scholarly journals Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit

Critical Care ◽  
2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Eli J. Finkelsztein ◽  
Daniel S. Jones ◽  
Kevin C. Ma ◽  
Maria A. Pabón ◽  
Tatiana Delgado ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Outcomes

Hyperoxia is associated with adverse outcomes in the cardiac intensive care unit: insights from the Medical Information Mart for Intensive Care (MIMI-III) database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.Y Lui ◽  
L Garber ◽  
M Vincent ◽  
L Celi ◽  
J Masip ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Positive Pressure ◽  
Cardiac Intensive Care Unit ◽  
Multivariable Logistic Regression ◽  
Cardiac Intensive Care

Abstract Background Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU). Methods Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 >120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP. Results Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002). Conclusions In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted. Funding Acknowledgement Type of funding source: None

scholarly journals Prolonged Central Venous Desaturation Measured by Continuous Oximetry Is Associated with Adverse Outcomes in Pediatric Cardiac Surgery

2011 ◽  
Vol 115 (5) ◽  
pp. 1033-1043 ◽  
Author(s):  
Ryan Crowley ◽  
Elizabeth Sanchez ◽  
Jonathan K. Ho ◽  
Kate J. Lee ◽  
Johanna Schwarzenberger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Adverse Outcomes ◽  
Central Venous ◽  
Major Adverse Events

Background The role of continuous central venous oxygen saturation (ScvO₂) oximetry during pediatric cardiac surgery for predicting adverse outcomes is not known. Using a recently available continuous ScvO₂ oximetry catheter, we examined the association between venous oxygen desaturations and patient outcomes. We hypothesized that central venous oxygen desaturations are associated with adverse clinical outcomes. Methods Fifty-four pediatric patients undergoing cardiac surgery were prospectively enrolled in an unblinded observational study. ScvO₂ was measured continuously in the operating room and for up to 24 h post-Intensive Care Unit admission. The relationships between ScvO₂ desaturations, clinical outcomes, and major adverse events were determined. Results More than 18 min of venous saturations less than 40% were associated with major adverse events with 100% sensitivity and 97.6% specificity. Significant correlations resulted between the ScvO₂ area under the curve less than 40% and creatinine clearance at 12 h in the Intensive Care Unit (r = -0.58), Intensive Care Unit length of stay (r = 0.56), max inotrope use (r = 0.52), inotrope use at 24 h (r = 0.40), inotrope index score (r = 0.39), hospital length of stay (r = 0.36), and length of intubation (r = 0.32). Conclusions We demonstrate that ScvO₂ desaturations by continuous oximetry are associated with major adverse events in pediatric patients undergoing cardiac surgery. The most significant associations with major adverse events are seen in patients with greater than 18 min of central venous saturations less than 40%. Our results support the further investigation of ScvO₂ as a potential target parameter in high-risk pediatric patients to minimize the risk of major adverse events.

Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system

2011 ◽  
Vol 7 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Vincent Liu ◽  
Patricia Kipnis ◽  
Norman W. Rizk ◽  
Gabriel J. Escobar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Healthcare System ◽  
Adverse Outcomes ◽  
Integrated Healthcare

scholarly journals Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series

2020 ◽  
Author(s):  
Anne M Hause ◽  
Lakshmi Panagiotakopoulos ◽  
Eric S Weintraub ◽  
Lina S Sy ◽  
Sungching C Glenn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Syncytial Virus ◽  
Respiratory Failure ◽  
Virus Infection ◽  
Respiratory Syncytial Virus Infection ◽  
Case Series ◽  
Adverse Outcomes ◽  
Syncytial Virus

Abstract We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.

scholarly journals Goldilocks, the Three Bears and Intensive Care Unit Utilization: Delivering Enough Intensive Care But Not Too Much. A Narrative Review

2020 ◽  
Vol 6 (1) ◽  
pp. 23-33
Author(s):  
Laura C. Myers ◽  
Gabriel Escobar ◽  
Vincent X. Liu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Safety Concern ◽  
Physician Behavior ◽  
The United States ◽  
Adverse Outcomes ◽  
Hospital Policy ◽  
Local Resources ◽  
Unit Capacity ◽  
High Intensive Care Unit

