients with clinically suspected HIT; SRA testing is recommended. Funding: Canadian Institutes for Health Research and Heart and Stroke Foundation of Canada Disclosures: Crowther: CSL Behring: Consultancy; Leo Pharma: Consultancy, Research Funding; BI: Research Funding; Bayer: Research Funding; Pfizer: Consultancy, Research Funding; Octapharm: Consultancy; Artisan: Consultancy. Off Label Use: Dalteparin is not indicated for prolonged DVT prophylaxis in medical intensive care unit patients. Zytaruk:Pfizer: donated study drug dalteparin for PROTECT. Cook:Pfizer: donated study drug dalteparin for PROTECT. Warkentin:GTI Diagnostics: Consultancy, Research Funding; GlaxoSmithKline: Consultancy, Research Funding; Pfizer Canada: Speakers Bureau; Sanofi-Aventis: Speakers Bureau; Informa: Patents & Royalties; Canyon Pharma: Consultancy, Speakers Bureau.

VTE Prophylaxis with Desirudin in Patients with Thrombocytopenia: Insights From the DESIRABLE Trial,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3293-3293
Author(s):  
Jerrold H Levy ◽  
Nigel S. Key ◽  
Andrew F Shorr ◽  
Michael A Kurz ◽  
Victor J. Marder
Keyword(s):  
Platelet Count ◽  
Case Report ◽  
Adverse Events ◽  
Critically Ill ◽  
Major Bleeding ◽  
Critically Ill Patients ◽  
Safety Profile ◽  
Study Drug ◽  
Serious Adverse Events ◽  
Vte Prophylaxis

Abstract Abstract 3293 Background: Prophylaxis for venous thromboembolism (VTEP) is recommended for critically ill patients with limited mobility or those undergoing major surgery. Commonly used agents are heparin-based therapies (unfractionated or low-molecular-weight heparin (H); fondaparinux) which are of limited utility in patients with thrombocytopenia (TCP) due to concerns about bleeding risk and the possibility of heparin-induced thrombocytopenia (HIT). The DESIRABLE trial was designed to examine the safety profile of desirudin (Iprivask®, recombinant hirudin), the only parenteral heparin alternative approved for VTEP in the US, in a broad range of perioperative and critically ill patients requiring VTEP. DESIRABLE was a multicenter, open-label, single-arm study which enrolled 516 subjects at 19 centers. Desirudin was administered for as long as clinically required at 15 mg Q12H SC. Patients with uncontrolled bleeding were excluded. The primary endpoint was Major Bleeding; secondary endpoints included incidence of new symptomatic VTE. The present analysis was performed to evaluate the safety profile of desirudin in DESIRABLE patients who were thrombocytopenic at enrollment. Methods: Case report forms were reviewed to identify subjects with TCP, defined as having a platelet count of <150 × 106/mL. Demographic characteristics, incidence of Major Bleeding, VTE, and serious adverse events were determined for comparison to the overall cohort. Results: Analysis of case report forms identified 93 subjects with TCP (<150 × 106/mL), 50 (54%) of whom had a platelet count <100 × 106/mL. Compared to subjects with normal platelet counts, TCP subjects were older (median age 66 vs. 59), more likely to be male (65% vs 34%) and underweight (BMI <25: 37% vs 23%), and less likely to be morbidly obese (BMI >35, 14% vs 31%). TCP subjects were also more likely to have a recent (<3 months or concurrent) history of cardiac surgery (CABG or valve, 24% vs 3%), coronary artery disease (47% vs 20%), congestive heart failure (18% vs 7%) and/or atrial fibrillation (16% vs 4%). HIT was suspected in 27 (29%) of TCP subjects, although the presence of HIT was not confirmed by SRA testing. No subjects had clinical evidence of thrombosis at enrollment. Treatment duration was similar between TCP subjects and the overall cohort (5.1±3.3 days vs 4.9±3.2 days, p=NS). The incidence of new VTE was similar between TCP and non-TCP subjects: 2 (2.2%) TCP subjects developed a VTE vs 6 of 423 non-TCP subjects (1.4%, p=NS). There were no bleeding events meeting criteria for the Primary Endpoint in either group. Serious adverse events occurred in 16 (17%) TCP subjects, all considered unrelated to study drug. Serious adverse events were reported in 64 (15%) non-TCP subjects, 5 of which were considered “possibly related” to study drug. Conclusions: DESIRABLE demonstrated the clinical utility and safety of desirudin in a broad population of critically ill perioperative and medical patients. The present subanalysis indicates that this finding holds true for hospitalized TCP patients, suggesting that desirudin may be a useful alternative for VTE prophylaxis patients for whom HIT is suspected or heparin-based therapies are considered inappropriate. Additional randomized trials in TCP patients are needed to confirm these findings. Disclosures: Levy: Canyon Pharmaceuticals: Consultancy. Off Label Use: Desirudin is approved for VTE prophylaxis following elective hip arthroplasty. Data presented may describe use of desirudin for VTE prophylaxis in patients who did not undergo total hip arthroscopy. Kurz:Canyon Pharmaceuticals: Employment. Marder:Canyon Pharmaceuticals: Clinical Trial Steering Committee.

