Factors associated with readmissions to an adult intensive care unit at a university hospital

Objective: to verify the rate and factors associated with readmissions in the Intensive Care Unit. Methods: a documentary study, carried out with a sample (n=441) of medical records of adult patients admitted to the Intensive Care Unit of a university hospital. The descriptive and inferential statistical analysis was applied, using Pearson’s correlation, the chi-square test, and the t-student test, at a 5% confidence level. Results: most were men (66.2%), with 52.8±18.5 years of age and hospital stay of 10.2±10.8 days. Of these, 29 (6.5%) were readmitted. Death was similar (p=0.893) between readmitted (31.0%) and not readmitted (29.8%). There was no significant correlation between the readmission outcome and age, Nursing Activities Score and time on mechanical ventilation. By comparison, the hospital stay, and extubation were significantly longer (p<0.05) among those readmitted. Conclusion: the rate of readmission was slightly low. Only extubation time was negatively and significantly correlated with the readmission outcome.

Download Full-text

Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome

SAGE Open Medicine ◽

10.1177/2050312120958908 ◽

2020 ◽

Vol 8 ◽

pp. 205031212095890

Author(s):

Man-ka Zhang ◽

Tian-qi Xu ◽

Xiao-jing Zhang ◽

Zhi-guo Rao ◽

Xiao-xu He ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bacterial Infection ◽

Platelet Transfusion ◽

Severe Thrombocytopenia ◽

Chi Square ◽

Adult Intensive Care Unit ◽

Factors Associated ◽

Platelet Counts ◽

Chi Square Test

Objective: We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia. Methods: We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression. Results: We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals ( p = 0.002) and bacterial infection ( p = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ2 = 9.719, p = 0.002). Conclusion: Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.

Download Full-text

The pattern of admission and outcome of neonates managed in the neonatal intensive care unit in a Sudanese hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211068 ◽

2021 ◽

Vol 8 (4) ◽

pp. 616

Author(s):

Safaa A. M. Ahmed ◽

Mohammed A. O. Ali ◽

Esraa A. A. Mahgoub ◽

Mohammed Nimir ◽

Elfatih M. Malik

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Medical Records ◽

Neonatal Intensive Care ◽

Binary Logistic Regression ◽

Neonatal Morbidity ◽

Chi Square ◽

Chi Square Test

Background: This study aimed to assess the admission pattern and outcome of neonates managed in the neonatal intensive care unit (NICU) in a Sudanese hospital.Methods: This hospital-based retrospective study was conducted in the NICU of Saad Abu Elella Teaching Hospital in Khartoum, Sudan. Data was collected from medical records of 207 neonates using an extraction form. Chi-square test and binary logistic regression were used in analysis.Results: Most of the neonates were term, and 43% of them had a birth weight less than 2.5 kg. Moreover, the most common morbidities among them were sepsis, respiratory distress syndrome, neonatal jaundice and asphyxia, and the mortality rate was 15%. Additionally, the birth weight, gestational age, the need for resuscitations, direct breast feeding and being beside mother were found to be significantly associated with the studied outcome.Conclusions: Majority of causes of neonatal morbidity and mortality in our study were preventable diseases. Therefore, interventions to improve services in the NICU are highly needed to improve the outcomes.

Download Full-text

Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

Clinical Nursing Research ◽

10.1177/10547738211050489 ◽

2021 ◽

pp. 105477382110504

Author(s):

Jeong Eun Yoon ◽

Ok-Hee Cho

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Medical Records ◽

Injury Severity ◽

University Hospital ◽

Factors Associated ◽

Braden Scale

Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.

Download Full-text

INCIDENCE AND FACTORS RELATED TO THE APPEARANCE OF PRESSURE INJURIES IN AN INTENSIVE CARE UNIT

ESTIMA Brazilian Journal of Enterostomal Therapy ◽

10.30886/estima.v19.1014_in ◽

2021 ◽

Author(s):

