TRENDS OF VASOPRESSOR USING IN MEDICAL INTENSIVE CARE UNIT: A 7-YEAR COHORT STUDY

Objectives: The purpose of this study was to assess the impact of the injectable opioid drug shortage on analgesia and sedation management in the medical intensive care unit (MICU). Methods: A single-center, retrospective cohort study was conducted of mechanically ventilated patients during the injectable opioid shortage. Outcomes were compared between a cohort of patients during the intravenous (IV) opioid shortage (01/01/18-03/31/18) and a control cohort (01/01/17-03/31/17). Total IV opioids and alternative sedative administration were assessed. Richmond Agitation Sedation Score (RASS) and Clinical Pain Observation Score (CPOT) assessments were also evaluated. The primary outcome was percentage of RASS within goal. Secondary outcomes included duration of mechanical ventilation, hospital/ICU length of stay, and mortality. Results: One hundred patients were included (50 patients per cohort). In the shortage cohort, 23.2% fewer IV opioids were used (40 501.8 vs 52 713.8 oral morphine equivalents [OME]). No statistical differences were found in percentage of patients within goal RASS between the shortage and control (median 63.7% vs 74.8%; P = .094) or CPOT (median 49.7% vs 47.7%; P = .575). More patients received enteral opioids and propofol on day 1 in the shortage cohort when compared to the control (22% vs 4%; P = .007 and 76% vs 56%; P = .035) but there were no differences in benzodiazepine, dexmedetomidine, or antipsychotic use. No differences in mechanical ventilation, hospital/ICU length of stay, or mortality were found. Conclusions: Use of less IV opioids during the injectable opioid shortage did not affect achievement of goal RASS and CPOT scores or increase prescribing of sedative medications such as benzodiazepines in the MICU.

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Association of low alanine aminotransferase values with extubation failure in adult critically ill patients: A retrospective cohort study

10.21203/rs.3.rs-108276/v1 ◽

2020 ◽

Author(s):

Yoav Weber ◽

Danny Epstein ◽

Asaf Miller ◽

Gad Segal ◽

Gidon Berger

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Cohort Study ◽

Intensive Care ◽

High Risk ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Extubation Failure ◽

Medical Intensive Care ◽

Ventilated Patients

Abstract Background: Liberation from mechanical ventilation is a cardinal landmark during hospitalization of ventilated patients in intensive care units. Sufficient respiratory muscle strength and function are essential for successful extubation; therefore, decreased muscle mass and sarcopenia are associated with a high risk of failure. A low level of alanine aminotransferase (ALT) is a known biomarker of sarcopenia. This study was aimed to determine whether low levels of ALT are associated with increased risk of extubation failure among critically ill patients.Methods: This was a retrospective single-center cohort study of mechanically ventilated patients hospitalized in a medical intensive care unit and undergoing their first extubation. The primary outcome was extubation failure, which was defined as reintubation within seven days. Multivariable logistic regression was performed to determine whether ALT was an independent predictor of this outcome.Results: The study included 329 patients with a median age of 62.3 years (interquartile range [IQR] 48.13–71.16); 210 (63.83%) patients were at high risk for extubation failure and 83 (25.23%) failed the first extubation attempt. Low ALT values were more common among patients requiring reintubation (61.45% vs. 41.06%, P=0.002). Multivariable logistic regression analysis identified the age of 75 years or older and low ALT values as the only independent predictors of extubation failure, with adjusted odds ratio (OR) of 2.74 (95% confidence interval [CI] 1.23-6.11, p=0.01) and 2.14 (95% CI 1.16-3.96, p=0.02), respectively.Conclusions: Low ALT, an established biomarker of sarcopenia and frailty, is an independent risk factor for extubation failure among adult patients hospitalized in the medical intensive care unit. This simple laboratory parameter can be used as an effective adjunct predictor, along with other weaning parameters, and thereby facilitate the identification of high-risk patients.

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