Outcomes for critical conditions in newborns depending on the time of interhospital transportation

2013 ◽  
Vol 4 (3) ◽  
pp. 15-23 ◽  
Author(s):  
Yuriy Stanislavovich Aleksandrovich ◽  
Konstantin Viktorovich Pshenisnov ◽  
Vadim Vladimirovich Andreyev ◽  
Yevgeniy Vladimirovich Parshin ◽  
Roman Ivanovich Cherevatenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Critically Ill ◽  
Bronchopulmonary Dysplasia ◽  
Critical State ◽  
Neonatal Period ◽  
Critical Conditions ◽  
Optimal Time ◽  
Neonatal Icu

This article analyzes the influence of interhospital transportation duration of newborns in critical state on the close outcome. The features of intensive care measures, the frequency of seizures, bronchopulmonary dysplasia and open arterial duct were studied regarding the age at which an infant was admitted to a neonatal ICU in a hospital of III level. It was found that transportation of critically ill infants at the age of one day or three days of life was associated with high risk of complications in the neonatal period. It was shown that the optimal time for interhospital transportation of a newborn baby to an intensive care unit of a hospital of III level is the second day after birth.

scholarly journals TARGET, PRESCRIPTION AND INFUSION OF ENTERAL NUTRITIONAL THERAPY OF CRITICAL PATIENTS IN INTENSIVE CARE UNIT

2018 ◽  
Vol 55 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Isabela Bernasconi JOSÉ ◽  
Vânia Aparecida LEANDRO-MERHI ◽  
José Luis Braga de AQUINO
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Critically Ill ◽  
Nutritional Therapy ◽  
Wilcoxon Test ◽  
Nutritional Risk ◽  
Albumin Ratio ◽  
Significant Difference ◽  
Prospective Longitudinal

ABSTRACT BACKGROUND: Enteral nutritional therapy (ENT) is the best route for the nutrition of critically ill patients with improved impact on the clinical treatment of such patients. OBJECTIVE: To investigate the energy and protein supply of ENT in critically ill in-patients of an Intensive Care Unit (ICU). METHODS: Prospective longitudinal study conducted with 82 critically ill in-patients of an ICU, receiving ENT. Anthropometric variables, laboratory tests (albumin, CRP, CRP/albumin ratio), NUTRIC-score and Nutritional Risk Screening (NRS-2002), energy and protein goals, and the inadequacies and complications of ENT were assessed. Statistical analysis was performed using the Chi-square or Fischer tests and the Wilcoxon test. RESULTS: A total of 48.78% patients were at high nutritional risk based on NUTRIC score. In the CRP/albumin ratio, 85.37% patients presented with a high risk of complications. There was a statistically significant difference (P<0.0001) for all comparisons made between the target, prescription and ENT infusion, and 72% of the quantities prescribed for both calories and proteins was infused. It was observed that the difference between the prescription and the infusion was 14.63% (±10.81) for calories and 14.21% (±10.5) for proteins, with statistically significant difference (P<0.0001). In the relationship between prescription and infusion of calories and proteins, the only significant association was that of patients at high risk of CRP/albumin ratio, of which almost 94% received less than 80% of the energy and protein volume prescribed (P=0.0111). CONCLUSION: The administration of ENT in severely ill patients does not meet their actual energy and protein needs. The high occurrence of infusion inadequacies, compared to prescription and to the goals set can generate a negative nutritional balance.

Clinical significance of calculating the plasma anion gap in metabolic acidosis in newborns with neonatal sepsis

2021 ◽  
Author(s):  
О.К. Кирилочев
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Neonatal Sepsis ◽  
Neonatal Period ◽  
Information Criterion ◽  
Anion Gap ◽  
Critical Conditions ◽  
Inclusion Criteria ◽  
Additional Information

