Trajectory of Depressive Symptoms in Family Caregivers of the Chronically Critically Ill From ICU Admission to 2 Months Post-ICU Discharge: A Pilot Study

CHEST Journal ◽  
2011 ◽  
Vol 140 (4) ◽  
pp. 360A
Author(s):  
JiYeon Choi ◽  
Leslie Hoffman ◽  
Dianxu Ren ◽  
Michael Donahoe ◽  
Paula Sherwood
Keyword(s):  
Depressive Symptoms ◽  
Pilot Study ◽  
Family Caregivers ◽  
Critically Ill ◽  
Icu Admission ◽  
Icu Discharge ◽  
Chronically Critically Ill

Serum Coenzyme Q10 Levels are Decreased in Critically-Ill Septic Patients: Results From a Preliminary Study

2020 ◽  
pp. 109980042094448
Author(s):  
Alice G. Vassiliou ◽  
Zafeiria Mastora ◽  
Edison Jahaj ◽  
Chrysi Keskinidou ◽  
Maria E. Pratikaki ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Septic Shock ◽  
Critically Ill ◽  
Coenzyme Q10 ◽  
Inflammatory Biomarkers ◽  
Healthy Controls ◽  
Icu Patients ◽  
Icu Admission ◽  
Icu Discharge ◽  
Sepsis And Septic Shock

Background: The increased oxidative stress resulting from the inflammatory responses in sepsis initiates changes in mitochondrial function which may result in organ damage, the most common cause of death in the intensive care unit (ICU). Deficiency of coenzyme Q10 (CoQ10), a key cofactor in the mitochondrial respiratory chain, could potentially disturb mitochondrial bioenergetics and oxidative stress, and may serve as a biomarker of mitochondrial dysfunction. Hence, we aimed to investigate in initially non-septic patients whether CoQ10 levels are decreased in sepsis and septic shock compared to ICU admission, and to evaluate its associations with severity scores, inflammatory biomarkers, and ICU outcomes. Methods: Observational retrospective analysis on 86 mechanically-ventilated, initially non-septic, ICU patients. CoQ10 was sequentially measured on ICU admission, sepsis, septic shock or at ICU discharge. CoQ10 was additionally measured in 25 healthy controls. Inflammatory biomarkers were determined at baseline and sepsis. Results: On admission, ICU patients who developed sepsis had lower CoQ10 levels compared to healthy controls (0.89 vs. 1.04 µg/ml, p < 0.05), while at sepsis and septic shock CoQ10 levels decreased further (0.63 µg/ml; p < 0.001 and 0.42 µg/ml; p < 0.0001, respectively, from admission). In ICU patients who did not develop sepsis, admission CoQ10 levels were also lower than healthy subjects (0.81 µg/ml; p < 0.001) and were maintained at the same levels until discharge. Conclusion: CoQ10 levels in critically-ill patients are low on ICU admission compared to healthy controls and exhibit a further decrease in sepsis and septic shock. These results suggest that sepsis severity leads to CoQ10 depletion.

scholarly journals Employment status and its associated factor for patients 12 months after intensive care: Secondary analysis of the SMAP-HoPe-study

2021 ◽  
Author(s):  
Takeshi Unoki ◽  
Mio Kitayama ◽  
Hideaki Sakuramoto ◽  
Akira Ouchi ◽  
Tomoki Kuribara ◽  
...  
Keyword(s):  
Intensive Care ◽  
Depressive Symptoms ◽  
Physical Function ◽  
Employment Status ◽  
Depression Scale ◽  
Community Support ◽  
Financial Status ◽  
Icu Admission ◽  
Number Of Patients ◽  
Icu Discharge