Inter-Rater Reliability of the 4Ts Scoring System for Diagnosing Heparin-Induced Thrombocytopenia in Critically Ill Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3995-3995 ◽  
Author(s):  
Mark A. Crowther ◽  
Nicole Zytaruk ◽  
Katherine Krolicki ◽  
Suzanne Duchesne ◽  
Theodore E. Warkentin ◽  
...  
Keyword(s):  
Platelet Count ◽  
Board Of Directors ◽  
Critically Ill ◽  
Scoring System ◽  
Research Funding ◽  
Advisory Committees ◽  
Icu Patients ◽  
Heparin Induced Thrombocytopenia ◽  
Surgical Icu ◽  
Stage 1

Abstract Abstract 3995 Poster Board III-931 Heparin-induced thrombocytopenia (HIT) is commonly suspected, but rarely confirmed, in the critically ill. The lack of readily available rapid diagnostic tests makes the timely diagnosis of HIT challenging. As a result, when HIT is suspected, heparin is often stopped and an alternative anticoagulant is initiated until diagnostic test results become available. A valid scoring system that accurately predicts the likelihood of HIT would be very valuable since it would allow rapid risk stratification that then might allow treatment to be modified in patients at moderate or high risk of harboring HIT, while other strategies might be employed for those at low risk. The 4Ts scoring system has been proposed as such a classification. 4Ts classifies patients on a 4 component, 8 point linear scale. The final score is assigned to 1 of 3 categories representing low, moderate and hand high pretest probability (scores of 0 to 3, 4 to 5 and 6 or more, respectively). We describe results of a pilot study using the 4Ts scoring system within the PROTECT trial (a 3650 patient randomized controlled trial comparing low molecular weight with unfractionated heparin for primary prevention of venous thromboembolism (VTE) in medical-surgical ICU patients). As per the PROTECT protocol, patients are evaluated for HIT if their platelet count falls more than 50% from their initial platelet count (study day 1), if their platelet count falls to less than 50 × 109/l, if VTE occurs, or if HIT is clinically suspected. As of August 6th, 2009, 2657 patients had been enrolled in PROTECT, of whom 523 (19.7%) met criteria for investigation of HIT (170 due to a platelet count fall; 106 due to a platelet count of less than 50×109/l; 343 due to VTE; and 39 due to clinical suspicion (categories not mutually exclusive)). All suspected cases of HIT are to be evaluated using the serotonin release assay (SRA), with HIT confirmed if the HIT test is positive, or HIT refuted if the SRA is negative. To evaluate the 4Ts score, patients are adjudicated independently by 2 experts blinded to each other's scores (MC, hematologist and DC, intensivist). The adjudication occurs in 2 stages: in Stage 1 the clinical case is reviewed and a 4Ts score assigned, masked to SRA testing; in Stage 2 the presence or absence of HIT is ascribed based on review of the patient's laboratory data. Discordant cases are then discussed and consensus achieved. To August 6th, 2009 100 cases have been adjudicated and consensus achieved. Stage 1 raw agreement on the 4Ts score was poor (raw agreement 47.0%). Stage 1 agreement on risk category (low, moderate or high) was better (77%, weighted kappa 0.36 (0.10 to 0.61) reflecting fair agreement). Discordance was largely due to differences in the timing component of the 4Ts score (raw agreement 77%) and the “other” potential cause of thrombocytopenia component (raw agreement 61%). Agreement for the degree of thrombocytopenia and thrombosis components was excellent (92% and 93%, respectively). We conclude that inter-rater reliability of the 4Ts score in medical-surgical ICU patients is fair overall. Additional calibration work or modification of the scoring system is required if 4Ts is to be widely used to accurately predict HIT in critically ill patients. This poster is p Disclosures: Crowther: Sanofi-Aventis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Leo Pharma: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BI: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Artisan Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees.