AbstractProfessional societies have developed recommendations for patient triage protocols, but wide variations in triage patterns for many acute conditions exist among hospitals in the United States. Differences in hospitals’ triage patterns can be attributed to factors such as physician behavior, hospital policy and real-time conditions such as intensive care unit capacity. The patient safety concern is that patients evaluated for admission to the intensive care unit during times of high intensive care unit capacity may have adverse outcomes related to delays in care. Because standardization of a national triage policy is not feasible due to differing resources available at each hospital, local guidelines should prevail that take into account hospitals’ local resources. The goal would be to better match intensive care unit bed supply with demand.

scholarly journals Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2152 ◽  
Author(s):  
Ming-Hung Tsai ◽  
Hui-Chun Huang ◽  
Yun-Shing Peng ◽  
Yung-Chang Chen ◽  
Ya-Chung Tian ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Variceal Bleeding ◽  
Assessment Tool ◽  
Prognostic Significance ◽  
Adverse Outcomes ◽  
Nutrition Risk ◽  
Cirrhotic Patients

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care unit (ICU) patients. This retrospective study was conducted to evaluate the prevalence and prognostic significance of nutrition risk in cirrhotic patients with acute gastroesophageal variceal bleeding (GEVB) using mNUTRIC scores computed on admission to the intensive care unit. The major outcome was 6-week mortality. One-hundred-and-thirty-one admissions in 120 patients were analyzed. Thirty-eight percent of cirrhotic patients with acute GEVB were categorized as being at high nutrition risk (a mNUTRIC score of ≥5). There was a significantly progressive increase in mortality associated with the mNUTRIC score (χ2 for trend, p < 0.001). By using the area under a receiver operating characteristic (ROC) curve, the mNUTRIC demonstrated good discriminative power to predict 6-week mortality (AUROC 0.859). In multivariate analysis, the mNUTRIC score was an independent factor associated with 6-week mortality. In conclusion, the mNUTRIC score can serve as a tool to assess nutrition risk in cirrhotic patients with acute GEVB.

Acquired Muscle Weakness in the Surgical Intensive Care Unit

2016 ◽  
Vol 124 (1) ◽  
pp. 207-234 ◽  
Author(s):  
Hassan Farhan ◽  
Ingrid Moreno-Duarte ◽  
Nicola Latronico ◽  
Ross Zafonte ◽  
Matthias Eikermann
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Muscle Weakness ◽  
Prolonged Mechanical Ventilation ◽  
Underlying Mechanism ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Drug Induced

Abstract Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

scholarly journals Kajian Penggunaan Antibiotik pada Neonatus Intensive Care Unit di Sebuah Rumah Sakit Pemerintah di Surabaya

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Felix Hidayat ◽  
Adji P. Setiadi ◽  
Eko Setiawan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Combination Therapy ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Public Hospital ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Utilization Review ◽  
Cross Sectional

