scholarly journals Myocardial Dysfunction in Elderly Patients Admitted with Non-Cardiac Diagnosis in Intensive Care Unit

2021 ◽  
Vol 9 (2) ◽  
pp. 127-132
Author(s):  
Dr. Yeshavanth G. ◽  
◽  
Dr. Edwin Joy ◽  
Dr. Aravind Bhagavath ◽  
◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Myocardial Injury ◽  
Clinical Symptoms ◽  
Troponin T ◽  
Myocardial Dysfunction ◽  
Statistical Significance ◽  
History Of ◽  
Cardiac Diagnosis

Background and Objectives: The diagnosis of acute coronary syndromes can be challenging inpatients admitted with the non-cardiac disease to the Intensive Care Unit (ICU). The study aimed todetermine the clinical profile of critically ill elderly patients developing myocardial injury who wereadmitted to ICU for non-cardiac diagnosis. Materials and Methods: The retrospective studysubjects are 130 patients admitted to the medical ICU. Within 24 hours of admission to ICU adetailed history, a 12 lead ECG, CK-MB, Cardiac troponin T was done and as required based on ECGfindings and development of clinical symptoms. Results: Our study showed that 35 out of 130patients developed acute myocardial injury. 13 out of 35 patients who had myocardial injury had afatal outcome. The prevalence of hypertension, diabetes mellitus, history of CVA, history of IHD andCOPD reached statistical significance (p<0.001) between the two groups of patients who developedmyocardial injury and who did not develop a myocardial injury. In patients with multiplecomorbidities, the presence of factors like hypoxia, hypotension and the use of vasopressorsincreases the risk of mortality. Conclusion: All elderly patients who are hospitalized with or withoutmultiple comorbidities with an acute form of stressors must be evaluated aggressively forprecipitants and adequately treated to prevent myocardial injury.

scholarly journals Emergence of KPC-2-Producing ST11-K64 Hypervirulent Klebsiella Pneumoniae for the Elderly in Intensive Care Unit: Antimicrobial Resistance, Molecular and Clinical Characteristics

2021 ◽  
Author(s):  
Tian Wei ◽  
Cheng-yun Zou ◽  
Jie Qin ◽  
Jian-min Tao ◽  
Li Yan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Elderly Patients ◽  
Antimicrobial Agents ◽  
Statistical Significance ◽  
Virulence Gene ◽  
Molecular Characteristics ◽  
Global Public Health ◽  
Carbapenem Resistant

Abstract Background: In recent years, carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) has been increasingly reported and poses severe therapeutic challenge to global public health, but has not yet been systematically studied in elderly patients. This study aimed to investigate the clinical and molecular characteristics and risk factors of CR-hvKP infections in elderly patients. Methods: We retrospectively investigated elderly patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in intensive care unit (ICU),between January 2020 and December 2020, the clinical data being collected from medical records, and microbiological data including antimicrobial susceptibility testing, phenotype experiment, carbapenemases production, string test, virulence gene, capsular serotype-specific (cps) genes and multilocus sequence typing, of the CR-hvKP group defined by the presence of some combination of rmpA, rmpA2, iucA, iroB, and peg-344 was compared with those of carbapenem-resistant non-hypervirulent Klebsiella pneumoniae (CR-non-hvKP) strains.Results: Of 80 CRKP strains, 51(63.8%) met the definition of CR-hvKP and 7 of them had all five of the virulence genes tested. The main mechanism of resistance to carbapenems found in CR-hvKP strains was the presence of the blaKPC-2 gene. There was no statistical significance in the resistance rates of antimicrobial agents between the CR-hvKP and CR-non-hvKP subgroups (p ≥ 0.05). Compared with the minimum inhibitory concentration (MIC) 50 values of CR-non-hvKP group, those of antimicrobials, including ceftazidime, ceftazidime/avibactam, imipenem/avibactam, tigecycline, levofloxacin, cefoperazone-sulbactam, exhibited higher levels in the CR-hvKP group. Avibactam (4 µg/mL) significantly decreased the MIC90 values more than sixteen-fold than that of ceftazidime and imipenem alone against KPC-2-producing Klebsiella pneumoniae. K64 and ST11 were highly prevalent and strongly associated with CR-hvKP (P<0.05). Cardiovascular disease (odds ratio [OR] = 11.956) and ST11-K64 (OR= 8.385) appeared to be independent variables associated with CR-hvKP infection by multivariate analysis.Conclusion: The CR-hvKP strains showed higher MIC50 values than CR-non-hvKP strains. KPC-2-producing ST11-K64 CR-hvKP is emerging, which might become new significant “superbugs” and a threat to elderly patients.

