scholarly journals Corticosteroids for pediatric septic shock patients

2019 ◽  
Vol 59 (2) ◽  
pp. 67-71
Author(s):  
Irene Yuniar ◽  
Vembricha Nindya Manusita ◽  
Sonya Leonardy Low
Keyword(s):  
Septic Shock ◽  
Mortality Rate ◽  
Corticosteroid Therapy ◽  
Pediatric Intensive Care ◽  
Median Number ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cross Sectional ◽  
Almost All

Background Septic shock remains a major cause of mortality and admission to the pediatric intensive care unit (PICU) in children. Management includes adequate fluid resuscitation, followed by catecholamine infusion, if needed. Corticosteroid therapy is advised for catecholamine-refractory shock, although this practice is controversial, as it was not beneficial in other studies. Objective To assess corticosteroid use in pediatric septic shock patients in Cipto Mangunkusumo Hospital. Methods This cross-sectional study included all patients aged 1 month-18 years with a diagnosis of septic shock during the study period of January 2014 to July 2018 admitted in PICU Dr. Cipto Mangunkuskumo Hospital, Jakarta. Data obtained from medical records were, age, sex, immunology status, port d’entrée of sepsis, inotropic and vasopressor usage, mechanical ventilation, corticosteroid type, hospital length of stay (LOS), and mortality outcome. Results Of 217 children with septic shock, 12 patients (5.5%) received corticosteroid therapy. The most common corticosteroid given was hydrocortisone (80%), with a 2 mg/kg BW loading dose, followed by a continuous infusion dose of 2-50 mg/kg BW/day. Almost all patients (11/12) received corticosteroid therapy until they died. Median duration of corticosteroid use was 2 (range 1-7) days, median number of inotropes and vasopressors used was 3 (range 2-4) agents, median LOS was 3 (range 1-9) days, and mortality rate was 100%. Conclusion A small proportion of pediatric septic shock patients received corticosteroid therapy. Their mortality rate was 100%. Further clinical study is needed to evaluate the benefit of corticosteroid therapy in pediatric septic shock patients.

Time to Seek Care and Hospital Length of Stay Among Older Adults With Acute Coronary Syndrome During the COVID-19 Pandemic

2021 ◽  
pp. 105477382110401
Author(s):  
Audai A. Hayajneh ◽  
Mohammad Rababa ◽  
Sami Al-Rawashedeh
Keyword(s):  
Older Adults ◽  
Acute Coronary Syndrome ◽  
Cross Sectional Study ◽  
Abrupt Onset ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Prehospital Delay ◽  
Coronary Syndrome

The prevalence of prehospital delay is high among older adults with acute coronary syndrome (ACS). The current study aimed to examine the associated factors of prehospital delay among patients with ACS during the COVID-19 pandemic. This cross-sectional study was conducted on a convenience sample of 300 older adults with ACS admitted to the emergency department in Jordan. Data were collected from June 1 to September 1, 2020. Bivariate and multivariate analyses were used to explore the predictors of prehospital delay. Being widowed, educational level, pain intensity, the gradual onset of ACS symptoms, symptoms lasting for more than 30 minutes, patients’ feeling anxious about their ACS symptoms, patients’ perceiving their symptoms to be particularly dangerous, history of myocardial infarction (MI), and mode of transportation were associated with the time taken before seeking emergency care. Significant predictors of time to seek help were chief complaint of chest pain or palpitations, abrupt onset of symptoms, the associated symptom of vertigo, and a higher number of chronic illnesses; they explained about 17.9% of the variance in the time to seek care. The average time to seek care among patients with ACS during the COVID-19 pandemic was found to be longer than the average time reported by studies conducted prior the pandemic. Improved understanding of the associations between prehospital delay is crucial for optimal ACS patient outcomes under the impacts of the COVID-19 pandemic.

Physical activity levels in hospitalised adults with burn injuries

2021 ◽  
Author(s):  
Anita Plaza ◽  
Julie Adsett ◽  
Angela Byrnes ◽  
Prue McRae
Keyword(s):  
Physical Activity ◽  
Total Body Surface Area ◽  
Physical Activity Behaviour ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Burn Injuries ◽  
Hospital Length Of Stay ◽  
Activity Levels ◽  
Cross Sectional ◽  
Activity Behaviour

Abstract Physical activity behaviour has not been previously described in hospitalised adults with burn injuries. This prospective, cross-sectional study used a standardised behavioural mapping protocol to observe patient behaviour related to physical activity over a 12-hour period on one weekday in a quaternary referral specialist burn centre. Structured observations were recorded for each of four domains: 1) patient location, 2) position, 3) activity performed and 4) the presence of others. Observations were summarised across all participants as median (IQR) proportion of time. Participants (n=17) were predominantly male (82%) with a mean age of 44.3 (SD 15.2) years, a mean burn size of 34.9% (SD 26.7) total body surface area and a median hospital length of stay of 18 (IQR 6-49) days at time of observation. Participants spent a median of 83% (IQR 73-93) of time in their bedroom, 92% (IQR 68-97) of time in or on their bed and a median of 5% (IQR 3-13) of time mobilising. Exercise accounted for 10% (IQR 8-17) of activity related observations. A median of 68% (IQR 39-83) of time was spent alone. Results suggest time spent engaging in physical activity is low. Further studies are required to investigate motivators and barriers to performing physical activity in this population. This will consequently inform the development and implementation of appropriate strategies to improve physical activity behaviour in this cohort.

