scholarly journals Causes influencing the length of stay of cardiac surgery patients in the intensive care unit

2015 ◽  
Vol 1 (1) ◽  
pp. 40
Author(s):  
Nikoleta Dimitropoulou ◽  
Aggeliki Stamou ◽  
Christina Marvaki
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Coronary Artery ◽  
Demographic Characteristics ◽  
Average Hospital ◽  
Prolonged Stay ◽  
Icu Stay ◽  
History Of ◽  
Prolonged Icu Stay

Introduction: The incidence of postoperative morbidity has increased, a fact which may lead to prolonged hospitalization of the patient in the Intensive Care Unit (ICU) and generally in the hospital.Aim: The aim of the present study was to explore the complications after cardiac surgery responsible for the prolonged stay of patients in the ICU.Material and method: The studied sample consisted of 80 patients who were hospitalized in the Intensive Care Unit General Hospital of Athens from January 2013 to June 2014. For data collection a special registration form with information coming from the medical records of patients was used. Data analysis was performed by the IBM SPSS 21.0 (Statistical Package for Social Sciences).Results: Regarding to demographic characteristics Regarding the demographic characteristics and medical history of the studied sample, the majority were male (58.7%, n=47), with a mean age of 73 years and an average hospital stay of 3.3 days. The major causes of prolonged ICU stay was respiratory failure (20%, n=16), arrhythmias (17.5%, n = 14), bleeding (15%, n=12), myocardial infarction (11.3%, n=9), and pulmonary edema (10%,n=8). Τhe bivariate analysis showed statistical relationship to the level of 0,20 (p<0,20) between the prolonged ICU stay and age, coronary artery disease as the cause of entry, coronary artery bypass, diabetes melitus and chronic obstructive pulmonary disease.Conclusion: Patients with a history of heart failure, diabetes or obstructive pulmonary disease seems to have a greater chance for a prolonged ICU stay after cardiac surgery. Early recognition of demographic and clinical factors that may lead to the prolonged ICU stay can provide very important information about how to improve perioperative care of the patient.

scholarly journals Predictors of Prolonged Stay in the Intensive Care Unit following Cardiac Surgery

ISRN Nursing ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Rokeia Eltheni ◽  
Konstantinos Giakoumidakis ◽  
Hero Brokalaki ◽  
Petros Galanis ◽  
Ioannis Nenekidis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Unit Length ◽  
Multivariate Regression Analysis ◽  
Tertiary Hospital ◽  
Healthcare Personnel ◽  
Resources Allocation ◽  
Prolonged Stay ◽  
History Of

The prediction of intensive care unit length of stay (ICU-LOS) could contribute to more efficient ICU resources' allocation and better planning of care among cardiac surgery patients. The aim of this study was to identify the preoperative and intraoperative predictors for prolonged cardiac surgery ICU-LOS. An observational cohort study was conducted among 150 consecutive patients, who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens, Greece from September 2010 to January 2011. Multivariate regression analysis revealed that patients with increased creatinine levels preoperatively (odds ratio (OR) 3.0, P=0.049), history of atrial fibrillation (AF) (OR 6.3, P=0.012) and high EuroSCORE values (OR 2.6, P=0.017) had a significant greater probability to stay in the ICU for more than 2 days. In addition, intraoperative hyperglycemia (OR 3.0, P=0.004) was strongly associated with longer ICU-LOS. In conclusion, the high perioperative risk, the history of AF and renal dysfunction, and the intraoperative hyperglycemia are significant predictors of prolonged ICU stay. The early identification of patients at risk could allow the efficient ICU resources' allocation and the reduction of healthcare costs. This would contribute to nursing care planning depending on the availability of healthcare personnel and ICU bed capacity.