Jacqueline Marques Rodrigues ◽

Kemily Covre Gregório ◽

Ursula Marcondes Westin ◽

Danielle Garbuio

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Hospital ◽

Chi Square ◽

Average Hospital ◽

Significance Level ◽

Sacral Region ◽

Adult Intensive Care Unit ◽

Pressure Injury ◽

Student’S T

Objectives: identify the incidence and characterize pressure injuries in an adult intensive care unit regarding the occurrence, locations and risk factors, and verify whether there is an association between these and the appearance of the injuries. Method: observational, cohort, prospective study, developed in an intensive care unit of a tertiary hospital, from October to December 2019. The population consists of adults on the first day of admission to the unit, without pressure injury at admission. Participants were monitored during hospitalization, sociodemographic and clinical variables, and risk assessment of developing a pressure injury, skin assessment and Braden scale were collected daily. Pearson’s chi-square tests and student’s t-test were used to assessing the relationship between variables and injuries. For the analyzes, a significance level (α) of 5% was considered. Results: 40 participants were included, 20% had pressure injuries with a predominance of stages 1 and 2; the main affected sites were the sacral region followed by the calcaneus. The average hospital stay was 23.38 days for the injured group and 5.77 days for the non-injured group; time showed a significant relationship with the appearance of lesions (p = 0.002). Conclusion: it was concluded that the most affected site was the sacral region and grade 1 was the most frequent staging; length of stay was the variable that influenced the appearance of injuries.

Download Full-text

Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multi-center cohort study

10.1101/2020.06.01.20086025 ◽

2020 ◽

Author(s):

Huanyuan Luo ◽

Songqiao Liu ◽

Yuancheng Wang ◽

Penelope A. Phillips-Howard ◽

Yi Yang ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Stay ◽

Older Patients ◽

Adverse Outcomes ◽

Trend Test ◽

Chronic Obstructive ◽

Chi Square ◽

Chi Square Test

Objectives To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. Design and setting This is a retrospective, multi-center cohort study performed at twenty-four hospitals in Jiangsu, China. Participants From January 10 to March 15, 2020, 625 patients with COVID-19 were involved. Results Of the 625 patients (median age, 46 years; 329 [52.6%] males), 37 (5.9%) were children (18 years or less), 261 (40%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years), and 79 (12.6%) elderly (65 years or more). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease, and diabetes comorbidities increased with age (trend test, P < .0001, P = 0.0003, P < .0001, and P < .0001 respectively). Fever, cough, and shortness of breath occurred more commonly among older patients, especially the elderly, compared to children (Chi-square test, P = 0.0008, 0.0146, and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both P < .0001). Older patients had significantly more abnormal values in many laboratory parameters than younger patients. Elderly patients contributed the highest proportion of severe or critically-ill cases (33.0%, Chi-square test P < 0.001), intensive care unit (ICU) (35.4%, Chi-square test P < 0.001), and respiratory failure (31.6%, Chi-square test P = 0.0266), and longest hospital stay (21 days, ANOVA-test P < 0.001). Conclusions Elderly (≥65) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure, and the longest hospital stay, which may be due partly to that they had higher incidence of comorbidities and poor immune responses to COVID-19.

Download Full-text

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n9p104 ◽

2019 ◽

Vol 9 (9) ◽

pp. 104

Author(s):

Fabiola Alves Gomes ◽

Denise Von Dolinger de Brito Röder ◽

Thúlio Marquez Cunha ◽

Rosângela De Oliveira Felice ◽

Guilherme Silva Mendonça ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Costs ◽

University Hospital ◽

Nursing Workload ◽

Ventilator Associated Pneumonia ◽

Adult Intensive Care Unit ◽

Icu Admission ◽

Stay Time ◽

The Impact

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

Download Full-text

Incidence and Risk Factors for Ventilator-Associated Pneumonia in Kathmandu University Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i1.6258 ◽

2012 ◽

Vol 9 (1) ◽

pp. 28-31 ◽

Cited By ~ 3

Author(s):

S Ranjit ◽

B Bhattarai

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Univariate Analysis ◽

University Hospital ◽

Ventilator Associated Pneumonia ◽

Chi Square ◽

H2 Blockers ◽

Observational Cohort ◽

Level Of Significance

Background Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. Objectives To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. Methods A prospective observational cohort study of 69 patients who were mechanically ventilated for more than 48 hours were evaluated to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. Results Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88±7.7 days vs 7.36±4.19 days) and stay (29±17.8 days vs 9.22±5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. ConclusionThe incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.http://dx.doi.org/10.3126/kumj.v9i1.6258 Kathmandu Univ Med J 2011;9(1):28-31

Download Full-text

Microbiology and Risk Factors for Catheter Exit-Site and -Hub Colonization in Neonatal Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/501913 ◽

2001 ◽

Vol 22 (6) ◽

pp. 357-362 ◽

Cited By ~ 24

Author(s):

