Effect of treatment applied in sepsis on intensive care unit and hospital stay: how effective are albumin/steroid/vasopressor agents?

Abstract Background The incidence and prevalence of sepsis have increased in recent years and it is the most common cause of intensive care admission. The aim of this study was to determine the effects of albumin, steroid, and vasopressor agents and other possible factors on the duration of intensive care unit and hospital stay in sepsis patients. Open access data set obtained from Tohoku Sepsis Registry database was used. Four hundred sixty-two patients admitted to intensive care unit with the diagnosis of sepsis were divided into four groups according to their intensive care unit (≤ 5 or > 5 days) and hospital length of stay (≤ 24 or > 24 days). Demographic data, vital signs, laboratory values, mechanical ventilation requirement, and treatment protocols such as albumin, steroid, and vasopressor agent use were used in the evaluation of the groups. Results The use of albumin (odds ratio [OR] = 3.76 [95% confidence interval (CI), 2.16–6.56]; p < 0.001), steroids (OR = 2.85 [95% CI, 1.67–4.86]; p < 0.001), and vasopressor agents (OR = 3.56 [95% CI, 2.42–5.24]; p < 0.001) were associated with an increasing risk of prolonged intensive care unit length of stay. Also, it was found that the use of albumin (OR = 3.43 [95% CI, 2.00–5.89]; p < 0.001), steroids (OR = 2.81 [95% CI, 1.66–4.78]; p < 0.001), and vasopressor agents (OR = 4.47 [95% CI, 3.02–6.62]; p < 0.001) were associated with an increasing risk of prolonged hospital length of stay. In addition, prognostic scoring systems, body temperature, mean arterial pressure, pH, PaO2/FiO2 ratio, and mechanical ventilation requirement in the first 24 h were also found to be associated with length of stay in intensive care unit and hospital. There was a significant relationship between platelet count, creatinine, Na, lactic acid, and time between diagnosis of sepsis and source control and intensive care unit length of stay, and between hematocrit and C-reactive protein and hospital length of stay. Conclusions The use of albumin, steroid, and vasopressor agents has been found to be significantly correlated with both intensive care unit and hospital length of stay. Further studies are needed to determine in what order or at what dosage these agents will be administered in sepsis treatment.

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Association of prescription opioid use on mortality and hospital length of stay in the intensive care unit

PLoS ONE ◽

10.1371/journal.pone.0250320 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250320

Author(s):

Nicole Hardy ◽

Fatima Zeba ◽

Anaelia Ovalle ◽

Alicia Yanac ◽

Christelle Nzugang-Noutonsi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Prescription Opioid ◽

Opioid Use ◽

Icu Admission ◽

Prescription Opioid Use

Objective Several studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases. However, the association of outpatient prescription opioid use on morbidity and mortality has not been adequately evaluated in a critical care setting. The purpose of this study was to determine if there is an association between chronic opioid use and mortality after an ICU admission. Design A single-center, longitudinal retrospective cohort study of all Intensive Care Unit (ICU) patients admitted to a tertiary-care academic medical center from 2001 to 2012 using the MIMIC-III database. Setting Medical Information Mart for Intensive Care III database based in the United States. Patients Adult patients 18 years and older were included. Exclusion criteria comprised of patients who expired during their hospital stay or presented with overdose; patients with cancer, anoxic brain injury, non-prescription opioid use; or if an accurate medication reconciliation was unable to be obtained. Patients prescribed chronic opioids were compared with those who had not been prescribed opioids in the outpatient setting. Interventions None. Measurements and main results The final sample included a total of 22,385 patients, with 2,621 (11.7%) in the opioid group and 19,764 (88.3%) in the control group. After proceeding with bivariate analyses, statistically significant and clinically relevant differences were identified between opioid and non-opioid users in sex, length of hospital stay, and comorbidities. Opioid use was associated with increased mortality in both the 30-day and 1-year windows with a respective odds ratios of 1.81 (95% CI, 1.63–2.01; p<0.001) and 1.88 (95% CI, 1.77–1.99; p<0.001), respectively. Conclusions Chronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after ICU admission. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage.

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Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study

SAGE Open Medicine ◽

10.1177/20503121211030837 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110308

Author(s):

Santiago Cegarra Garcia ◽

Michael Toolis ◽

Max Ubels ◽

Taha Mollah ◽

Eldho Paul ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Pancreatitis ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Intensive Care Unit Mortality ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Index Of Severity

Objectives: To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. Methods: Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. Results: A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. Conclusion: Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.

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Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

10.21203/rs.2.230/v2 ◽

2019 ◽

Author(s):

Hesham Abowali ◽

Matteo Paganini ◽

Garrett A Enten ◽

Ayman Elbadawi ◽

Enrico Camporesi

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Time Dependent ◽

Hospital Length Of Stay ◽

Ventilation Time ◽

Mechanical Ventilation Time

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

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Body Mass Index and Intensive Care Unit Outcomes in African American Patients

Ethnicity & Disease ◽

10.18865/ed.27.2.161 ◽

2017 ◽

Vol 27 (2) ◽

pp. 161 ◽

Cited By ~ 4

Author(s):

O’Dene Lewis ◽

Julius Ngwa ◽

Angesom Kibreab ◽

Marc Phillpotts ◽

Alicia Thomas ◽

...