scholarly journals SARS-CoV-2 Persistent Viral Shedding in the Context of Hydroxychloroquine-Azithromycin Treatment

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 890
Author(s):  
Michel Drancourt ◽  
Sébastien Cortaredona ◽  
Cléa Melenotte ◽  
Sophie Amrane ◽  
Carole Eldin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Rare Event ◽  
Viral Shedding ◽  
Qrt Pcr ◽  
Viral Culture ◽  
D Dimer

SARS-CoV-2 nasopharyngeal shedding contributes to the spread of the COVID-19 epidemic. Among 3271 COVID-19 patients treated at the Hospital University Institute Méditerranée Infection, Marseille, France from 3 March to 27 April 2020, tested at least twice by qRT-PCR, the median SARS-CoV-2 nasopharyngeal shedding duration was 6 days (range 2–54 days). Compared with short shedders (qRT-PCR positivity < 10 days), 34 (1.04%) persistent shedders (qRT-PCR positivity ≥ 17 days; mean ± SD: 23.3 ± 3.8 days) were significantly older, with associated comorbidities, exhibiting lymphopenia, eosinopenia, increased D-dimer and increased troponin (p < 0.05), and were hospitalized in intensive care unit in 17.7% vs. 1.1% of cases (p < 0.0001). Viral culture was positive in six persistent shedders after day 10, including in one patient after day 17, and no viral co-pathogen was detected in 33 tested patients. Persistent shedders received azithromycin plus hydroxychloroquine ≥ 3 days in 26/34 (76.5%) patients, a figure significantly lower than in short shedders (86.6%) (p = 0.042). Accordingly, mortality was 14.7% vs. 0.5% (p < 0.0001). Persistent shedding was significantly associated with persistent dyspnea and anosmia/ageusia (p < 0.05). In the context of COVID-19 treatment, including treatment with azithromycin plus hydroxychloroquine, the persistence of SARS-CoV-2 nasopharyngeal shedding was a rare event, most frequently encountered in elderly patients with comorbidities and lacking azithromycin plus hydroxychloroquine treatment.

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals Intraperitoneal Microdialysis as a Monitoring Method in the Intensive Care Unit

2014 ◽  
Vol 99 (6) ◽  
pp. 729-733 ◽  
Author(s):  
Tasiopoulos Konstantinos ◽  
Komnos Apostolos ◽  
Paraforos Georgios ◽  
Tepetes Konstantinos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glucose Concentration ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Monitoring Method ◽  
P Values ◽  
Repeated Measures Analysis ◽  
Low Glucose ◽  
Surgical Condition

Abstract Studies on surgical patients provide some evidence of prompt detection of enteric ischemia with microdialysis. The purpose of the study was to measure intraperitoneal microdialysis values (glucose, glycerol, pyruvate, and lactate) in patients hospitalized in an intensive care unit (ICU) with an underlying abdominal surgical condition and to correlate these values with patients' outcomes. Twenty-one patients, 10 female, were enrolled in the study. The intraperitoneal metabolite values were measured for 3 consecutive days, starting from the first day of ICU hospitalization. Descriptive and inferential statistics were performed. The t-test, repeated measures analysis, Holm's test, and a logistic regression model were applied. Level of statistical significance was set at P = 0.05. Mean age of participants was 68.10 ± 8.02 years old. Survivors exhibited statistically significantly higher glucose values on day 3 (6.61 ± 2.01 against 3.67 ± 1.62; P = 0.002). Mean lactate/ pyruvate (L/P) values were above 20 (35.35 ± 27.11). All non-survivors had a mean three day L/P values greater than 25.94. Low L/P values were related to increased survival possibilities. High microdialysis glucose concentration, high L/P ratio and low glucose concentration were the major findings during the first three ICU hospitalization days in non-survivors. Intraperitoneal microdialysis may serve as a useful tool in understanding enteric ischemia pathophysiology.

scholarly journals Access to Intensive Care Unit Care for Elderly Patients with COVID-19 in Portugal

2020 ◽  
pp. 1-3
Author(s):  
Filipe S. Cardoso ◽  
André Borges ◽  
Isabel Botelho ◽  
André Real ◽  
Ana C. Araújo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Intensive Care Unit Care

scholarly journals ASSISTÊNCIA DE ENFERMAGEM NOS CUIDADOS PALIATIVOS AO PACIENTE IDOSO EM UNIDADE DE TERAPIA INTENSIVA / NURSING CARE IN PALLIATIVE CARE FOR ELDERLY PATIENTS IN AN INTENSIVE CARE UNIT

