Benefits and challenges associated with the timing of tracheostomy in critically ill patients: experience at a tertiary intensive care unit

Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tracheostomy is performed with an aim to facilitate pulmonary toileting and also protect the upper airways from the associated ill effects of prolonged endotracheal intubation. The timing of this procedure is a matter of considerable debate and varies according to different centres.Methods: 50 patients were assessed. 34 belonged to the early group and 16 belonged to the late group. The study was carried out in the ICU of a tertiary care referral centre. The timing of occurrence of ventilator associated pneumonia (VAP), duration of ICU stay and duration of tracheostomy and the was compared between the early and late groups respectively.Results: It was found that early tracheostomy leads to reduced ICU stay and delayed occurrence of VAP. The results were statistically significant. Additionally, it was also observed in this study that early tracheostomy leads to reduced duration of tracheostomy as compared to the late group although not statistically significant.Conclusions: Due to large clinical heterogeneity amongst cases admitted to the ICU, the timing of tracheostomy is different in different centres. Hence, guidelines need to be formulated in order to perform tracheostomy in critically ill patients in order to prevent the demerits associated with late tracheostomy such as prolonged ICU stay, early occurrence of VAP and late decannulation. In addition to this, economic advantages also need to be considered as most of the population in developing countries do not have universal health insurance.

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Delirium in Critically Ill Patients with and without COVID-19—A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10194412 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4412

Author(s):

Markus Jäckel ◽

Nico Aicher ◽

Paul Marc Biever ◽

Laura Heine ◽

Xavier Bemtgen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Propensity Score ◽

Critically Ill ◽

Primary Endpoint ◽

Critically Ill Patients ◽

Icu Stay ◽

Nursing Delirium Screening Scale ◽

Prolonged Icu Stay ◽

Icu Delirium

Background: Delirium complicating the course of Intensive care unit (ICU) therapy is a known driver of morbidity and mortality. It has been speculated that infection with the neurotrophic SARS-CoV-2 might promote delirium. Methods: Retrospective registry analysis including all patients treated at least 48 h on a medical intensive care unit. The primary endpoint was development of delirium as diagnosed by Nursing Delirium screening scale ≥2. Results were confirmed by propensity score matching. Results: 542 patients were included. The primary endpoint was reached in 352/542 (64.9%) patients, without significant differences between COVID-19 patients and non-COVID-19 patients (51.4% and 65.9%, respectively, p = 0.07) and correlated with prolonged ICU stay in both groups. In a subgroup of patients with ICU stay >10 days delirium was significantly lower in COVID-19 patients (p ≤ 0.01). After adjustment for confounders, COVID-19 correlated independently with less ICU delirium (p ≤ 0.01). In the propensity score matched cohort, patients with COVID-19 had significantly lower delirium incidence compared to the matched control patients (p ≤ 0.01). Conclusion: Delirium is frequent in critically ill patients with and without COVID-19 treated at an intensive care unit. Data suggests that COVID-19 itself is not a driver of delirium per se.

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Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46882.14586 ◽

2021 ◽

Author(s):

Reetu Verma ◽

Sasmita Panda ◽

Rajeev Kumar Nishad

Keyword(s):

Intensive Care ◽

Environmental Factors ◽

Critically Ill ◽

Nursing Care ◽

Critically Ill Patients ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Icu Patients ◽

Common Cause

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

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Sequential organ failure assessment score as prognostic marker in critically ill patients in a tertiary care intensive care unit

International Journal of Medicine and Public Health ◽

10.4103/2230-8598.118956 ◽

2013 ◽

Vol 3 (3) ◽

pp. 155 ◽

Cited By ~ 2

Author(s):

ZubinD Sharma ◽

Charan Bale ◽

ArjunL Kakrani ◽

VarshaS Dabadghao

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Critically Ill ◽

Prognostic Marker ◽

Critically Ill Patients ◽

Tertiary Care ◽

Assessment Score ◽

Failure Assessment

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P044 HYPOCALORIC NUTRITION AND OUTCOME IN CRITICALLY ILL PATIENTS WITH PROLONGED ICU STAY

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(08)70106-6 ◽

2008 ◽

Vol 3 ◽

pp. 47

Author(s):

S. Iff ◽

M. Leuenberger ◽

Z. Stanga ◽

S.M. Jakob

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Icu Stay ◽

Prolonged Icu Stay

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How to Feed the Critically Ill—A Review

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.202064 ◽

2020 ◽

Vol 49 (8) ◽

pp. 573-581

Author(s):

Charles CH Lew ◽

Chengsi Ong ◽

Amartya Mukhopadhyay ◽

Andrea Marshall ◽

Yaseen M Arabi

Keyword(s):