AbstractReturning to work is a serious issue that affects patients who are being discharged from the intensive care unit (ICU). This study aimed to clarify the employment status and the perceived household financial status of ICU patients 12 months following discharge from the ICU. Additionally, a hypothesis of whether depressive symptoms were associated with subsequent unemployment status was tested. This study was a subgroup analysis using data from the published Survey of Multicenter Assessment with Postal questionnaire for Post-Intensive Care Syndrome (PICS) for Home Living Patients (the SMAP-HoPe study) in Japan. The patients included those who had a history of staying in the ICU for at least three nights and had been living at home for one year following discharge, between October 2019 and July 2020. We assessed employment status, subjective cognitive functions, household financial status, Hospital Anxiety and Depression Scale scores, and EuroQOL-5 dimensions of physical function at 12 months following intensive care. This study included 328 patients who were known to be employed prior to ICU admission. The median age was 64 (Interquartile Range [IQR] 52-72), and males were predominant (86%). Seventy-nine (24%) of those evaluated were unemployed. The number of patients who reported worsened financial status was significantly higher in the unemployed group. (p<.01) Multivariate analysis showed that higher age (Odds Ratio [OR]: 1.06, 95% Confidence Interval [CI]: 1.03-1.08]) and severity of depressive symptoms (OR: 1.13 [95% CI: 1.05-1.23]) were independent factors for employment status after 12 months from being discharged from the ICU. These factors were determined to be significant even after adjusting for sex, physical function, and cognitive function. We found that one-fourth of our patients who had been employed prior to ICU admission were subsequently unemployed 12 months following ICU discharge. Additionally, depressive symptoms were associated with unemployment status. The government and the local municipalities should provide medical and financial support to such patients. Additionally, community support for such patients is warranted.

scholarly journals Metabolic and Nutritional Characteristics of Long-Stay Critically Ill Patients

2019 ◽  
Vol 8 (7) ◽  
pp. 985 ◽  
Author(s):  
Marina V. Viana ◽  
Olivier Pantet ◽  
Geraldine Bagnoud ◽  
Arianne Martinez ◽  
Eva Favre ◽  
...  
Keyword(s):  
Critically Ill ◽  
Protein Delivery ◽  
Nutrition Risk ◽  
Icu Stay ◽  
Arterial Blood ◽  
Icu Discharge ◽  
Two Phases ◽  
Poor Outcomes ◽  
Chronically Critically Ill ◽  
Arterial Blood Glucose

Background: insufficient feeding is frequent in the intensive care unit (ICU), which results in poor outcomes. Little is known about the nutrition pattern of patients requiring prolonged ICU stays. The aims of our study are to describe the demographic, metabolic, and nutritional specificities of chronically critically ill (CCI) patients defined by an ICU stay >2 weeks, and to identify an early risk factor. Methods: analysis of consecutive patients prospectively admitted to the CCI program, with the following variables: demographic characteristics, Nutrition Risk Screening (NRS-2002) score, total daily energy from nutritional and non-nutritional sources, protein and glucose intakes, all arterial blood glucose values, length of ICU and hospital stay, and outcome (ICU and 90-day survival). Two phases were considered for the analysis: the first 10 days, and the next 20 days of the ICU stay. Statistics: parametric and non-parametric tests. Results: 150 patients, aged 60 ± 15 years were prospectively included. Median (Q1, Q3) length of ICU stay was 31 (26, 46) days. The mortality was 18% at ICU discharge and 35.3% at 90 days. Non-survivors were older (p = 0.024), tended to have a higher SAPSII score (p = 0.072), with a significantly higher NRS score (p = 0.033). Enteral nutrition predominated, while combined feeding was minimally used. All patients received energy and protein below the ICU’s protocol recommendation. The proportion of days with fasting was 10.8%, being significantly higher in non-survivors (2 versus 3 days; p = 0.038). Higher protein delivery was associated with an increase in prealbumin over time (r2 = 0.19, p = 0.027). Conclusions: High NRS scores may identify patients at highest risk of poor outcome when exposed to underfeeding. Further studies are required to evaluate a nutrition strategy for patients with high NRS, addressing combined parenteral nutrition and protein delivery.