scholarly journals The laboratory findings and different COVID-19 severities: a systematic review and meta-analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Erfan Kazemi ◽  
Reihane Soldoozi Nejat ◽  
Fatemeh Ashkan ◽  
Hossein Sheibani
Keyword(s):  
Systematic Review ◽  
Platelet Count ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lymphocyte Count ◽  
Leukocyte Count ◽  
Mean Value ◽  
The Other ◽  
Invasive Ventilation ◽  
Laboratory Findings

Abstract Background Abnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to investigate the effect of the level of some laboratory factors (C-reactive protein (CRP), creatinine, leukocyte count, hemoglobin, and platelet count) on the severity and outcome of coronavirus disease 2019 (COVID-19). Methods We searched PubMed, Web of Science, Scopus, and Google Scholar. We collected the articles published before May 26, 2020. We gathered the laboratory factors in groups of patients with COVID-19, and studied the relation between level of these factors with severity and outcome of the disease. Results Mean CRP level, creatinine, hemoglobin, and the leukocytes count in the critically ill patients were significantly higher than those of the other groups (non-critical patients); mean CRP = 54.81 mg/l, mean creatinine = 86.82 μmol/l, mean hemoglobin = 144.05 g/l, and mean leukocyte count = 7.41 × 109. The lymphocyte count was higher in patients with mild/moderate disease (mean: 1.32 × 109) and in the invasive ventilation group (mean value of 0.72 × 109), but it was considerably lower than those of the other two groups. The results showed that the platelet count was higher in critically ill patients (mean value of 205.96 × 109). However, the amount was lower in the invasive ventilation group compared with the other groups (mean level = 185.67 × 109). Conclusion With increasing disease severity, the leukocyte count and the level of CRP increase significantly and the lymphocyte count decreases. There seems to be a significant relation between platelet level, hemoglobin, and creatinine level with severity of the disease. However, more studies are required to confirm this.

scholarly journals Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses to Reduce Nonbeneficial Intensive Care Unit Treatments: Protocol for a Multicenter Quality Improvement Study (Preprint)

2019 ◽  
Author(s):  
Dong Chang ◽  
Jennifer Parrish ◽  
Nader Kamangar ◽  
Janice Liebler ◽  
May Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Care Planning ◽  
Improvement Strategy ◽  
Icu Patients ◽  
Family Meetings ◽  
Planning Approach ◽  
Icu Physicians