Prognostic Value of GDF-15 in Predicting Prolonged Intensive Care Stay following Cardiac Surgery: A Retrospective Case-Control Study

2021 ◽  
Author(s):  
Henry Barton ◽  
Elisabeth Zechendorf ◽  
Dirk Ostareck ◽  
Antje Ostareck-Lederer ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Confidence Interval ◽  
Prediction Models ◽  
Unit Length ◽  
Icu Stay ◽  
Intensive Care Stay ◽  
Cardio Pulmonary Bypass ◽  
Prolonged Icu Stay ◽  
Pulmonary Bypass

Abstract Background: Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Methods: We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardio-pulmonary bypass time and indicators of organ dysfunction.Results: Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis we could show that preoperatively raised levels of GDF-15 was positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardio-pulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% Confidence Interval 1 – 1.02, p= 0.029). On ROC curves, GDF-15 was found to predict prolonged ICU stay (AUC= 0.86, 95% Confidence Interval 0.71 – 0.99, p= 0.003).Conclusion: GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.

Ventilator-Associated Tracheobronchitis Increases the Length of Intensive Care Unit Stay

2013 ◽  
Vol 34 (8) ◽  
pp. 800-808 ◽  
Author(s):  
Marios Karvouniaris ◽  
Demosthenes Makris ◽  
Efstratios Manoulakas ◽  
Paris Zygoulis ◽  
Konstantinos Mantzarlis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Protein Level ◽  
Significant Risk ◽  
University Hospital ◽  
C Reactive Protein ◽  
Prolonged Stay ◽  
Reactive Protein ◽  
Icu Stay ◽  
The Impact

Objective.To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality.Design.Prospective cohort study.Setting.University Hospital Larissa, Larissa, GreecePatients.Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011.Methods.The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria.Results.A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; P = .02). The occurrence of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35-6.85]; P = .01). Age (OR [95% CI], 1.04 [1.015-1.06]; P = .02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015-1.16]; P = .02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.011.1]; P = .02) were independent factors for ICU mortality.Conclusions.VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study.

scholarly journals A Decision for Predicting Successful Extubation of Patients in Intensive Care Unit

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Chang-Shu Tu ◽  
Chih-Hao Chang ◽  
Shu-Chin Chang ◽  
Chung-Shu Lee ◽  
Ching-Ter Chang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Minute Ventilation ◽  
Bootstrap Method ◽  
Academic Medical Center ◽  
Icu Stay ◽  
Rapid Shallow Breathing Index ◽  
Prolonged Icu Stay ◽  
Successful Extubation

Approximately 40% of patients admitted to the medical intensive care unit (ICU) require mechanical ventilation. An accurate prediction of successful extubation in patients is a key clinical problem in ICU due to the fact that the successful extubation is highly associated with prolonged ICU stay. The prolonged ICU stay is also associated with increasing cost and mortality rate in healthcare system. This study is retrospective in the aspect of ICU. Hence, a total of 41 patients were selected from the largest academic medical center in Taiwan. Our experimental results show that predicting successful rate of 87.8% is obtained from the proposed predicting function. Based on several types of statistics analysis, including logistic regression analysis, discriminant analysis, and bootstrap method, three major successful extubation predictors, namely, rapid shallow breathing index, respiratory rate, and minute ventilation, are revealed. The prediction of successful extubation function is proposed for patients, ICU, physicians, and hospital for reference.

scholarly journals Behavior of the functional independence domains in patients submitted to the revascularization of the myocardium during intensive care unit stay

2018 ◽  
Vol 8 (2) ◽  
pp. 175-182
Author(s):  
André Luiz Cordeiro ◽  
André Raimundo Guimarães ◽  
Thiago Araújo Melo ◽  
Jefferson Petto ◽  
Mansueto Gomes-Neto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Myocardial Revascularization ◽  
Functional Independence ◽  
Preoperative Period ◽  
Icu Stay ◽  
Stay Time ◽  
The Mean ◽  
Functional Independence Measurement

INTRODUCTION: Functional Independence Measurement (MIF) is used to evaluate the functional status of patients being divided into domains and should be applied in patients undergoing cardiac surgery due to their high potential for deleterious effects. OBJECTIVE: To analyze the behavior of MIF domains in patients submitted to myocardial revascularization. MATERIALS AND METHODS: This is a cohort study. At the time of hospital admission, the functionality was evaluated through the MIF and computed the six domains. After the surgery on the day of discharge from the Intensive Care Unit (ICU), the MIF was again applied for comparison with the preoperative period and correlation with the length of stay in the ICU. RESULTS: A total of 38 patients were analyzed: 21 (55.3%) men, mean age was 57.3 ± 13.3 years. The mean ICU stay was 2.9 ± 1.3 days, with a FIM of 125.7 ± 0.5 and a mean of 87.4 ± 16.8 (p <0.001). In relation to the domains, a reduction was observed in all of them, with the exception of Communication from 14 to 13.1 ± 2.1 (p = 0.24) and Cognition 20.9 ± 0.1 to 19.2 ± 4, 4 (p = 0.24). However, there was a strong correlation between ICU stay time with the communication domains (r -0.76 and p <0.01) and cognition (r -0.77 and p <0.01). CONCLUSION: It is concluded that the functionality is reduced due to cardiac surgery and that the time spent in the ICU is directly related to the worsening of communication and cognition.