Penggunaan antibiotik menjadi salah satu terapi yang banyak diberikan pada bayi di Neonatal Intensive Care Unit (NICU). Penelitian ini ditujukan untuk mengetahui profil dan mengkaji biaya, ketepatan dan ketercampuran atau kompatibilitas penggunaan antibiotik pada pasien di NICU salah satu rumah sakit pemerintah di Surabaya dalam kurun waktu November–Desember 2015. Penelitian ini merupakan penelitian potong lintang yang dilakukan secara prospektif dengan memanfaatkan data rekam medis sebagai sumber data utama. Seluruh informasi yang diperoleh dari pasien NICU yang menggunakan antibiotik dan masuk dalam kriteria inklusi dan eksklusi dianalisis secara deskriptif. Total 32 orang pasien dilibatkan dalam penelitian ini. Penggunaan antibiotik terdiri dari 25 kali penggunaan antibiotik tunggal dan 14 kali penggunaan antibiotik kombinasi. Ampisilin merupakan antibiotik tunggal yang paling banyak digunakan, sedangkan penggunaan antibiotik kombinasi terbanyak adalah penggunaan kombinasi ampisilin dan gentamisin. Dari total seluruh pasien, hanya terdapat 13 pasien dengan diagnosis infeksi dan hanya 2 pasien (15,38%) yang mendapat terapi antibiotik yang tepat. Proses pergantian terapi didominasi oleh proses de-eskalasi yaitu sebesar 44,44%. Berdasarkan analisis kompatibilitas, terdapat banyak pencampuran sediaan antibiotik intravena yang tidak dapat diklasifikasikan compatible atau not compatible akibat tidak tersedianya informasi terkait kompatibilitasnya. Biaya penggunaan antibiotik yang harus dikeluarkan pasien rata-rata sebesar Rp265.252,00 (min–max= Rp16.100,00 s.d. Rp2.091.590,00). Ketepatan penggunaan antibiotik di ruang NICU perlu ditingkatkan sebagai upaya untuk meminimalkan risiko dampak negatif khususnya peningkatan biaya dan risiko resistensi.Kata kunci: Biaya antibiotik, kajian penggunaan antibiotik, kompatibilitas, neonatal intensive care unit Antibiotics Utilization Review in a Neonate Intensive Care Unit of a Public Hospital in SurabayaAbstractAntibiotic is frequently used in the Neonatal Intensive Care Unit (NICU). The aim of this study was to identify the usage pattern and to review the cost, appropriateness, and compatibility of antibiotics given to the patients in the NICU of one public hospital in Surabaya during November to December 2015. This was a cross-sectional study using medical record as the main source of the data. All information about eligible patients receiving antibiotics in the NICU was analysed descriptively. A total of 32 patients was involved in this study. The antibiotics utilization profile consisted of 25 single and 14 combination therapy. Ampicillin and ampicillin-gentamycin were found as the most frequently used in the single and combination therapy, consecutively. From all patients received antibiotics, 13 patients had confirmed with infections problem and only 2 patients (15.38%) received appropriate antibiotics therapy. From all therapeutic modification made, 44.44% was de-escalation. According to the compatibility analysis, lots of antibiotic intravenous admixtures in this research could not be clearly identified as compatible or not compatible because no information was available. The average cost of antibiotics per patient was IDR 265,252 (range IDR 16,100 to IDR 2,091,500). There is a need to optimize the use of antibiotics in the NICU in order to minimize the risk of adverse outcomes especially the increased cost and risk of resistance.Keywords: Antibiotics utilisation review, compatibility, cost of antibiotics, neonatal intensive care unit

scholarly journals Incidence and etiology of acute kidney injury in children admitted to PICU using pRIFLE criteria

2018 ◽  
Vol 5 (3) ◽  
pp. 917
Author(s):  
Javid Maqbool ◽  
Aajaz Ahmad Mir ◽  
Nisar Ahmad Bhat ◽  
Waseem Qadir Moona
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Consensus Definition ◽  
Schwartz Formula

Background: Acute kidney injury is a common problem highly associated with hospitalization. Acute Kidney Injury (AKI) is associated with severe morbidity and mortality especially in children. Lack of consensus definition has been major limitation in improving outcomes. This study tries to address the need of limited data on pediatric AKI. Detection of the incidence, etiological profile and outcome of AKI is important for the initiation of preventive and therapeutic strategies, identifying patients early to avoid renal replacement therapy.Methods: This prospective observational study was conducted in the pediatric intensive care unit (PICU) of tertiary hospital (GMC Srinagar) between January 2015 to December 2016.This is the only prospective study conducted in this hospital, all other studies conducted here and other higher centers were retrospective. Serum creatinine level was estimated on all patients on admission and alternate days till discharge from Pediatric Intensive Care Unit (PICU). Urine output was recorded. Estimated Creatinine- Clearance (eCrCL) was calculated using Schwartz formula. AKI diagnosis and staging was based on pRIFLE (pediatric RIFLE) criteria. eCrCl criteria was used to diagnose and stage AKI. Maximal stage that the patient progressed during the stay in PICU was assigned the stage for that case.Results: Of total 500 cases, 480 cases met inclusion criteria. Of them, the incidence of AKI was 154 (32.1%). Stage ‘Risk (R)’, ‘Injury (I)’ and ‘Failure (F)’ constituted 93(60.38%), 46 (29.8%) and15 (9.74%) respectively. Maximum AKI occurred in <1 year (30.5%). Infections were commonest etiology. Amongst infections sepsis (30.5%) was most common, followed by acute gastroenteritis (20.7%) and pneumonia (16.9%). Hypotension, nephrotoxic drugs, sepsis, need for mechanical ventilation were significant (p<0.001) risk factors for AKI. Pre-renal causes constituted 68% and intrinsic renal 32%.Conclusions: The incidence of AKI is high among critically ill children. AKI continues to be associated with adverse outcomes. pRIFLE staging system provides early identification and stratification of AKI. Infections are leading etiology of AKI in children. 

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