Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

Abstract Background Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients. Methods Adult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed. Results A total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065). Conclusions Compared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.

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Anticonvulsants: Pharmacotberapeutic Issues in the Critically Ill Patient

AACN Advanced Critical Care ◽

10.4037/15597768-1991-4004 ◽

1991 ◽

Vol 2 (4) ◽

pp. 639-656 ◽

Cited By ~ 2

Author(s):

Robert E. Dupuis ◽

Jorge Miranda-Massari

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Setting ◽

Critical Care Setting ◽

Critically Ill Patient ◽

Care Nurse ◽

Critical Care Nurse ◽

Epilepsy Treatment

Critically ill patients often have or develop conditions that make them susceptible to seizures and epilepsy. Treatment frequently involves the use of anticonvulsants. In order to use these effectively, the critical care nurse must be aware of the indications and controversies surrounding their use, the pathophysiologic conditions that impact on the disposition, and appropriate dosing and monitoring of these agents in the critical care setting

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The effect of opioids on gastrointestinal function in the ICU

Critical Care ◽

10.1186/s13054-021-03793-1 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Yun Yan ◽

Yu Chen ◽

Xijing Zhang

Keyword(s):

Critical Care ◽

Clinical Outcomes ◽

Critically Ill ◽

Potential Risk ◽

Critically Ill Patients ◽

Care Setting ◽

Critical Care Setting ◽

Gastrointestinal Function ◽

Opioid Antagonists

AbstractGastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

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Updates in Nutrition Support for Critically III Adult Patients

Hospital Pharmacy ◽

10.1310/hpj5201-17 ◽

2017 ◽

Vol 52 (1) ◽

pp. 17-26 ◽

Cited By ~ 3

Author(s):

Diana Wells Mulherin ◽

Sarah V. Cogle

Keyword(s):

Critical Care ◽

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Setting ◽

Hospital Pharmacist ◽

Critical Care Medicine ◽

Critical Care Setting ◽

Nutrition Support ◽

American Society

Specialized nutrition support is often employed in critically ill patients who are unable to maintain volitional intake. The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently updated guidelines for the provision of nutrition support in critically ill patients. The purpose of this review is to summarize key changes from the previous guidelines as they relate to recently published literature, which will aid the hospital pharmacist in optimizing nutrition support therapies in the critical care setting.

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Academic education. Creating a laboratory that simulates the critical care environment

Critical Care Nurse ◽

10.4037/ccn1996.16.6.76 ◽

1996 ◽

Vol 16 (6) ◽

pp. 76-81 ◽

Cited By ~ 23

Author(s):

PG Morton

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Setting ◽

Teaching Method ◽

Critical Care Setting ◽

Academic Education ◽

Clinical Experiences ◽

Care Environment ◽

Excellent Teaching

Educating students and practicing nurses for the complexities and demands of critical care is a challenge. Training in a laboratory that simulates the critical care setting is an excellent teaching method that can be used to supplement lectures and clinical experiences. Developing such a laboratory is an exciting and rewarding process that will promote learning and ultimately benefit the care of critically ill patients.

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Psychopharmacology in the Critical Care Setting

10.1093/oso/9780190077013.003.0011 ◽

2021 ◽

pp. 235-250

Author(s):

Sandeep Nayak ◽

Jonathan Brigham ◽

Ted Avi Gerstenblith ◽

Elizabeth Prince

Keyword(s):

Critical Care ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Setting ◽

Psychotropic Medications ◽

Oral Medication ◽

Critical Care Setting ◽

Confounding Factors

Psychotropic medications can be a powerful tool for enabling treatment of critically ill patients. However, a careful approach to psychopharmacology is necessary in the critical care setting. Special considerations include interactions with other medications and treatments, high levels of physiologic stress that alter metabolism, and the challenges of obtaining diagnostic clarity due to limitations in assessment and confounding factors during critical illness. This chapter outlines common consult questions posed by intensive care teams to psychiatry consultation teams, including management of agitation and sedation, poor participation in care, anxiety, continuation of outpatient medication regimens, and alternatives to oral medication.

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Anticoagulation strategies in critical care for the treatment of atrial fibrillation: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-037591 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037591

Author(s):

Brian Johnston ◽

Alexandra Nelson ◽

Alicia C Waite ◽

Gedeon Lemma ◽

Ingeborg Welters

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Critical Care ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Setting ◽

Meta Analysis ◽

Risk Of Bias ◽

Critical Care Setting

IntroductionAtrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients and is associated with an increased risk of thromboembolic events and mortality. Oral anticoagulation for thromboembolism prophylaxis is a key component of managing AF in the general population and is recommended by National Institute for Health and Care Excellence guidelines. However, assessment tools used to aid decision making about anticoagulation have not yet been validated in the critical care setting. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes in critically ill patients with AF. We present a protocol for a systematic review and meta-analysis to evaluate the effectiveness of anticoagulation strategies for AF used specifically in critical care.Methods and analysisWe will conduct a systematic review of the literature by searching MEDLINE, EMBASE, CENTRAL and PubMed databases for articles published from January 1990 to October 2019. Studies reporting anticoagulation strategies for AF in adults (>18 years) admitted to a general critical care setting will be assessed for inclusion. Outcomes of interest will include (1) percentage of patients started on anticoagulation in critical care for AF, (2) incidence of thromboembolism, (3) incidence of bleeding events, (4) intensive care unit (ICU) mortality, (5) hospital mortality, (6) ICU length of stay and (7) hospital length of stay. We will conduct a meta-analysis of trials. Risk of bias will be assessed using the Cochrane Risk of Bias tool for randomised trials or the Newcastle-Ottawa Risk of Bias assessment tool for non-randomised studies. This protocol and subsequent systematic review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.Ethics and disseminationThis proposed systematic review will include data extracted from published studies; therefore, ethical approval is not required. The results of this review will be published in clinical specialty journals and presented at international meetings and conferences.Trial registration numberCRD42020158237.

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