scholarly journals Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

2020 ◽  
Author(s):  
Likui Fang ◽  
Guocan Yu ◽  
Jinpeng Huang ◽  
Wuchen Zhao ◽  
Bo Ye
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Postoperative Complication ◽  
Constrictive Pericarditis ◽  
Functional Class ◽  
Cox Regression Analysis ◽  
Nyha Functional Class ◽  
Icu Stay ◽  
Prolonged Icu Stay

Abstract Purpose The risk factors of postoperative outcomes after pericardiectomy in tuberculous constrictive pericarditis have still been unclear. This study aimed to investigate the predictors of postoperative complication and prolonged intensive care unit (ICU) stay in the patients with tuberculous constrictive pericarditis undergoing pericardiectomy. Methods A total of 88 patients with tuberculous constrictive pericarditis undergoing pericardiectomy were retrospectively enrolled. Logistic regression and Cox regression analysis were performed to identify the predictors of postoperative complication and prolonged ICU stay, respectively. Results All patients underwent complete pericardiectomy and 35 (39.8%) had postoperative complications with no mortality within 30 days after surgery. Postoperative complication delayed postoperative ICU stay (P < 0.001), duration of chest drainage (P < 0.001) and postoperative hospital stay (P < 0.001). Preoperative NYHA functional class (P = 0.004, OR 4.051, 95%CI 1.558–10.533) and preoperative central venous pressure (CVP) (P = 0.031, OR 1.151, 95%CI 1.013–1.309) were independent risk factors of postoperative complication. Postoperative complication (P < 0.001, HR 4.132, 95%CI 2.217–7.692) was the independent risk factor for prolonged ICU stay. Conclusion Complete pericardiectomy was associated with high risk of postoperative complication in tuberculous constrictive pericarditis. Poor preoperative NYHA functional class and high preoperative CVP were shown to predict postoperative complication which was the predictor of prolonged ICU stay.

Predictive Values of Initial Severity Scores at Intensive Care Unit Admission for Patients With Overnight or Prolonged Stay

2021 ◽  
Author(s):  
Koji Hosokawa ◽  
Nobuaki Shime
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Apache Ii ◽  
Icu Patients ◽  
Prolonged Stay ◽  
Saps Ii ◽  
Icu Stay ◽  
Severity Scores

Abstract Background: The predictive value of disease severity scores for intensive care unit (ICU) patients is occasionally inaccurate because ICU patients with mild symptoms are also considered. We, thus, aimed to evaluate the accuracy of severity scores in predicting mortality of patients with complicated conditions admitted for > 24 hours. Methods: Overall, 35,353 adult patients using nationwide ICU data were divided into two groups: (1) overnight ICU stay after elective surgery and alive on discharge within 24 hours and (2) death within 24 hours or prolonged stay. The performance and accuracy of Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II and III, and Simplified Acute Physiology Score (SAPS) II scores in predicting in-hospital mortality were evaluated. Results: In the overnight stay group, the correlation between SOFA and APACHE III scores or SAPS II was low because many had a SOFA score of 0. In the prolonged stay group, the predictive value of SAPS II and APACHE II and III showed high accuracy but that of SOFA was moderate. Conclusions: When overnight ICU stay patients were not included, the high predictive value for in-hospital mortality of SAPS II and APACHE II and III was evident.

scholarly journals High Tidal Volumes in Mechanically Ventilated Patients Increase Organ Dysfunction after Cardiac Surgery

