scholarly journals The challenge of prognostic markers in acute pancreatitis: internist’s point of view

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ombretta Para ◽  
Lorenzo Caruso ◽  
Maria Teresa Savo ◽  
Elisa Antonielli ◽  
Eleonora Blasi ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Care Setting ◽  
Adverse Outcome ◽  
Intensive Care Setting ◽  
Internal Medicine Ward

AbstractAcute pancreatitis, the most frequent hospitalization reason in internal medicine ward among gastrointestinal diseases, is burdened by high mortality rate. The disease manifests mainly in a mild form, but about 20-30% patients have a severe progress that requires intensive care. Patients presenting with acute pancreatitis should be clinically evaluated for organ failure signs and symptoms. Stratifying patients in the first days from symptoms onset is essential to determine therapy and care setting. The aim of our study is to evaluate prognostic factors for acute pancreatitis patients, hospitalized in internal medicine wards, and moreover, understanding the role of various prognostic scores validated in intensive care setting in predicting in-hospital mortality and/or admission to intensive care unit. We conducted a retrospective study enrolling all patients with diagnosis of acute pancreatitis admitted took an internal medicine ward between January 2013 and May 2019. Adverse outcome was considered in-hospital mortality and/or admission to intensive care unit. In total, 146 patients (137 with positive outcome and 9 with adverse outcome) were enrolled. The median age was (67.89 ± 16.44), with a slight prevalence of male (55.1%) compared to female (44.9%). C protein reactive (p = 0.02), creatinine (p = 0.01), sodium (p = 0.05), and troponin I (p = 0.013) after 48 h were significantly increased in patients with adverse outcome. In our study, progression in SOFA score independently increases the probability of adverse outcome in patients hospitalized with acute pancreatitis. SOFA score > 5 is highly predictive of in-hospital mortality (O.R. 32.00; C.I. 6.73-152.5; p = 0.001) compared to other scores. The use of an easy tool, validated in intensive care setting such as SOFA score, might help to better stratify the risk of in-hospital mortality and/or clinical worsening in patients hospitalized with acute pancreatitis in internal medicine ward.

Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India

2011 ◽  
Vol 26 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Christina George ◽  
Jayakrishnan Sukumaran Nair ◽  
Johann Alex Ebenezer ◽  
Alan Gangadharan ◽  
Anna ChristuDas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
South India ◽  
Care Setting ◽  
Intensive Care Setting ◽  
Resource Poor ◽  
Medical Intensive Care

Sequential Organ Failure Assessment (SOFA) Score As a Predictor of Outcome in Sepsis in Pediatric Intensive Care Unit

2020 ◽  
Author(s):  
A.V. Lalitha ◽  
J.K. Satish ◽  
Mounika Reddy ◽  
Santu Ghosh ◽  
Jiny George ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Pediatric Intensive Care Unit ◽  
Sofa Score ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Inotropic Support ◽  
Discriminative Power ◽  
Failure Assessment

AbstractSequential organ failure assessment (SOFA) score is used as a predictor of outcome of sepsis in the pediatric intensive care unit. The aim of the study is to determine the application of SOFA scores as a predictor of outcome in children admitted to the pediatric intensive care unit with a diagnosis of sepsis. The design involved is prospective observational study. The study took place at the multidisciplinary pediatric intensive care unit (PICU), tertiary care hospital, South India. The patients included are children, aged 1 month to 18 years admitted with a diagnosis of sepsis (suspected/proven) to a single center PICU in India from November 2017 to November 2019. Data collected included the demographic, clinical, laboratory, and outcome-related variables. Severity of illness scores was calculated to include SOFA score day 1 (SF1) and day 3 (SF3) using a pediatric version (pediatric SOFA score or pSOFA) with age-adjusted cutoff variables for organ dysfunction, pediatric risk of mortality III (PRISM III; within 24 hours of admission), and pediatric logistic organ dysfunction-2 or PELOD-2 (days 1, 3, and 5). No intervention was observed during the period of study. A total of 240 patients were admitted to the PICU with septic shock during the study period. The overall mortality rate was 42 of 240 patients (17.5%). The majority (59%) required mechanical ventilation, while only 19% required renal replacement therapy. The PRISM III, PELOD-2, and pSOFA scores correlated well with mortality. All three severity of illness scores were higher among nonsurvivors as compared with survivors (p < 0.001). pSOFA scores on both day 1 (area under the curve or AUC 0.84) and day 3 (AUC 0.87) demonstrated significantly higher discriminative power for in-hospital mortality as compared with PRISM III (AUC, 0.7), and PELOD-2 (day 1, [AUC, 0.73]), and PELOD-2 (day 3, [AUC, 0.81]). Utilizing a cutoff SOFA score of >8, the relative risk of prolonged duration of mechanical ventilation, requirement for vasoactive infusions (vasoactive infusion score), and PICU length of stay were all significantly increased (p < 0.05), on both days 1 and 3. On multiple logistic regression, adjusted odds ratio of mortality was elevated at 8.65 (95% CI: 3.48–21.52) on day 1 and 16.77 (95% confidence interval or CI: 4.7–59.89) on day 3 (p < 0.001) utilizing the same SOFA score cutoff of 8. A positive association was found between the delta SOFA ([Δ] SOFA) from day 1 to day 3 (SF1–SF3) and in-hospital mortality (chi-square for linear trend, p < 0.001). Subjects with a ΔSOFA of ≥2 points had an exponential mortality rate to 50%. Similar association was—observed between ΔSOFA of ≥2 and—longer duration of inotropic support (p = 0.0006) with correlation co-efficient 0.2 (95% CI: 0.15–0.35; p = 0.01). Among children admitted to the PICU with septic shock, SOFA scores on both days 1 and 3, have a greater discriminative power for predicting in-hospital mortality than either PRISM III score (within 24 hours of admission) or PELOD-2 score (days 1 and 3). An increase in ΔSOFA of >2 adds additional prognostic accuracy in determining not only mortality risk but also duration of inotropic support as well.