BACKGROUND Invasive intensive care unit (ICU) treatments for patients with advanced medical illnesses and poor prognoses may prolong suffering with minimal benefit. Unfortunately, the quality of care planning and communication between clinicians and critically ill patients and their families in these situations are highly variable, frequently leading to overutilization of invasive ICU treatments. Time-limited trials (TLTs) are agreements between the clinicians and the patients and decision makers to use certain medical therapies over defined periods of time and to evaluate whether patients improve or worsen according to predetermined clinical parameters. For patients with advanced medical illnesses receiving aggressive ICU treatments, TLTs can promote effective dialogue, develop consensus in decision making, and set rational boundaries to treatments based on patients’ goals of care. OBJECTIVE The aim of this study will be to examine whether a multicomponent quality-improvement strategy that uses protocoled TLTs as the default ICU care-planning approach for critically ill patients with advanced medical illnesses will decrease duration and intensity of nonbeneficial ICU care without changing hospital mortality. METHODS This study will be conducted in medical ICUs of three public teaching hospitals in Los Angeles County. In Aim 1, we will conduct focus groups and semistructured interviews with key stakeholders to identify facilitators and barriers to implementing TLTs among ICU patients with advanced medical illnesses. In Aim 2, we will train clinicians to use protocol-enhanced TLTs as the default communication and care-planning approach in patients with advanced medical illnesses who receive invasive ICU treatments. Eligible patients will be those who the treating ICU physicians consider to be at high risk for nonbeneficial treatments according to guidelines from the Society of Critical Care Medicine. ICU physicians will be trained to use the TLT protocol through a curriculum of didactic lectures, case discussions, and simulations utilizing actors as family members in role-playing scenarios. Family meetings will be scheduled by trained care managers. The improvement strategy will be implemented sequentially in the three participating hospitals, and outcomes will be evaluated using a before-and-after study design. Key process outcomes will include frequency, timing, and content of family meetings. The primary clinical outcome will be ICU length of stay. Secondary outcomes will include hospital length of stay, days receiving life-sustaining treatments (eg, mechanical ventilation, vasopressors, and renal replacement therapy), number of attempts at cardiopulmonary resuscitation, frequency of invasive ICU procedures, and disposition from hospitalization. RESULTS The study began in August 2017. The implementation of interventions and data collection were completed at two of the three hospitals. As of September 2019, the study was at the postintervention stage at the third hospital. We have completed focus groups with physicians at each medical center (N=29) and interviews of family members and surrogate decision makers (N=18). The study is expected to be completed in the first quarter of 2020, and results are expected to be available in mid-2020. CONCLUSIONS The successful completion of the aims in this proposal may identify a systematic approach to improve communication and shared decision making and to reduce nonbeneficial invasive treatments for ICU patients with advanced medical illnesses. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16301

scholarly journals Low albumin levels are associated with poorer outcomes in a case series of COVID-19 patients in Spain: a retrospective cohort study

2020 ◽  
Author(s):  
Roberto de la Rica ◽  
Marcio Borges ◽  
María Aranda ◽  
Alberto del Castillo ◽  
Antonia Socias ◽  
...  
Keyword(s):  
Disease Severity ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Limited Information ◽  
Icu Patients ◽  
Epidemiological Features ◽  
Initial Symptoms

ABSTRACTOBJECTIVETo describe the clinical characteristics and epidemiological features of severe (non-ICU) and critically patients (ICU) with COVID-19 at triage, prior hospitalization, in one of the main hospitals in The Balearic Islands health care system.DESIGNRetrospective observational studySETTINGSon Llatzer University Hospital in Palma de Mallorca (Spain)PARTICIPANTSAmong a cohort of 52 hospitalized patients as of 31 March 2020, 48 with complete demographic information and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test, were analyzed. Data were collected between March 15th, 2020, and March 31th 2020, inclusive of these dates.MAIN OUTCOMESClinical, vital signs and routine laboratory outcomes at the time of hospitalization, including symptoms reported prior to hospitalization. Demographics and baseline comorbidities were also collected. Mortality was reported at the end of the study.RESULTS48 patients (27 non-ICU and 21 ICU) resident in Mallorca, Spain (mean age, 66 years, [range, 33-88 years]; 67% males) with positive SARS-CoV-2 infection were analyzed. There were no differences in age or sex among groups (p >.05). Initial symptoms included fever (100%), coughing (85%), dyspnea (76%), diarrhea (42%) and asthenia (21%). The majority of patients in this case series were hospitalized because of low SpO2 (SpO2 below 90%) and presentation of bilateral pneumonia (94%) at triage. ICU patients had a higher prevalence of dyspnea compared to non-ICU patients (95% vs 61%, p = .022). Acute respiratory syndrome (ARDS) was presented in 100% of the ICU-patients. All the patients included in the study required oxygen therapy. ICU-patients had lymphopenia as well as hypoalbuminemia. Inflammatory markers such as lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin were significantly higher in ICU patients compared to non-ICU (p < .001).Lower albumin levels were associated with poor prognosis measured as longer hospital length (r= −0.472, p <.001) and mortality (r= −0.424, p=.003). Interestingly we also found, that MCV was lower among of those patients who died (p=.0002). As of April 28, 2020, 10 patients (8 ICU and 2 non-ICU) had died (21% mortality) and while 100% of the non-ICU patients had been discharged, 33% of ICU patients still remained hospitalized (5 in ICU and 2 had been transferred to ward).CONCLUSIONCritically ill patients with COVID-19 present lymphopenia, hypoalbuminemia as well high levels of inflammation. Lower levels of albumin were associated with poorer outcomes in COVID-19 patients. Albumin might be of importance because of its association with disease severity in patients infected with SARS-CoV-2.WHAT IS ALREADY KNOWN IN THIS TOPICSpain has been hit particularly hard by the pandemic. By the time that this manuscript was written more than 25.000 deaths related to COVID-19 have been confirmed. There is limited information available describing the clinical and epidemiological features of Spanish patients requiring hospitalization for COVID-19. Also, it is important to know the characteristics of the hospitalized patients who become critically illWHAT THIS STUDY ADDSThis small case series provides the first steps towards a comprehensive clinical characterization of severe and critical COVID-19 adult patients in Spain. The overall mortality in our patients was 21%. To our knowledge this is the first report with reporting these features in Spain. At triage the majority of patients had lower SpO2 (<90%) and bilateral pneumonia. The most common comorbidities were hypertension (70%), dyslipidemia (62%) and cardiovascular disease (30%). Critically ill patients present hypoalbuminemia and lymphopenia, as well as higher levels of inflammation. Albumin might be of importance because of its association with disease severity and mortality in patients infected with SARS-CoV-2.