Body Composition ◽

Intensive Care ◽

Critically Ill ◽

Indirect Calorimetry ◽

Critically Ill Patients ◽

Assessment Tools ◽

Nutrition Support ◽

Clinical Practices ◽

Icu Stay ◽

Key Words Critical Care

Introduction: Number of recently published studies on nutritional support in the intensive care unit (ICU) have resulted in a paradigm shift of clinical practices. This review summarises the latest evidence in four main topics in the ICU, namely: (1) function of validated nutrition screening/assessment tools, (2) types and validity of body composition measurements, (3) optimal energy and protein goals, and (4) delivery methods. Methods: Recent studies that investigated the above aims were outlined and discussed. In addition, recent guidelines were also compared to highlight the similarities and differences in their approach to the nutrition support of critically ill patients. Results: Regardless of nutritional status and body composition, all patients with >48 hours of ICU stay are at nutrition risk and should receive individualised nutrition support. Although a recent trial did not demonstrate an advantage of indirect calorimetry over predictive equations, it was recommended that indirect calorimetry be used to set energy targets with better accuracy. Initiation of enteral nutrition (EN) within 24–48 hours was shown to be associated with improved clinical outcomes. The energy and protein goals should be achieved gradually over the first week of ICU stay. This practice should be protocolised and regularly audited as critically ill patients receive only part of their energy and protein goals. Conclusions: Metabolic demands of critically ill patients can be variable and nutrition support should be tailored to each patient. Given that many nutrition studies are on-going, we anticipate improvements in the individualisation of nutrition support in the near future. Key words: Critical care, Critical illness, Intensive care, Nutrition, Nutritional intake, Nutrition support

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Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.4.2021.060 ◽

2021 ◽

Author(s):

Sunil K. Nadar ◽

Muhammad M. Shaikh ◽

Muhammad A. Khatri ◽

Wael A. Abdelmottaleb ◽

Sheeraz Ahmed ◽

...

Keyword(s):

Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Myocardial Injury ◽

Tertiary Care ◽

Hospital Length Of Stay ◽

Care Hospital ◽

Coronary Syndrome

Objectives: Critically ill patients have been shown to have raised troponins. The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients. Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.

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Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database

Journal of Intensive Care Medicine ◽

10.1177/0885066619872449 ◽

2019 ◽

Vol 35 (1) ◽

pp. 48-54

Author(s):

Marjorie Bateman ◽

Ala Alkhatib ◽

Thomas John ◽

Malhar Parikh ◽

Fayez Kheir

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Pleural Effusion ◽

Hospital Stay ◽

Disease Severity ◽

Pleural Fluid ◽

Critically Ill ◽

Critically Ill Patients ◽

Pleural Effusions ◽

Icu Stay

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P < .0001), 1-month (43.1% vs 36.1%, P < .0001), 6-month (63.6% vs 55.7%, P < .0001), and 1-year mortality (73.8% vs 66.1%, P < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P < .0001), ICU stay (7.3 vs 5.1 days, P < .0001), need for mechanical ventilation (63.1% vs 55.7%, P < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P = .0002), 1-month (47.7% vs 39.7%, P = .0005), 6-month (67.1% vs 61.8%, P = .0161), and 1-year mortality (77.1% vs 72.1%, P = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P < .0001), ICU stay (9.2d vs 6.4 days, P < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P < .0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.

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Study of incidence of acute renal failure and its associated factors and complications amongst patients admitted in intensive care unit of a tertiary care teaching hospital

Medpusle International Journal of Medicine ◽

10.26611/102111210 ◽

2021 ◽

Vol 11 (2) ◽

pp. 108-111

Author(s):

Rameshwar A Warkad ◽

Keyword(s):

Intensive Care Unit ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Intensive Care ◽

Critically Ill ◽

Teaching Hospital ◽

Critically Ill Patients ◽

Tertiary Care ◽

Tertiary Care Teaching Hospital

Background: Impairment of renal function is a serious complication in critically ill patients. Mortality of acute renal failure remains high ranging from 35% to 86% despite haemodialysis therapy and substantial improvement of dialysis techniques. Therefore attention must be paid to the conditions favouring deterioration of renal function in order to prevent acute renal failure or to intervene in an early phase when less invasive therapies might be even more promising. Methods: This prospective study was conducted in a tertiary care teaching hospital in Mumbai from 1st January 2006 to 31st December 2006. All patients consecutively admitted in intensive care unit were studied. Results: Total number of patients admitted during the said period to the Intensive care Unit was 406, of which 50 had evidence of acute renal failure. The incidence of acute renal failure in the critically ill patients included in our study was 12.31%. There was a statistically significant difference in the incidence of fluid overload, oliguria and hyperkalemia between the pre-renal and renal failure groups. Conclusion: The incidence of acute renal failure in the critically ill patients was 12.31% and commonest predisposing factors associated with acute renal failure were acute insults like hypotension, sepsis and risk factors like age >50 years and pre-existing renal disease.

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