Keyword(s):

Body Mass Index ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Body Mass ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Obese Patients ◽

Icu Mortality

Purpose: We sought to determine whether body mass index (BMI) is associated with worse intensive care unit (ICU) outcomes among Black patients.Methods: Patients admitted to the medical ICU during 2012 were categorized into six BMI groups based on the World Health Organization criteria. ICU mortality, ICU and hospital length of stay (LOS), need for and duration of mechanical ventilation and organ failure rate were assessed.Results: A total of 605 patients with mean age 58.9 ± 16.0 years were studied. Compared with those with normal BMI, obese patients had significant higher rates of hypertension, diabetes mellitus and obstructive sleep apnea diagnoses (P<.001 for all). A total of 100 (16.5%) patients died during their ICU stay. Obesity was not associated with increased odds of ICU mortality (OR=.58; 95% CI, .16-2.20). Moreover, improved survival was observed for class II obese patients (OR, .031; 95% CI, .001–.863). There were no differences in the need for and duration of mechanical ventilation between the BMI groups. However, ICU and hospital LOS were significantly longer in patients with obesity.Conclusion: Obesity was not associated with increased ICU mortality; however, obesity was associated with increased comorbid illness and with significant longer ICU and hospital length of stay. Ethn Dis.2017;27(2):161-168; doi:10.18865/ed.27.2.161

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Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

10.21203/rs.2.21359/v1 ◽

2020 ◽

Author(s):

Hesham A. Abowali ◽

Matteo Paganini ◽

Garrett Enten ◽

Ayman Elbadawi ◽

Enrico Camporesi

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Time Dependent ◽

Hospital Length Of Stay ◽

Ventilation Time ◽

Mechanical Ventilation Time

Abstract Background The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries are controversial when compared to propofol. Methods A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed through July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were selected. The primary study outcomes were divided into time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes of heart valve surgery and CABG patients. Additionally, time-dependent outcomes are affected by several confounding factors, and more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes.

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The impact of intensive care unit physician staffing change at a community hospital

SAGE Open Medicine ◽

10.1177/20503121211066471 ◽

2022 ◽

Vol 10 ◽

pp. 205031212110664

Author(s):

Christopher D Adams ◽

Luigi Brunetti ◽

Liza Davidov ◽

Jose Mujia ◽

Michael Rodricks

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Patient Care ◽

Hospital Costs ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Mechanically Ventilated ◽

Unit Model

Objectives: A high-intensity staffing model has been defined as either mandatory intensivist consultation or a closed intensive care unit in which intensivists manage all aspects of patient care. In the current climate of limited healthcare resources, transitioning to a closed intensive care unit model may lead to significant improvements in patient care and resource utilization. Methods: This is a single-center, retrospective cohort study of all mechanically ventilated intensive care unit admissions in the pre-intensive care unit closure period of 1 October 2014 to 30 September 2015 as compared with the post-intensive care unit closure period of 1 November 2015 to 31 October 2016. Patient demographics as well as outcome data (duration of mechanical ventilation, length of stay, direct costs, complications, and mortality) were abstracted from the electronic health record. All data were analyzed using descriptive and inferential statistics. Regression analyses were used to adjust outcomes for potential confounders. Results: A total of 549 mechanically ventilated patients were included in our analysis: 285 patients in the pre-closure cohort and 264 patients in the post-closure cohort. After adjusting for confounders, there was no significant difference in mortality rates between the pre-closure (40.7%) and post-closure (38.6%) groups (adjusted odds ratio = 0.82; 95% confidence interval = 0.56–1.18; p = 0.283). The post-closure cohort was found to have significant reductions in duration of mechanical ventilation (3.71–1.50 days; p < 0.01), intensive care unit length of stay (5.8–2.7 days; p < 0.01), hospital length of stay (10.9–7.3 days; p < 0.01), and direct hospital costs (US $16,197–US $12,731; p = 0.009). Patient complications were also significantly reduced post-intensive care unit closure. Conclusion: Although a closed intensive care unit model in our analysis did not lead to a statistical difference in mortality, it did demonstrate multiple beneficial outcomes including reduced ventilator duration, decreased intensive care unit and hospital length of stay, fewer patient complications, and reduced direct hospital costs.

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Analysis of Vasopressor Discontinuation and the Incidence of Rebound Hypotension in Patients With Septic Shock

Hospital Pharmacy ◽

10.1177/0018578719867646 ◽

2019 ◽

pp. 001857871986764

Author(s):

Christopher T. Buckley ◽

Ben Turner ◽

Dalton Walsh ◽

Meghan J. Garrett ◽

Vishal N. Ooka

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Length Of Stay ◽

Unit Length ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Study Population ◽

Secondary Outcomes ◽

Stay Hospital

Purpose: The purpose of this study was to examine the incidence of rebound hypotension in patients with septic shock requiring both norepinephrine and vasopressin infusions once discontinuation of 1 of these agents is warranted. Methods: A multicenter, retrospective study was conducted in 3 hospitals within a single health system between January 1, 2016, and December 31, 2017. The study population included adults, 18 years and older, diagnosed with septic shock and requiring concurrent infusions of norepinephrine and vasopressin. The primary outcome evaluated the incidence of rebound hypotension within 24 hours after the first vasopressor was discontinued. Secondary outcomes included intensive care unit length of stay, hospital length of stay, total vasopressor duration, and the time to rebound hypotension after first vasopressor discontinuation. Results: A total of 69 patients were included in the study, 38 in the vasopressin discontinued first group and 31 in the norepinephrine discontinued first group. Rebound hypotension occurred in 82% of patients in the vasopressin discontinued first group compared with 48% in the norepinephrine discontinued first group ( P = .004). No differences were observed in secondary outcomes, including intensive care unit or hospital length of stay, total vasopressor duration, or the time to rebound hypotension. Conclusions: Discontinuation of norepinephrine before vasopressin may lead to less incidence of rebound hypotension in patients with septic shock who require concurrent norepinephrine and vasopressin infusions. Similar to previous studies, this study found no difference in secondary outcomes.

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