The psychological impact of COVID-19 on staff and patients in a psychiatric intensive care setting

2020 ◽  
Author(s):  
Bethan Harries ◽  
Luke Skelton ◽  
Lucy Blake ◽  
Ria Pugh ◽  
Margaret Butler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Care Setting ◽  
Psychological Impact ◽  
Intensive Care Setting

This article is part of a series exploring how the COVID-19 pandemic affected,and continues to affect, a psychiatric intensive care unit (PICU) in London, UK. The series so far has focused primarily on the systems, processes and practical challenges of managing acutely disturbed patients in the npatient setting with the added complexity of COVID-19 infection. This article outlines the psychological impact on staff and patients on a PICU during this time.

scholarly journals Quality of penicillin allergy management in the intensive care unit and internal medicine ward

2010 ◽  
Vol 6 (S2) ◽  
Author(s):  
Philippe Bégin ◽  
Matthieu Picard ◽  
Hugues Bouchard ◽  
Jonathan Cloutier ◽  
Émilie Daoust ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Penicillin Allergy ◽  
Internal Medicine Ward ◽  
Allergy Management

Rumination—A New Complication of Neonatal Intensive Care

PEDIATRICS ◽  
1980 ◽  
Vol 66 (4) ◽  
pp. 551-555
Author(s):  
Thomas G. Sheagren ◽  
Henry H. Mangurten ◽  
Frantz Brea ◽  
Susan Lutostanski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Treatment Program ◽  
Successful Treatment ◽  
Neonatal Intensive Care ◽  
Care Setting ◽  
Intensive Care Setting ◽  
Rumination Syndrome ◽  
Newborn Intensive Care Unit ◽  
Newborn Intensive Care

The infant rumination syndrome has not been previously reported in a neonatal intensive care setting. We recently managed three infants in our newborn intensive care unit who developed rumination following chronic courses in the unit. The events leading to this condition in each infant are described, as well as the successful treatment program that was instituted. With recognition of factors predisposing to this disorder, the problem may be avoided, providing these infants with the best chance for optimal development despite the need for prolonged intensive care.

Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

2012 ◽  
Vol 11 (4) ◽  
pp. 219-221
Author(s):  
Robert John ◽  
◽  
Hemang Yadav ◽  
Martin John ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Ketone Body ◽  
Insulin Infusion ◽  
Care Setting ◽  
Intensive Care Setting

Euglycaemic ketoacidosis is a rare endocrine emergency, which can have disastrous consequences if left undiagnosed. We present the case of a 57 year old man with type 2 diabetes who developed ketoacidosis (DKA) following a myocardial infarction, despite being normoglycaemic, following discontinuation of his insulin infusion in an intensive care setting. The case highlights the importance of capillary ketone body testing in this scenario as well as the dangers of an over reliance on blood glucose values in the diagnosis of ketoacidosis. The notion that DKA can occur in both type 1 and type 2 diabetes is reaffirmed and the value of adequate insulin therapy in euglycaemic ketoacidosis is emphasized.

scholarly journals Different Hypercoagulable Profiles in Patients with COVID-19 Admitted to the Internal Medicine Ward and the Intensive Care Unit

2020 ◽  
Vol 120 (10) ◽  
pp. 1474-1477 ◽  
Author(s):  
Luca Spiezia ◽  
Annalisa Boscolo ◽  
Christelle Correale ◽  
Nicolò Sella ◽  
Elisa Pesenti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Internal Medicine Ward

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

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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