scholarly journals Clinical profile, etiology, management and outcome of serum sodium disturbances in children admitted in PICU

2017 ◽  
Vol 5 (6) ◽  
pp. 2546
Author(s):  
Balaji Jayakumar ◽  
Ekambaranath Sambasivam
Keyword(s):  
Intensive Care ◽  
Venous Blood ◽  
Pediatric Intensive Care ◽  
Urine Osmolality ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Glucose Levels ◽  
Sick Children ◽  
Almost All

Background: Sodium disorders are common in children who need intensive care, they occur in variety of conditions, may remain unrecognized if not suspected and monitored and result in morbidity and mortality irrespective of primary problem. The aim of the study is to know etiology, management and outcome of sodium disturbances in sick children admitted to pediatric intensive care unit to Institute of Social Pediatrics Stanley Medical College.Methods: This is a hospital based cross sectional study. Two hundred and twenty-seven children in the age group of 1month to 12 years admitted in PICU over the period of 8 months were included in the study. Venous blood sampling is obtained from each patient enrolled in the study and is sent for estimation of electrolytes, blood urea, glucose levels. Serum osmolality (calculated), urine osmolality, urine spot sodium were done in selected patients.Results: Among the 227 children studied, 85 children had sodium disturbances that included both hyponatremia (80 children) and hypernatremia (5 children) The most common cause of hyponatremia is CNS disorder 25 patients (31.25%) followed by poisoning 17.Conclusions: Hyponatremia occurs frequently and should be looked for in all sick children. It is of hypotonic- euvolemic type in almost all the acute infections except diarrhea and should be managed accordingly. They contribute significantly to the mortality and morbidity. 

scholarly journals Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand

2021 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Late Onset ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Resistance Patterns

Abstract Background: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (16.7% VS 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95% confidence interval (CI), 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.

Septic Shock Outcome and Factors Associated with Mortality in the Intensive Care Unit in Vietnam

2021 ◽  
Vol 104 (8) ◽  
pp. 1249-1254
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Mortality Rate ◽  
Mortality Risk ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Old Patients ◽  
Shock Outcome

Objective: To evaluate the mortality rate of septic shock patients and to learn about the associated risk factors for death. Materials and Methods: Septic shock is a life-threatening subset of sepsis with profound circulatory, cellular, and metabolic abnormalities. The authors conducted an analytical cross-sectional study on adult patients diagnosed with septic shock using Sepsis-3 criteria between May 2016 and May 2018 at an intensive care unit at a hospital in Vietnam. Data on patients’ outcomes and associated factors were collected through questionnaires and the patient medical records. To measure the association between independent variables and outcomes, odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression. Results: One hundred fifty patients with septic shock were enrolled in the present study. Septic shock occurred in 71.3% of the 60-years-old patients and 54% were men. The mean age was 68.5±15.52 years. The mortality rate was 62% and 17.3% of patients died within 24 hours after being diagnosed with septic shock. The median length of ICU stay was four days. The initial mean SOFA and APACHE II scores were significantly higher in the death group. Septic shock patients with comorbidities had a higher mortality risk compared to those without comorbidity (OR 2.9, 95% CI 1.116 to 7.700). Patients who developed septic shock in the hospital were at greater death risk (OR 7.8, 95% CI 3.3 to 18.2). Septic shock due to pneumonia had a higher mortality risk in comparison with those due to the other causes (OR 5.2, 95% CI 2.4 to 11.0). Conclusion: The mortality rate of patients with septic shock in Vietnam was considerably high. Many factors were identified as risks, such as nosocomial infection and respiratory tract diseases. Keywords: Septic shock; Outcome; Risk factors; Vietnam

scholarly journals Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Late Onset ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Resistance Patterns

Abstract Background Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50% EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8%) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS [median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days], hospital LOS [median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days] shorter MV days [median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days] and lower hospital mortality (16.7% vs 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 [95% confidence interval (CI), 1.08–4.54, p = 0.02]. Conclusion LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.

scholarly journals Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand

2021 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Late Onset ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Resistance Patterns

Abstract Background: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (16.7% VS 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95% confidence interval (CI), 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.

scholarly journals Postoperative cardiac surgery complications and hospital length of stay