scholarly journals Health Disparities of Critically Ill Children in Poverty: A Nationwide Population-Based Study

2020 ◽  
Author(s):  
Esther Park ◽  
Hyejeong Park ◽  
Danbee Kang ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
...  
Keyword(s):  
Health Disparities ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Household Income ◽  
Pediatric Patients ◽  
Admission Rate ◽  
National Database ◽  
Critically Ill Children ◽  
Icu Admission ◽  
Icu Discharge

Abstract Background: There is a lack of nationwide studies on health disparity of critically ill patients under the National Health Insurance (NHI) System. We aim to evaluate health disparities in intensive care unit (ICU) admission, outcomes, and readmission after ICU discharge in an impoverished pediatric population.Methods: We conducted a retrospective cohort study using a national database of claims submitted to the Korean NHI and Medical Aid Program (MAP). MAP provides support for the population whose household income is lower than 40% of the median Korean household income, and we defined poverty as being a MAP beneficiary. Patients between 28 days and 18 years old who were admitted to the ICU between August 1, 2010 and September 30, 2013, were included. Demographic characteristics, procedures, admission rates, and clinical outcomes were compared between the poverty and reference groups. Logistic regression model used to analyze hospital mortality and readmission with adjustment for patient characteristics, hospital type, and management procedures.Results: Out of 17,893 patients, 1,153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There were more deaths among impoverished patients who were admitted to the ICU (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group had a similar risk of adjusted in-hospital mortality to those not in the poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42).Conclusion: Pediatric patients in poverty were more likely to die in association with ICU admission. A high ICU admission rate rather than the high in-hospital mortality rate may cause the disparity in deaths. Further policies and studies are required to improve the health status of pediatric patients in poverty to decrease ICU admission.Trial registration: retrospectively registered

scholarly journals Prognostic Value of Bone Formation and Resorption Proteins in Heterotopic Ossification in Critically-Ill Patients. A Single-Centre Study

2021 ◽  
Vol 7 (1) ◽  
pp. 37-45
Author(s):  
Alice Georgia Vassiliou ◽  
Edison Jahaj ◽  
Zafeiria Mastora ◽  
Ioannis Karnezis ◽  
Ioanna Dimopoulou ◽  
...  
Keyword(s):  
Bone Formation ◽  
Heterotopic Ossification ◽  
Critically Ill ◽  
Bone Morphogenetic Proteins ◽  
Critically Ill Patients ◽  
Soft Tissues ◽  
Osteoclast Formation ◽  
Icu Admission ◽  
Icu Discharge ◽  
Single Centre Study

Abstract Introduction A potential complication in critically ill patients is the formation of bone in soft tissues, termed heterotopic ossification. The exact pathogenetic mechanisms are still undetermined. Bone morphogenetic proteins induce bone formation, while signalling through the receptor activator of nuclear factor kappa-Β (RANK) and its ligand (RANKL), regulates osteoclast formation, activation, and survival in normal bone modelling and remodelling. Osteoprotegerin protects bone from excessive bone loss by blocking RANKL from binding to RANK. Aim The study aimed to investigate these molecules as potential prognostic biomarkers of heterotopic ossification development in critically ill patients. Materials and Methods In this prospective observational study, BMP-2, RANKL, and osteoprotegerin were measured by ELISA in twenty-eight critically-ill, initially non-septic patients, on admission to an ICU, seven days post-admission, and thirty days after ICU discharge. Results In the critically-ill cohort, nine of the twenty-eight patients developed heterotopic ossification up to the 30-day follow-up time-point. The patients who developed heterotopic ossification exhibited significantly reduced BMP-2 and RANKL levels on ICU admission, compared to patients who did not; Osteoprotegerin readings were similar in both groups. Conclusions Critically-ill patients who will subsequently develop heterotopic ossification, have significantly lower BMP-2 and RANKL levels at the time of ICU admission, suggesting that these proteins may be useful as prognostic markers for this debilitating condition.

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