scholarly journals Lower blood pH as a strong prognostic factor for fatal outcomes in critically ill COVID-19 patients at an intensive care unit: A multivariable analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0258018
Author(s):  
Martin Kieninger ◽  
Annemarie Sinning ◽  
Timea Vadász ◽  
Michael Gruber ◽  
Wolfram Gronwald ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Clinical Decision Making ◽  
Ph Value ◽  
Clinical Decision ◽  
Blood Ph

Background Data of critically ill COVID-19 patients are being evaluated worldwide, not only to understand the various aspects of the disease and to refine treatment strategies but also to improve clinical decision-making. For clinical decision-making in particular, prognostic factors of a lethal course of the disease would be highly relevant. Methods In this retrospective cohort study, we analyzed the first 59 adult critically ill Covid-19 patients treated in one of the intensive care units of the University Medical Center Regensburg, Germany. Using uni- and multivariable regression models, we extracted a set of parameters that allowed for prognosing in-hospital mortality. Results Within the cohort, 19 patients died (mortality 32.2%). Blood pH value, mean arterial pressure, base excess, troponin, and procalcitonin were identified as highly significant prognostic factors of in-hospital mortality. However, no significant differences were found for other parameters expected to be relevant prognostic factors, like low arterial partial pressure of oxygen or high lactate levels. In the multivariable logistic regression analysis, the pH value and the mean arterial pressure turned out to be the most influential prognostic factors for a lethal course.

scholarly journals Lower Blood pH as a High Predisposing Factor for a Fatal Outcome in Critically Ill COVID-19 Patients at Intensive Care Unit: a Multivariable Analysis

2021 ◽  
Author(s):  
Martin Kieninger ◽  
Annemarie Sinning ◽  
Timea Vadász ◽  
Michael Gruber ◽  
Wolfram Gronwald ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Clinical Decision Making ◽  
Ph Value ◽  
Fatal Outcome ◽  
Multivariable Analysis ◽  
Blood Ph

Abstract Background: Data of critically ill COVID-19 patients are being evaluated worldwide, not only to understand the various aspects of this disease and to refine treatment strategies but also to improve clinical decision-making. For the last aspect in particular, predictors of a lethal course of disease would be highly relevant.Methods:In this retrospective cohort study, we analyzed the first 59 adult critically ill Covid-19 patients treated in one of the intensive care units of the University Medical Center Regensburg, Germany. Using uni- and multivariable regression models, we extracted a set of parameters that allowed predictions of in-hospital mortality.Results:Blood pH value, mean arterial pressure, base excess, troponin, and procalcitonin were identified as highly significant predictors (p < 0.001) of in-hospital mortality. In the multivariable logistic regression analysis, the pH value and the mean arterial pressure turned out to be the most influential predictors and thus predisposing factors for a lethal course.Conclusions:We developed a formula that enables the easy calculation of the probability of a fatal outcome in COVID-19 intensive care patients. Currently a follow-up study with a larger group of patients is in progress to re-evaluate the established predictors.

scholarly journals Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units

2014 ◽  
Vol 11 (02) ◽  
pp. 105-118 ◽  
Author(s):  
Karleen Gwinner ◽  
Louise Ward
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Intensive Care ◽  
Lived Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Review Of Literature ◽  
Psychiatric Distress ◽  
Nurse Knowledge

AbstractBackground and aimIn recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.MethodData gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.ResultsFour defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.ConclusionThe four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

Impact of lung ultrasound on clinical decision making in critically ill patients

2013 ◽  
Vol 40 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Nektaria Xirouchaki ◽  
Eumorfia Kondili ◽  
George Prinianakis ◽  
Polychronis Malliotakis ◽  
Dimitrios Georgopoulos
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

2019 ◽  
Vol 40 (03) ◽  
pp. 170-187 ◽  
Author(s):  
Martin B. Brodsky ◽  
Emily B. Mayfield ◽  
Roxann Diez Gross
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Level Of Care ◽  
Assessment And Treatment ◽  
Proper Training ◽  
Screening Assessment

AbstractClinicians often perceive the intensive care unit as among the most intimidating environments in patient care. With the proper training, acquisition of skill, and approach to clinical care, feelings of intimidation may be overcome with the great rewards this level of care has to offer. This review—spanning the ages of birth to senescence and covering oral/nasal endotracheal intubation and tracheostomy—presents a clinically relevant, directly applicable review of screening, assessment, and treatment of dysphagia in the patients who are critically ill for clinical speech–language pathologists and identifies gaps in the clinical peer-reviewed literature for researchers.

Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study

2015 ◽  
Vol 29 (4) ◽  
pp. 324-335 ◽  
Author(s):  
Daren K Heyland ◽  
Peter Dodek ◽  
Sangeeta Mehta ◽  
Deborah Cook ◽  
Allan Garland ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Cohort Study ◽  
Intensive Care ◽  
Elderly Patients ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Family Members ◽  
Very Elderly

Background: Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit. Aim: To describe family members’ perspectives about care provided to very elderly critically ill patients. Design: Multicenter, prospective, cohort study. Participants and setting: In total, 535 family members of patients aged 80 years or older admitted to 22 intensive care units for more than 24 h. Results: Family members reported that the “patient be comfortable and suffer as little as possible” was their most important value and “the belief that life should be preserved at all costs” was their least important value considered in making treatment decisions. Most family members (57.9%) preferred that life support be used for their family member, whereas 24.1% preferred comfort measures only, and 14.4% were unsure of their treatment preferences. Only 57.3% reported that a doctor had talked to them about treatment options for the patient. Overall, 29.7% of patients received life-sustaining treatments for more than 7 days and 50.3% of these died in hospital. Families were most satisfied with the skill and competency of nurses and least satisfied with being included and supported in the decision-making process and with their sense of control over the patient’s care. Conclusion: There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.

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