При критических состояниях одним из самых частых нарушений кислотно-основного состояния является метаболический ацидоз. При этом незаслуженно забытым параметром при диагностике метаболического ацидоза является анионный пробел плазмы. Целью исследования было определить возможности использования анионного пробела плазмы для дифференциальной диагностики метаболического ацидоза у новорожденных с неонатальным сепсисом. Для реализации поставленной цели проведено обследование пациентов отделения реанимации и интенсивной терапии для новорожденных. Критериями включения в исследование были период новорожденности, наличие неонатального сепсиса, лабораторные признаки метаболического ацидоза. Всего под наблюдением находились 17 новорожденных детей с неонатальным сепсисом. Диагноз неонатального сепсиса устанавливался на основании подозреваемой или документированной инфекции в сочетании с остро возникшей органной дисфункцией, о развитии которой судили по индексу шкалы pSOFA на 2 балла и более от базового значения. Метаболический ацидоз был выявлен у 5 пациентов. У новорожденных с неонатальным сепсисом чаще регистрировался метаболический ацидоз с ростом анионного пробела плазмы, что обусловлено лактатным ацидозом в результате накопления молочной кислоты как маркера тканевой гипоксии. Уменьшение анионного пробела плазмы выявлялось реже и могло свидетельствовать о потерях бикарбонатного аниона через желудочно-кишечный тракт или в результате гипоальбуминемии. Показано, что анионный пробел плазмы может служить дополнительным информационным критерием для характеристики метаболического ацидоза. Расчет анионного пробела плазмы является недорогим и эффективным инструментом, способным помочь провести дифференциальный диагноз метаболического ацидоза у новорожденных с неонатальным сепсисом для назначения адекватной интенсивной терапии. In critical conditions, one of the most common acid-base disorders is metabolic acidosis. At the same time, an undeservedly forgotten parameter in the diagnosis of metabolic acidosis is the plasma anion gap. Purpose of the study: to determine the possibility of using the plasma anion gap for differential diagnosis of metabolic acidosis in newborns with neonatal sepsis. To achieve this goal, the patients of the intensive care unit and intensive care unit for newborns were examined. Inclusion criteria: neonatal period, presence of neonatal sepsis, laboratory signs of metabolic acidosis. In total, 17 newborns with neonatal sepsis were under observation. The diagnosis of neonatal sepsis was established on the basis of a suspected or documented infection in combination with acute organ dysfunction, the development of which was judged by the pSOFA index by 2 points or more from the baseline value. Metabolic acidosis was identified in 5 patients. In newborns with neonatal sepsis, metabolic acidosis was more often recorded with an increase in the plasma anion gap, which is due to lactic acidosis as a result of the accumulation of lactic acid, as a marker of tissue hypoxia. A decrease in the plasma anion gap was detected less frequently and could indicate a loss of bicarbonate anion through the gastrointestinal tract or as a result of hypoalbuminemia. It has been shown that the plasma anion gap can serve as an additional information criterion for characterizing metabolic acidosis. Plasma anion gap calculation is an inexpensive and effective tool that can help differentiate metabolic acidosis in newborns with neonatal sepsis for adequate intensive care.

scholarly journals Delivery Room Intensive Care Unit: 5 Years' Experience in Assistance of High-Risk Newborns at a Referral Center

2021 ◽  
Vol 9 ◽  
Author(s):  
Silvia Buratti ◽  
Elisabetta Lampugnani ◽  
Monica Faggiolo ◽  
Isabella Buffoni ◽  
Dario Paladini ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Clinical Pathways ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Delivery Room ◽  
Critical Conditions ◽  
Acute Complications

Objective: The aim of the study is to describe a delivery room intensive care unit (DRICU) model and evaluate its effectiveness in preventing morbidity and mortality in high-risk newborns.Design: This retrospective case series includes all DRICU procedures performed from 2016 to 2020.Setting: Gaslini Children's Hospital is a major pediatric tertiary care center where high-risk pregnancies are centralized. The Neonatal and Pediatric Intensive Care Unit admits every year about 100 high-risk newborns.Patients: The selected patients are newborns at risk of critical conditions immediately after birth for respiratory or cardiovascular congenital disorders.Interventions: The perinatal plan is defined by the multidisciplinary team of Fetal and Perinatal Medicine. The DRICU procedure provides highly specialized care through a protocol that includes logistics, personnel, equipment, and clinical pathways.Main Outcome Measures: The primary outcome is the prevention of acute complications and mortality in the delivery room and early neonatal period.Results: From 2016 to 2020, 40 DRICU procedures were performed. The main prenatal diagnoses included congenital heart disease with a high risk of life-threatening events immediately after birth (38%), congenital diaphragmatic hernia (35%), and fetal hydrops/hydrothorax (23%). Mean gestational age was 35.9 weeks (range: 31–39), and mean birth weight was 2,740 grams (range: 1,480–3,920). DRICU assistance completed in all patients by neonatal intensivists included tracheal intubation and arterial and central venous cannulation; complex procedures such as ex-utero intrapartum technique and extracorporeal membrane oxygenation cannulation are described. No deaths nor severe acute complications occurred in the delivery room or in the immediate postnatal period.Conclusions: The outcome in critical newborns is potentially affected by planned assistance strategies and specialized competencies through the implementation of a DRICU protocol.

scholarly journals Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium

2019 ◽  
Vol 131 (2) ◽  
pp. 328-335
Author(s):  
Paul J. T. Rood ◽  
Marieke Zegers ◽  
Arjen J. C. Slooter ◽  
Albert Beishuizen ◽  
Koen S. Simons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Placebo Group ◽  
High Risk ◽  
Critically Ill ◽  
Mental Component Summary ◽  
Long Term Outcomes

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life. Methods A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed. Results Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 ± 11 and 39 ± 11, respectively, and P = 0.350; and mental component summary score of 50 ± 10 and 51 ± 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life. Conclusions Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

scholarly journals Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Stephana J. Moss ◽  
Krista Wollny ◽  
Therese G. Poulin ◽  
Deborah J. Cook ◽  
Henry T. Stelfox ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Critically Ill Patients ◽  
Informal Caregivers ◽  
Post Traumatic Stress ◽  
Bereavement Support ◽  
Complex Needs ◽  
Post Traumatic

Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

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