scholarly journals Aetiology of community-acquired pneumonia in the ICU setting and its effect on mortality, length of mechanical ventilation and length of ICU stay: a 1-year retrospective review

Critical Care ◽  
2014 ◽  
Vol 18 (S2) ◽  
Author(s):  
D Ryan ◽  
R Connolly ◽  
J Fennell ◽  
G Fitzpatrick
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Review ◽  
Community Acquired Pneumonia ◽  
Icu Stay ◽  
Length Of Icu Stay

scholarly journals Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 708 ◽  
Author(s):  
Harri Hemilä ◽  
Elizabeth Chalker
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Vitamin C ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Practical Significance ◽  
Controlled Trials ◽  
Elective Cardiac Surgery ◽  
Icu Stay ◽  
Length Of Icu Stay

A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.

scholarly journals Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Priyam Batra ◽  
Kapil Dev Soni ◽  
Purva Mathur
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

Off-Hours Admissions and Mortality in PICU Without 24-Hour Onsite Intensivist Coverage

2018 ◽  
Vol 35 (7) ◽  
pp. 694-699 ◽  
Author(s):  
Farah Chedly Thabet ◽  
Faisal Ahmed alHaffaf ◽  
Iheb Mohamed Bougmiza ◽  
Hend Ali Bafaqih ◽  
May Said Chehab ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Icu Stay ◽  
Risk Of Mortality ◽  
Public Holidays ◽  
Time Of Admission ◽  
Pediatric Icu ◽  
Length Of Icu Stay

Objective: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. Design: Prospective cohort study. Setting: A 34-bed tertiary PICU. Patients: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. Measurements and Main Results: A total of 1254 patients were nonelectively admitted to the PICU. They were categorized according to time of PICU admission as either office hours (07:30 to 16:30 from Sunday to Thursday and whenever an intensivist is present in the ICU) or off-hours (16:30 to 07:30, Friday and Saturday and public holidays). Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Risk of Mortality (PRISM2) score. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the PRISM2. The mortality observed in the office-hours group was 9.4% and in the off-hours group was 8.1%. The PRISM2-based SMR was 0.83 (95% confidence interval [CI]: 0.43-1.47) for the office-hours group and 0.68 (95% CI: 0.34-1.36) for the off-hours group. No significant differences in length of ICU stay or duration of mechanical ventilation were observed between patients admitted during off-hours and those admitted during office hours. In the logistic regression model, off-hours admission was not significantly associated with a higher mortality (odds ratio: 0.85, 95% CI: 0.57-1.27; P = .44). Conclusions: The absence of an in-house intensivist during off-hours is not associated with an increase in mortality, length of ICU stay, or duration of mechanical ventilation for patients admitted to our pediatric ICU.

The Total Inotrope Exposure Score: an extension of the Vasoactive Inotrope Score as a predictor of adverse outcomes after paediatric cardiac surgery

2017 ◽  
Vol 27 (6) ◽  
pp. 1146-1152 ◽  
Author(s):  
Harish Bangalore ◽  
Michael Gaies ◽  
Elena C. Ocampo ◽  
Jeffrey S. Heinle ◽  
Danielle Guffey ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Drug Exposure ◽  
Invasive Mechanical Ventilation ◽  
Study Cohort ◽  
Icu Stay ◽  
Average Maximum ◽  
Inotrope Score ◽  
Length Of Icu Stay