2012 ◽  
Vol 116 (5) ◽  
pp. 1072-1082 ◽  
Author(s):  
François Lellouche ◽  
Stéphanie Dionne ◽  
Serge Simard ◽  
Jean Bussières ◽  
François Dagenais
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Body Weight ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Lung Injury ◽  
Tidal Volume ◽  
Organ Failure ◽  
Predicted Body Weight ◽  
Prolonged Stay

Background High tidal volumes in patients with acute respiratory distress syndrome and acute lung injury lead to ventilator-induced lung injury and increased mortality. We evaluated the impact of tidal volumes on cardiac surgery outcomes. Methods We examined prospectively recorded data from 3,434 consecutive adult patients who underwent cardiac surgery. Three groups of patients were defined based on the tidal volume delivered on arrival at the intensive care unit: (1) low: below 10, (2) traditional: 10-12, and (3) high: more than 12 ml/kg of predicted body weight. We assessed risk factors for three types of organ failure (prolonged mechanical ventilation, hemodynamic instability, and renal failure) and a prolonged stay in the intensive care unit. Results The mean tidal volume/actual weight was 9.2 ml/kg, and the tidal volume/predicted body weight was 11.5 ml/kg. Low, traditional, and high tidal volumes were used in 724 (21.1%), 1567 (45.6%), and 1,143 patients (33.3%), respectively. Independent risks factors for high tidal volumes were body mass index of 30 or more (odds ratio [OR] 6.25; CI: 5.26-7.42; P &lt; 0.001) and female sex (OR 4.33; CI: 3.64-5.15; P &lt; 0.001). In the multivariate analysis, high and traditional tidal volumes were independent risk factors for organ failure, multiple organ failure, and prolonged stay in the intensive care unit. Organ failures were associated with increased intensive care unit stay, hospital mortality, and long-term mortality. Conclusion Tidal volumes of more than 10 ml/kg are risk factors for organ failure and prolonged intensive care unit stay after cardiac surgery. Women and obese patients are particularly at risk of being ventilated with injurious tidal volumes.

scholarly journals Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Louise Y. Sun ◽  
Anan Bader Eddeen ◽  
Marc Ruel ◽  
Erika MacPhee ◽  
Thierry G. Mesana
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Clinical Judgment ◽  
Validation Cohort ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Prolonged Stay ◽  
C Statistic

Background Across the globe, elective surgeries have been postponed to limit infectious exposure and preserve hospital capacity for coronavirus disease 2019 (COVID‐19). However, the ramp down in cardiac surgery volumes may result in unintended harm to patients who are at high risk of mortality if their conditions are left untreated. To help optimize triage decisions, we derived and ambispectively validated a clinical score to predict intensive care unit length of stay after cardiac surgery. Methods and Results Following ethics approval, we derived and performed multicenter valida tion of clinical models to predict the likelihood of short (≤2 days) and prolonged intensive care unit length of stay (≥7 days) in patients aged ≥18 years, who underwent coronary artery bypass grafting and/or aortic, mitral, and tricuspid value surgery in Ontario, Canada. Multivariable logistic regression with backward variable selection was used, along with clinical judgment, in the modeling process. For the model that predicted short intensive care unit stay, the c‐statistic was 0.78 in the derivation cohort and 0.71 in the validation cohort. For the model that predicted prolonged stay, c‐statistic was 0.85 in the derivation and 0.78 in the validation cohort. The models, together termed the CardiOttawa LOS Score , demonstrated a high degree of accuracy during prospective testing. Conclusions Clinical judgment alone has been shown to be inaccurate in predicting postoperative intensive care unit length of stay. The CardiOttawa LOS Score performed well in prospective validation and will complement the clinician's gestalt in making more efficient resource allocation during the COVID‐19 period and beyond.

scholarly journals The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Chien-Lung Chan ◽  
Hsien-Wei Ting ◽  
Hsin-Tsung Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Insurance ◽  
Intracerebral Hemorrhage ◽  
National Health Insurance ◽  
National Health ◽  
Research Database ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Icu Stay ◽  
Prolonged Icu Stay

Introduction.Length of stay (LOS) in the intensive care unit (ICU) of spontaneous intracerebral hemorrhage (sICH) patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD) to define the threshold of a prolonged ICU stay in sICH patients.Methods.This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis.Results.There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases.Conclusion.This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

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