2018 ◽  
Vol 12 (8) ◽  
pp. 2105
Author(s):  
Alexandre Lins Werneck ◽  
Ligia Marcia Contrin ◽  
Lucia Marinilza Beccaria ◽  
Gabriela Taparo De Castro ◽  
Carolina Varine Teixeira ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cross Sectional ◽  
Cardiac Surgery Complications ◽  
Set Up ◽  
Previous Disease

RESUMOObjetivo: associar as principais complicações com pacientes submetidos à cirurgia cardíaca e o tempo de internação. Método: estudo quantitativo, transversal, descritivo e correlacional, para identificar os registros médicos de pacientes submetidos a cirurgias cardíacas e aqueles no pós-operatório na Unidade de Terapia Intensiva. O teste de Regressão Linear Multivariada foi utilizado para a análise e a previsão de independência entre as variáveis. Resultados: dos 103 pacientes submetidos a cirurgias cardíacas, 26 apresentaram complicações pós-operatórias. As complicações mais prevalentes foram cardíacas, pulmonares e infecciosas. Nove pacientes morreram. A doença anterior mais prevalente foi hipertensão arterial sistêmica. Em relação aos dias de hospitalização, o predomínio foi de um a três dias, seguido de três a seis dias. Conclusão: a revascularização miocárdica foi a principal cirurgia realizada, seguida de endarterectomia e as complicações observadas foram cardíacas, seguidas das pulmonares. A duração hospitalar dos pacientes variou de um a três dias. Este estudo mostrou que é imprescindível o planejamento da alta do paciente o mais precocemente possível para a diminuição do tempo de internação e possíveis complicações. Descritores: Complicações; Cirurgias Cardíacas; Pacientes; Tempo de Internação; Tempo de Internação; Alta do Paciente; Unidade de Terapia Intensiva.ABSTRACT Objective: to associate the main complications experienced by patients submitted to cardiac surgery and the length of stay in a Cardiac ICU. Method: this was a quantitative, cross-sectional study using descriptive and correlation designs. We identified medical records of patients undergoing cardiac surgeries and those who were in the postoperative period in the Intensive Care Unit. Multivariate Linear Regression test was used for THE analysis and THE prediction of independence between variables. Results: twenty-six out of 103 patients submitted to cardiac surgeries presented postoperative complications. The most prevalent complications were cardiac, pulmonary, and infectious ones. Nine patients died. The most prevalent previous disease was systemic arterial hypertension. Regarding the hospital length of stay, the predominance was ONE to THREE days, followed by THREE to six days. Conclusion: The hospital length of stay ranged from ONE to THREE days long. This STUDY showed that planning is essential to set up the patient’s discharge as early as possible, as well as to reduce the hospital length of stay and potential complications. Descriptor: Complications; Thoracic Surgery; Patients; Length of Stay; Discharge Plannings; Intensive Care Unit.RESUMENObjetivo: Asociar las principales complicaciones con pacientes sometidos a la cirugía y con el tempo de internación. Método: Estudio cuantitativo, transversal, descriptivo y correlacional del banco de datos del hospital para identificar los registros médicos de pacientes sometidos a cirugías torácicas y de aquellos en el postoperatorio en la Unidad de Cuidados Intensivos. Se utilizó la prueba de Regresión Lineal Múltiple para análisis y predicción de independencia entre las variables.  Resultados: De los 103 pacientes sometidos a cirugías torácicas, 26 presentaron complicaciones postoperatorias. Las complicaciones más prevalentes fueron las cardíacas, las pulmonares y las infecciosas. Nueve pacientes murieron. La enfermedad anterior más prevalente ha sido la hipertensión arterial sistémica. Acerca de los días de hospitalización, el período predominante fue de UNO a TRES días, seguido de TRES a SEIS días. Conclusión: La cirugía de revascularización coronaria ha sido la principal cirugía, seguida de la endarterectomía, y las complicaciones observadas fueron las cardíacas, seguidas de las pulmonares. El tiempo de internación de los pacientes varió de UNO a TRES días. Eso ESTUDIO ha mostrado que es imprescindible planificar el egreso del paciente lo más temprano posible, para reducción del tiempo de internación y de las posibles complicaciones. Descriptores: Complicaciones; Cirurgía Torácica; Pacientes; Tiempo de Internación; Alta del Paciente; Unidades de Cuidados Intensivos.

scholarly journals Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand

2020 ◽  
Author(s):  
Pavarit Arayasukawat ◽  
Apichart - So-ngern ◽  
Wipa Reechaipichitkul ◽  
Worawat Chumpangern ◽  
Itthiphat Arunsurat ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Late Onset ◽  
Demographic Data ◽  
Simplified Acute Physiology Score ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Tertiary Center

Abstract Back ground: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 (22%) were EOVAP and 148 (78%) were LOVAP. Acinetobacter baummanii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (11.9 % VS 27.7%) than LOVAP ( p < 0.05). The factor associated with hospital mortality was having simplified acute physiology score (SAP) ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95%CI, 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.

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