AbstractObjectiveThe aim of the present study was to explore and compare the association between a new vasoactive score – the Total Inotrope Exposure Score – and outcome and the established Vasoactive Inotrope Score in children undergoing cardiac surgery with cardiopulmonary bypassDesignThe present study was a single-centre, retrospective study.SettingThe study was carried out at a 21-bed cardiovascular ICU in a Tertiary Children’s Hospital between September, 2010 and May, 2011MethodsThe Total Inotrope Exposure Score is a new vasoactive score that brings together cumulative vasoactive drug exposure and incorporates dose adjustments over time. The performance of these scores – average, maximum Vasoactive Inotrope Score at 24 and 48 hours, and Total Inotrope Exposure Score – to predict primary clinical outcomes – either death, cardiopulmonary resuscitation, or extra-corporeal membrane oxygenation before hospital discharge – and secondary outcomes – length of invasive mechanical ventilation, length of ICU stay, and hospital stay – was calculated.Main resultsThe study cohort included 167 children under 18 years of age, with 37 (22.2%) neonates and 65 (41.3%) infants aged between 1 month and 1 year. The Total Inotrope Exposure Score best predicted the primary outcome (six of 167 cases) with an unadjusted odds ratio for a poor outcome of 42 (4.8, 369.6). Although the area under curve was higher than other scores, this difference did not reach statistical significance. The Total Inotrope Exposure Score best predicted prolonged invasive mechanical ventilation, length of ICU stay, and hospital stay as compared with the other scores.ConclusionThe Total Inotrope Exposure Score appears to have a good association with poor postoperative outcomes and warrants prospective validation across larger numbers of patients across institutions.

scholarly journals Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0248883
Author(s):  
Hilmi Demirkiran ◽  
Mehmet Kilic ◽  
Yakup Tomak ◽  
Tahir Dalkiran ◽  
Sadik Yurttutan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
University Hospitals ◽  
Icu Stay ◽  
Chronic Critical Illness ◽  
Length Of Icu Stay

Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children’s hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.

scholarly journals GASTROINTESTINAL BLEEDING;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Mujtaba Jaffary ◽  
Nida ◽  
Saeed Ahmad Khan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Gastrointestinal Bleeding ◽  
Mortality And Morbidity ◽  
Mechanically Ventilated ◽  
Icu Stay ◽  
Trust Hospital ◽  
Length Of Icu Stay ◽  
Duration Of Ventilation

Background: Gastrointestinal bleeding (GIB) among patients with critical illness is one of the leading sources of mortality and morbidity. The prevalence of GIB differs from 15-50 percent during first 24 hours stay in intensive care unit. Mechanical ventilation is a most leading risk factor of GIB among patients admitted in ICU (intensive care unit). Objectives: The objective of the study is to know the prevalence and risk factors associated with gastrointestinal bleeding among mechanically ventilated patients. Study Deign: Retrospectively study. Setting: Ch Rehmat Ali Memorial Trust Hospital, Lahore. Period: 1st October 2017 to 31st March 2018. Materials and Method: A group of 120 patients in intensive care unit who received mechanical ventilation for a period of 48 hours or above were included. Results: Among 56 patients with gastrointestinal bleeding, mean age was 49.2±12.1, mean length of ICU stay was 29.2±16.6 and mean duration of ventilation was 30.2±20.5. Among 64 patients with no gastrointestinal bleeding, mean age was 51.9±15.0, mean length of ICU stay was 12.7±6.8 and mean duration of ventilation was 13.5±7.9. There were 12 (21.1%) mortalities among patients with gastrointestinal bleeding and 10 (15.6%) mortalities among patients with no gastrointestinal bleeding. Conclusion: Study concluded that length of ICU stay, duration of ventilation, renal failure, liver failure and mortalities were more among patients with gastrointestinal bleeding.

scholarly journals Evaluating the Neuroprotective Effect of Melatonin on Patients with Hemorrhagic Stroke Using Serum S100B Protein as a Prognostic Marker

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hamidreza Sharifnia ◽  
Mojtaba Mojtahedzadeh ◽  
Mehrnoush Dianatkhah ◽  
Atabak Najafi ◽  
Arezoo Ahmadi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hemorrhagic Stroke ◽  
Neuroprotective Effect ◽  
Plasma Concentrations ◽  
Control Group ◽  
P Value ◽  
Neuroprotective Agents ◽  
Icu Stay ◽  
Baseline Values ◽  
Length Of Icu Stay