Ludo M. Mahieu ◽

Jozef J. De Dooy ◽

Aimé O. De Muynck ◽

Guillaume Van Melckebeke ◽

Margareta M. Ieven ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Strong Association ◽

University Hospital ◽

Exit Site ◽

Coagulase Negative Staphylococci ◽

Factors Associated

AbstractObjective:To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates.Design:During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal.Setting:A neonatal intensive care unit at a university hospital.Results:Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%;P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6;P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244;P<.001), and colonization of the catheter hub (OR, 8.9; CI95,3.5-22.8;P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95,1.029-1.083;P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34;P<.001). No association was found between colonization at these sites and duration of catheterzation and venue of insertion, physician's experience, postnatal age and patient's weight, ventilation, steroids or antibiotics, and catheter repositioning.Conclusion:These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.

Download Full-text

COMEPA (COVID-19 Medicina Policlinico Palermo): a study in hospitalized patients

Geriatric Care ◽

10.4081/gc.2021.9895 ◽

2021 ◽

Vol 7 (3) ◽

Author(s):

The COMEPA group

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Clinical Practice ◽

Medical Records ◽

University Hospital ◽

Efficacy And Safety ◽

The Past ◽

The University

Coronavirus disease 2019 (COVID-19) has dramatically changed our lives. In the past months, hospitals were saturated of patients; therefore, it is still important to have simple and standardized prognostic factors and to evaluate the efficacy and safety of medications commonly used for COVID-19. We aimed to collect data of the patients hospitalized in Internal Medicine and Geriatrics Wards at the University Hospital (Policlinico) ‘P. Giaccone’ in Palermo, Italy (COMEPA, COVID-19 Medicina Policlinico Palermo), with the main purpose of finding prognostic tools that can be easily used in clinical practice in order to identify patients hospitalized for/with COVID-19 at higher risk of negative outcomes, such as mortality, transfer to Intensive Care Unit (ICU) and institutionalization, as well as evaluating the efficacy/safety of medications commonly used for COVID-19. For reaching these aims, the medical records of approximately 600 patients will be recorded, having data on several parameters and including as outcomes mortality, ICU placement, institutionalization. With the COMEPA study, we therefore plan to update current literature, giving new data on prognostic factors and on the efficacy/safety of some medications used for COVID-19.

Download Full-text

Off-label use of drugs administered by enteral feeding tubes in an Intensive Care Unit in Fortaleza, Brazil

Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde ◽

10.30968/rbfhss.2021.121.0562 ◽

2021 ◽

Vol 12 (1) ◽

pp. 562

Author(s):

Gabriela A. ABREU ◽

Elana F. CHAVES ◽

José A. NETO ◽

Lívia P. MOREIRA ◽

Johann V. SILVA ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular System ◽

Enteral Feeding ◽

University Hospital ◽

Adult Intensive Care Unit ◽

Feeding Tubes ◽

Oral Medications ◽

Oral Formulations ◽

Administration Methods

Objective: To analyze the prescription profile of drugs administered through enteral feeding tubes in an adult intensive care unit and gather recommendations for their safe administration. Methods: This is a descriptive and retrospective study conducted with adult critical clinical patients of a university hospital in Fortaleza-Ceará from March to May 2018. We performed analyses of patients’ medical records and prescriptions regarding drugs, pharmaceutical presentations and the possibility of administration through enteral tubes. Results: 489 prescriptions containing 1914 items were evaluated, from which 16.6% (n = 318) through tubes. Medicines for the cardiovascular system (34.6%), nervous system (27.4%) and digestive system and metabolism (15.1%) were the most predominant, with an average of 5.8 (DP: 4.2) different per patient. Regarding the pharmaceutical presentation, oral solids were frequently prescribed via enteral tube (67.9%), especially risperidone (8.8%), carvedilol (8.3%) and amiodarone (7.9%). There were contraindications for administration through tubes in 21.6% of solid oral formulations, while there were alternative standardized pharmaceutical forms in the hospital for 43.1%. In addition, substitution for liquid preparations from the market were possible in 43.1%. Among those to which there were no alternative formulations, drugs targeting the cardiovascular system prevailed (52.2%). A table with guidelines for the proper administration of the prescribed solid medications was elaborated then. Conclusion: Solid oral medications were frequently prescribed through enteral tubes, especially those for the cardiovascular system without alternative formulations, which shows the need for guidelines to promote the safety of this process.

Download Full-text