scholarly journals Hemotransfusion and mechanical ventilation time are associated with intra-hospital mortality in patients with traumatic brain injury admitted to intensive care unit

2016 ◽  
Vol 74 (8) ◽  
pp. 644-649 ◽  
Author(s):  
Kelson James Almeida ◽  
Ânderson Batista Rodrigues ◽  
Luiz Euripedes Almondes Santana Lemos ◽  
Marconi Cosme Soares de Oliveira Filho ◽  
Brisa Fideles Gandara ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Hospital Death ◽  
Factors Associated ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

ABSTRACT Objective To identify the factors associated with the intra-hospital mortality in patients with traumatic brain injury (TBI) admitted to intensive care unit (ICU). Methods The sample included patients with TBI admitted to the ICU consecutively in a period of one year. It was defined as variables the epidemiological characteristics, factors associated with trauma and variables arising from clinical management in the ICU. Results The sample included 87 TBI patients with a mean age of 28.93 ± 12.72 years, predominantly male (88.5%). The intra-hospital mortality rate was of 33.33%. The initial univariate analysis showed a significant correlation of intra-hospital death and the following variables: the reported use of alcohol (p = 0.016), hemotransfusion during hospitalization (p = 0.036), and mechanical ventilation time (p = 0.002). Conclusion After multivariate analysis, the factors associated with intra-hospital mortality in TBI patients admitted to the intensive care unit were the administration of hemocomponents and mechanical ventilation time.

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

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.

scholarly journals Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

2019 ◽  
Author(s):  
Hesham Abowali ◽  
Matteo Paganini ◽  
Garrett A Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Time Dependent ◽  
Hospital Length Of Stay ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

scholarly journals COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242127 ◽  
Author(s):  
Siegbert Rieg ◽  
Maja von Cube ◽  
Johannes Kalbhenn ◽  
Stefan Utzolino ◽  
Katharina Pernice ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Study Entry ◽  
Hospital Death ◽  
Care Model ◽  
Cox Regression Analysis ◽  
Hospitalised Patients

Background Reported mortality of hospitalised Coronavirus Disease-2019 (COVID-19) patients varies substantially, particularly in critically ill patients. So far COVID-19 in-hospital mortality and modes of death under state of the art care have not been systematically studied. Methods This retrospective observational monocenter cohort study was performed after implementation of a non-restricted, dynamic tertiary care model at the University Medical Center Freiburg, an experienced acute respiratory distress syndrome (ARDS) and extracorporeal membrane-oxygenation (ECMO) referral center. All hospitalised patients with PCR-confirmed SARS-CoV-2 infection were included. The primary endpoint was in-hospital mortality, secondary endpoints included major complications and modes of death. A multistate analysis and a Cox regression analysis for competing risk models were performed. Modes of death were determined by two independent reviewers. Results Between February 25, and May 8, 213 patients were included in the analysis. The median age was 65 years, 129 patients (61%) were male. 70 patients (33%) were admitted to the intensive care unit (ICU), of which 57 patients (81%) received mechanical ventilation and 23 patients (33%) ECMO support. Using multistate methodology, the estimated probability to die within 90 days after COVID-19 onset was 24% in the whole cohort. If the levels of care at time of study entry were accounted for, the probabilities to die were 16% if the patient was initially on a regular ward, 47% if in the intensive care unit (ICU) and 57% if mechanical ventilation was required at study entry. Age ≥65 years and male sex were predictors for in-hospital death. Predominant complications–as judged by two independent reviewers–determining modes of death were multi-organ failure, septic shock and thromboembolic and hemorrhagic complications. Conclusion In a dynamic care model COVID-19-related in-hospital mortality remained very high. In the absence of potent antiviral agents, strategies to alleviate or prevent the identified complications should be investigated. In this context, multistate analyses enable comparison of models-of-care and treatment strategies and allow estimation and allocation of health care resources.

Influence of Erythrocyte Concentrate Storage Time on Postsurgical Morbidity in Cardiac Surgery Patients

2003 ◽  
Vol 98 (4) ◽  
pp. 815-822 ◽  
Author(s):  
Santiago R. Leal-Noval ◽  
Irene Jara-López ◽  
José L. García-Garmendia ◽  
Ana Marín-Niebla ◽  
Angel Herruzo-Avilés ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Confidence Interval ◽  
Prolonged Storage ◽  
Prolonged Stay ◽  
Ventilation Time ◽  
Duration Of Storage ◽  
Mechanical Ventilation Time