Background: Intracerebral hemorrhage (ICH) is one of the most debilitating kinds of stroke. Recent evidence shows that the proper initiation of neuroprotective agents might save at risk neurons and improve the outcome. Objectives: The focus of this study is to evaluate the neuroprotective effect of melatonin on patients with hemorrhagic stroke. Methods: Forty adult patients with confirmed nontraumatic ICH, who were admitted to the ICU within 24 hours of the stroke onset were enrolled in this study. Subjects in the melatonin group received 30 mg of melatonin every night for 5 consecutive nights. In order to evaluate the intensity of the neuronal injury, S100B was assessed once on day 1 and, day 5 post ICU admission. Additionally, the length of ICU stay, mortality, and the duration of mechanical ventilation were also recorded. Results: Forty patients completed the study. In both groups the plasma concentrations of S100B decreased after 5 days compared with their baseline values. However, this reduction was more significant in the melatonin compared to the control group (P-value < 0.05). The duration of mechanical ventilation and length of ICU stay was shorter in the melatonin group, and this difference was statistically significant for the length of ICU stay (P-value < 0.05), and marginally significant for the duration of mechanical ventilation (P-value = 0.065). The in-ICU mortality rate of the melatonin group was 15%, almost half of that of the control group (30%). However, this difference was not statistically significant. Conclusions: In conclusion, melatonin can be considered as a harmless and effective nueroprotective agent with some unique features which has made it an appropriate adjunctive medicine for critically ill intubated patients.

scholarly journals Clinical Characteristics, Risk Factors and Outcomes of Mixed Candida Albicans/Bacterial Bloodstream Infections

2020 ◽  
Author(s):  
Li Zhong ◽  
Shufang Zhang ◽  
Kankai Tang ◽  
Feifei Zhou ◽  
Cheng Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Candida Albicans ◽  
Bloodstream Infection ◽  
Multivariable Analysis ◽  
Bloodstream Infections ◽  
Coagulase Negative Staphylococcus ◽  
Prolonged Length ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Purpose: The purpose of this study was to explore the clinical features, risk factors, and outcomes of the mixed Candida albicans/bacterial bloodstream infections (mixed-CA/B-BSIs) compared with monomicrobial Candida albicans bloodstream infection (mono-CA-BSI) in adult patients in China.Methods: All adult hospitalized cases of Candida albicans bloodstream infection (CA-BSI) were recruited in the retrospective observational study from January 1, 2013, to December 31, 2018.Results: Of the 117 patients with CA-BSI, 24 patients (20.5%) were mixed-CA/B-BSIs. The most common co-pathogens were Coagulase-negative Staphylococcus (24.0%), followed by Klebsiella pneumoniae (20.0%) and Staphylococcus aureus (16.0%). In multivariable analysis, prior ICU stay>2days (adjusted odds ratio [OR], 7.808; 95% confidence interval [CI], 1.264-48.233) was an independent factor of mixed-CA/B-BSIs. In comparison with mono-CA-BSI, patients with mixed-CA/B-BSIs developed with prolonged length of mechanical ventilation [17.5(4.5,34.8) vs. 3.0(0.0,24.5), P=0.019], prolonged length of ICU stay [22.0(14.3, 42.2) vs. 8.0(0.0, 31.5), P=0.010], whereas the mortality was not significantly different. Conclusions: A high rate of mixed-CA/B-BSIs is among CA-BSI, and Coagulase-negative Staphylococcus is the predominant co-existed species. Prior ICU stay>2 days is an independent risk factor for mixed-CA/B-BSIs. Although there is no difference in mortality, the outcomes of patients with mixed-CA/B-BSIs including prolonged length of mechanical ventilation and prolonged length of ICU stay were worse than those with mono-CA-BSI, which deserves further attention of clinicians.

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