2020 ◽  
Vol 6 (12) ◽  
pp. 102261-102281
Author(s):  
Airton César Leite ◽  
Jaiciane Jorge da Silva ◽  
Maria Merciane Medeiros do nascimento Ferreira ◽  
Vanessa Bonfim Mendes ◽  
Lianna Emanuelli Carvalho Silva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Elderly Patients ◽  
Nursing Care ◽  
Terapia Intensiva

scholarly journals Never Too Early: Parenteral Nutrition Administration in Elderly Emergency General Surgery Patients

2021 ◽  
pp. 1-8
Author(s):  
A.K. Gergen ◽  
P. Hosokawa ◽  
C. Irwin ◽  
M.J. Cohen ◽  
F.L. Wright ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Elderly Patients ◽  
Parenteral Nutrition ◽  
Early Initiation ◽  
Unplanned Admission ◽  
Emergency General Surgery ◽  
Early Administration ◽  
Late Initiation

Objectives: Elderly patients requiring emergency general surgery (EGS) are at high risk for complications due to preexisting malnutrition. Thus, correcting nutritional deficits perioperatively is essential to improve outcomes. However, even in patients unable to tolerate enteral nutrition, initiation of parenteral nutrition (PN) is often delayed due to concerns of associated complications. In this study, we hypothesized that in elderly EGS patients with relative short-term contraindications to enteral nutrition, early administration of PN is as safe as delayed administration. Furthermore, early PN may improve outcomes by enhancing caloric intake and combatting malnutrition in the immediate perioperative period. Design and Setting: A single-institution, retrospective review was performed at a quaternary academic medical center. Participants: Participants consisted of 58 elderly patients >65 years of age admitted to the EGS service who required PN between July 2017 and July 2020. Measurements: Postoperative outcomes of patients started on PN on hospital day 0-3 (early initiation) were compared to patients started on PN on hospital day 4 or later (late initiation). Bivariate analysis was conducted using the Chi-square or Fisher’s exact test for categorical variables and the Wilcoxon-Mann-Whitney test and F-test for continuous variables. Results: Fifty-eight patients met inclusion criteria, with 27 (46.6%) patients receiving early PN and 31 (53.4%) receiving late PN. Both groups shared similar baseline characteristics, including degree of frailty, body mass index, and nutritional status at time of admission. Complications associated with PN administration were negligible, with no instances of central venous catheter insertion-related complications, catheter-associated bloodstream infection, or factors leading to early termination of PN therapy. A significantly higher proportion of patients in the early administration group met 60% of their caloric goal within 72 hours of admission (62.9% versus 19.5%, p=0.0007). Patients receiving late PN demonstrated a significantly higher rate of unplanned admission to the intensive care unit (38.7% versus 14.8%, p=0.04). Moreover, there was a 21.5% reduction in mortality among patients in the early initiation group compared to patients in the late initiation group (33.3% versus 54.8%, p=0.10). Conclusions: Early initiation of PN in hospitalized elderly EGS patients was not associated with increased adverse events compared to patients undergoing delayed PN administration. Furthermore, patients receiving early PN demonstrated a 2.6-fold decrease in the rate of unplanned admission to the intensive care unit and trended toward improved mortality. Based on these results, further prospective studies are warranted to further explore the safety and potential benefits of early PN administration in elderly surgical patients unable to receive enteral nutrition.

scholarly journals The effect of vitamin-d levels on prognosis of elderly patients treated in intensive care unit

2020 ◽  
Vol 10 (1) ◽  
pp. 13-17
Author(s):  
Hülya YİĞİT ÖZAY ◽  
İbrahim MUNGAN ◽  
Güneş ÇOBANOĞLU ERCAN ◽  
Sema TURAN ◽  
Banu ELER ÇEVİK
Keyword(s):  
Intensive Care Unit ◽  
Vitamin D ◽  
Intensive Care ◽  
Elderly Patients ◽  
Vitamin D Levels

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Annalisa Franco ◽  
Chiara Gerli ◽  
Monica De Luca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Troponin T ◽  
Mechanical Activity ◽  
Double Blind ◽  
Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

scholarly journals Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

2019 ◽  
Vol 5 (2) ◽  
pp. 118-122
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Shah Jahirul Hoque Chowdhury ◽  
Mohammad Enayet Hussain ◽  
Mohammad Asaduzzaman ◽  
Md Sirajul Islam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intravenous Immunoglobulin ◽  
Statistical Significance ◽  
Axonal Neuropathy ◽  
Male Predominance ◽  
Icu Stay ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

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