Background The transfusion of erythrocytes that have been stored for long periods of time can produce visceral ischemia and favor the acquisition of postsurgical infections. To estimate the role of the duration of storage of erythrocytes on morbidity in cardiac surgery, we performed an observational study. Methods All patients (n = 897) undergoing cardiac surgery during three consecutive years were included. Morbidity (main outcome measure) was evaluated by means of four surrogate measures: duration of stay in the intensive care unit longer than 4 days, mechanical ventilation time longer than 1 day, perioperative myocardial infarction rate, and severe postoperative infection rate. The mean duration of storage of all erythrocytes transfused and the duration of storage of the oldest unit transfused were used as storage variables. Results After considering multiple confounding variables related to patient severity, illness, and surgical difficulty, the duration of storage of erythrocytes was found to be associated neither with a more prolonged stay in the intensive care unit or mechanical ventilation time nor with increased rates of perioperative infarction, mediastinitis, or sepsis. However, each day of storage of the oldest unit was associated with an increment of the risk of pneumonia of 6% (95% confidence interval, 1-11; P = 0.018). The cutoff point of maximum sensitivity and specificity (54.8 and 66.9%) associated with a greater risk for pneumonia corresponded to 28 days of storage for the oldest unit (odds ratio, 2.74; 95% confidence interval, 1.18-6.36; P = 0.019). Conclusions Prolonged storage of erythrocytes does not increase morbidity in cardiac surgery. However, storage for longer than 28 days could be a risk factor for the acquisition of nosocomial pneumonia.

scholarly journals Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

2019 ◽  
Author(s):  
Hesham Abowali ◽  
Matteo Paganini ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Time Dependent ◽  
Confounding Factors ◽  
Ventilation Time ◽  
Significant Difference ◽  
Mechanical Ventilation Time

Abstract BACKGROUND: The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries is controversial when compared to propofol. METHODS: A computerized search of Medline, Cochrane and Google Scholar databases was performed through August 2018. Studies evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were searched. The main study outcomes were divided into time dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and in the hospital) and non-time dependent (delirium, bradycardia, and hypotension). RESULTS: The final analysis included 15 trials with a total of 2488 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.54, 95% Confidence Interval (CI): -0.89 to -0.18, p=0.003), as well as mechanical ventilation time (SMD= -0.71, 95% CI: -1.19 to -0.23, p=0.004). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.38, 95% CI: -0.60 to -0.16, p=0.001) and hospital length of stay (SMD= -0.39, 95% CI: -0.60 to -0.19, p<0.001). However, these time dependent outcomes could have been affected by several confounding factors, thus limiting the value of these results. Incidence of delirium was reduced in the dexmedetomidine group (OR: 0.47, 95% CI: 0.29 to 0.76, p=0.002), while this group of patients had higher rates of bradycardia (OR: 2.52, 95% CI: 1.15 to 5.55, p=0.021). There was no significant difference in rates of hypotension between the two groups. CONCLUSION: Despite the apparent time advantages afforded by dexmedetomidine over propofol, the former does not show particular overall improvements in postoperative care of cardiac surgery patients. Since time dependent outcomes seems to be affected by several confounding factors, more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes. KEYWORDS: Dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

scholarly journals Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Farhad Soltani ◽  
Seyedkamalaldin Tabatabaei ◽  
Farahzad Jannatmakan ◽  
Nozar Nasajian ◽  
Fereshteh Amiri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Brain Injury ◽  
Assessment Method ◽  
Trauma Patients ◽  
Moderate Traumatic Brain Injury ◽  
Significant Difference ◽  
Haloperidol Group

Background: Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined. Objectives: This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU. Methods: Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium. Results: Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05). Conclusions: There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.

scholarly journals The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury

2011 ◽  
Vol 64 (7-8) ◽  
pp. 403-407 ◽  
Author(s):  
Vesna Marjanovic ◽  
Vesna Novak ◽  
Ljubinka Velickovic ◽  
Goran Marjanovic
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Prolonged Mechanical Ventilation ◽  
Chest Injury ◽  
Ventilator Associated Pneumonia

Introduction. Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator- associated pneumonia and outcome in patients with severe traumatic brain injury. Material and Methods. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Results. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p<0.001), longer stay at intensive care unit (17 vs 5 days, p<0.001) and chest injury (51.61 vs 19.51%, p< 0.009) compared to patients without ventilator-associated pneumonia.. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p= 0.12). Conclusion. The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.

scholarly journals Factors Associated with Mortality in Patients with a Solid Malignancy Admitted to the Intensive Care Unit - A Prospective Observational Study

2018 ◽  
Vol 4 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Pascal Kingah ◽  
Nasser Alzubaidi ◽  
Jihane Zaza Dit Yafawi ◽  
Emad Shehada ◽  
Khaled Alshabani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Performance Status ◽  
Academic Medical Center ◽  
Factors Associated ◽  
Solid Malignancy

Abstract Purpose: Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes. Methods and Materials: All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented. Results: There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 – 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races. Conclusion: This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.

scholarly journals Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

2020 ◽  
Author(s):  
Hesham A. Abowali ◽  
Matteo Paganini ◽  
Garrett Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Time Dependent ◽  
Hospital Length Of Stay ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Background The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries are controversial when compared to propofol. Methods A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed through July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were selected. The primary study outcomes were divided into time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes of heart valve surgery and CABG patients. Additionally, time-dependent outcomes are affected by several confounding factors, and more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes.

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