Pro-enkephalin in plasma of surgical icu-patients with sepsis - a pilot study

Abstract Rationale: No published randomized trials have compared low molecular weight heparin (LMWH) to unfractionated heparin (UFH) for thromboprophylaxis in medical-surgical ICU patients. Objectives: A) Our Feasibility Objectives were to assess: 1) timely enrollment and complete, blinded study drug administration, 2) LMWH bioaccumulation in renal insufficiency, 3) twice weekly leg ultrasounds, and 4) recruitment rates for a future trial. B) Our Clinical Objectives were to assess 1) the effectiveness of LMWH vs UFH by estimating DVT, and pulmonary embolism (PE) rates, and 2) the safety of LMWH vs UFH regarding bleeding, thrombocytopenia and HIT. Methods: In this prospective randomized stratified concealed blinded multicenter trial, we included patients ≥18 with expected ICU stay ≥72h. We excluded trauma, orthopaedic, cardiac, or neurosurgery, severe hypertension, DVT, PE or hemorrhage within 3 mos, INR >2ULN, PTT >2ULN, platelets <100 x109/L, creatinine clearance <30ml/min, therapeutic anticoagulation, >2 doses of heparin, and palliative care patients. By centralized telephone randomization, we allocated patients to dalteparin 5,000 IU QD SC or UFH 5,000 IU BID SC. All clinicians caring for patients were blinded except the pharmacist. Bilateral leg compression ultrasounds were performed within 48h of ICU admission, twice weekly, on suspicion of DVT, and 7 days post ICU discharge. Results: A) Feasibility Objectives: 1) Timely, complete study drug administration occurred for >99% of scheduled doses; every dose was blinded. 2) No LWMH bioaccumulation was observed as measured by anti-Xa levels when creatinine clearance decreased to <30 ml/min. 3) Ultrasounds were performed without exception. 4) Estimated recruitment for a future trial is 4–5 patients/month/center. B) Clinical Objectives: 1) Effectiveness: Among 128 patients, 11 (8.6 %) had DVT, 2 (1.6 %) had PE. 2) Safety: 6 (4.7 %) had clinically important bleeds, 23 (18 %) had minor bleeds, 4 (3.1%) developed a platelet count <50 x109/L, and 2 (0.8%) had HIT diagnosed by serotonin release assay. Conclusions: DVT rates remain high in medical-surgical ICU patients despite universal heparin thromboprophylaxis. This pilot study suggests that a randomized clinical trial comparing LMWH vs UFH feasible. An adequately powered trial is needed to achieve the clinical objectives.

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Developing a mortality risk score for long-term surgical ICU patients: A pilot study

The American Journal of Surgery ◽

10.1016/j.amjsurg.2020.05.030 ◽

2020 ◽

Vol 220 (5) ◽

pp. 1368-1369

Author(s):

Justin S. Hatchimonji ◽

Andrew J. Young ◽

Kristina Dortche ◽

Brendon L. DiDonna ◽

Elizabeth A. Merulla ◽

...

Keyword(s):

Pilot Study ◽

Risk Score ◽

Mortality Risk ◽

Icu Patients ◽

Surgical Icu

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Utilizing Technology for Optimization of Pain Management and Mobilization in High Risk Cardiac Surgical ICU Patients

Case Medical Research ◽

10.31525/ct1-nct04146727 ◽

2019 ◽

Author(s):

Keyword(s):

Pain Management ◽

High Risk ◽

Icu Patients ◽

Surgical Icu

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Hospital acquired pressure injury prediction in surgical critical care patients

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01371-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jenny Alderden ◽

Kathryn P. Drake ◽

Andrew Wilson ◽

Jonathan Dimas ◽

Mollie R. Cummins ◽

...

Keyword(s):

Risk Assessment ◽

Model Performance ◽

Routine Care ◽

Predictor Variables ◽

Classification Algorithms ◽

Data Set ◽

Icu Patients ◽

Pressure Injury ◽

Surgical Icu ◽

Hospital Acquired

Abstract Background Hospital-acquired pressure injuries (HAPrIs) are areas of damage to the skin occurring among 5–10% of surgical intensive care unit (ICU) patients. HAPrIs are mostly preventable; however, prevention may require measures not feasible for every patient because of the cost or intensity of nursing care. Therefore, recommended standards of practice include HAPrI risk assessment at routine intervals. However, no HAPrI risk-prediction tools demonstrate adequate predictive validity in the ICU population. The purpose of the current study was to develop and compare models predicting HAPrIs among surgical ICU patients using electronic health record (EHR) data. Methods In this retrospective cohort study, we obtained data for patients admitted to the surgical ICU or cardiovascular surgical ICU between 2014 and 2018 via query of our institution's EHR. We developed predictive models utilizing three sets of variables: (1) variables obtained during routine care + the Braden Scale (a pressure-injury risk-assessment scale); (2) routine care only; and (3) a parsimonious set of five routine-care variables chosen based on availability from an EHR and data warehouse perspective. Aiming to select the best model for predicting HAPrIs, we split each data set into standard 80:20 train:test sets and applied five classification algorithms. We performed this process on each of the three data sets, evaluating model performance based on continuous performance on the receiver operating characteristic curve and the F1 score. Results Among 5,101 patients included in analysis, 333 (6.5%) developed a HAPrI. F1 scores of the five classification algorithms proved to be a valuable evaluation metric for model performance considering the class imbalance. Models developed with the parsimonious data set had comparable F1 scores to those developed with the larger set of predictor variables. Conclusions Results from this study show the feasibility of using EHR data for accurately predicting HAPrIs and that good performance can be found with a small group of easily accessible predictor variables. Future study is needed to test the models in an external sample.

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Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

Infection Control and Hospital Epidemiology ◽

10.1086/675292 ◽

2014 ◽

Vol 35 (3) ◽

pp. 243-250 ◽

Cited By ~ 23

Author(s):

Melissa A. Viray ◽

James C. Morley ◽

Craig M. Coopersmith ◽

Marin H. Kollef ◽

Victoria J. Fraser ◽

...

Keyword(s):

At Risk ◽

Staphylococcus Aureus ◽

Tertiary Care ◽

Control Unit ◽

Post Intervention ◽

Icu Patients ◽

Chlorhexidine Bathing ◽

Before And After ◽

Surgical Icu ◽

Time Series Methodology

Objective.Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.Design.Prospective pre-post-intervention study with control unit.Setting.A 1,250-bed tertiary care teaching hospital.Patients.Medical and surgical ICU patients.Methods.Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.Results.The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, −2.62 [95% confidence interval (CI), −5.19 to −0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, −11.10 [95% CI, −37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, −7.25 to −0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).Conclusions.Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.

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