scholarly journals Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

2021 ◽  
Author(s):  
Reetu Verma ◽  
Sasmita Panda ◽  
Rajeev Kumar Nishad
Keyword(s):  
Intensive Care ◽  
Environmental Factors ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Common Cause

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

Abstract 13704: Simulation-based Uptraining Improves Provider Comfort in the Management of Critically Ill Patients With Covid-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
James M Horowitz ◽  
Eugene Yuriditsky ◽  
Sunil Nair ◽  
Brian S Kaufman
Keyword(s):  
Critically Ill ◽  
Nurse Practitioners ◽  
Critically Ill Patients ◽  
Simulation Training ◽  
Icu Patients ◽  
Large Numbers ◽  
Simulation Based ◽  
Critical Care Ultrasound ◽  
Simulation Session ◽  
Icu Physicians

Introduction: The COVID-19 surge at our institution required deployment of large numbers of non-intensive care unit (ICU) physicians and advanced practice providers to assist in the management of the critically ill. A 3-hour “uptraining” simulation session was offered to these providers that focused on various aspects of ICU care. Hypothesis: We hypothesized that following a 3-hour simulation session, providers would feel more comfortable in managing critically-ill patients with COVID-19. Methods: One hundred and seventy-five providers underwent a 3-hour simulation-based session focused on management of shock, acute respiratory distress syndrome, and critical care ultrasound. All participants were sent surveys to assess their comfort with various aspects of ICU care following return to their usual work environments. Results: One hundred and eight providers of 175 (62%) completed the surveys. Cardiology fellows and faculty accounted for 36% of the responders, acute care nurse practitioners (NPs) accounted for 16%, while other NPs, residents, and fellows accounted for the remainder. Prior to simulation training, 31% regularly managed patients in the ICU and 28% occasionally managed ICU patients. Following training, 71% of participants were deployed to a COVID-19 ICU as part of their workflow. Overall, 104/108 responders (96%) felt training either significantly or somewhat improved their knowledge in the management of ICU patients. Ninety-four participants (91%) felt training impacted their care of critically ill patients with COVID-19. Table 1 is a display of specific ICU skillsets taught in the session and if the participants felt better equipped to utilize what was covered post deployment. Conclusions: Simulation-based training improved provider comfort in the management of critically ill patients with COVID-19. Table 1: Participants response to “if they felt better equipped to utilize ICU skills following simulation training”

scholarly journals Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

2020 ◽  
Vol 8 (2) ◽  
pp. 287 ◽  
Author(s):  
Georgios Papathanakos ◽  
Ioannis Andrianopoulos ◽  
Athanasios Papathanasiou ◽  
Efthalia Priavali ◽  
Despoina Koulenti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Problem ◽  
Hospital Infections ◽  
Colistin Resistance ◽  
Icu Patients ◽  
Icu Admission ◽  
Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

scholarly journals Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2616
Author(s):  
M Bordejé ◽  
Juan Montejo ◽  
M Mateu ◽  
Manuel Solera ◽  
Jose Acosta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urinary Catheter ◽  
Abdominal Pressure ◽  
Icu Patients ◽  
Group A ◽  
Group B ◽  
Low Sensitivity

To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

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