Iatrogenic blood loss due to daily laboratory testing and the risk of subsequent anaemia in intensive care unit patients: case series

Introduction: Anaemia is associated with a wide range of negative outcomes. Diagnostic blood loss (DBL) may contribute to its occurrence. We aimed to evaluate DBL and its impact on haemoglobin (HGB) concentration and developing anaemia in the intensive care unit (ICU) patients. Methods: A study group comprised of 36 adult ICU patients. DBL during 7 consecutive, post-admission days was calculated. Anaemia occurrence was assessed using the WHO thresholds. Data on HGB and haematocrit (HCT) was subjected to analysis. Results: Upon admission, 24 (67%) patients were diagnosed with anaemia, on the eighth day 29 (80%) subjects (with 6 new cases). The median volume of blood collected was 143.15 mL (IQR 121.4–161.65) per week. No differences in DBL were found between the subjects with newly developed anaemia and their counterparts (p=0.4). The median drop of HGB (HbΔ) was 18 gL–1 (IQR 5–28) and the median drop of haematocrit (HtΔ) was 4.55% (IQR 1.1–7.95). There was no correlation between neither HbΔ and DBL (p=0.8) nor HtΔ and DBL (p=0.7). There were also no differences in HbΔ/HtΔ when age, gender or the primary critical illness were taken into account for the analysis (p>0.05 for all). The 7-day fluid balance was associated with haemoglobin drop (R=0.45; p=0.006). Conclusions: Anaemia is frequent in ICU patients. Diagnostic blood loss in our institution is acceptable and seems to protect patients against significant iatrogenic blood loss and subsequent anaemia. Dilutional anaemia may interfere with the results so before-after interventional research is needed to explore this interesting topic.

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Critical illness neuro-myopathy (CINM) and focal amyotrophy in intensive care unit (ICU) patients with SARS-CoV-2: a case series

Neurological Sciences ◽

10.1007/s10072-020-04820-9 ◽

2020 ◽

Author(s):

Nicola Alessandro Nasuelli ◽

Roberto Pettinaroli ◽

Laura Godi ◽

Claudio Savoini ◽

Fabiola De Marchi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Case Series ◽

Icu Patients

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Long-Term Cognitive Impairment After Critical Illness

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0017 ◽

2018 ◽

pp. 86-90

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cognitive Impairment ◽

Critical Illness ◽

Cognitive Outcomes ◽

Adult Patients ◽

Illness Experience ◽

Icu Patients ◽

Global Cognition

This case focuses on long-term cognitive impairment after critical illness by asking the question: What is the prevalence of long-term cognitive impairment after critical illness, and does the duration of delirium and use of sedative or analgesic medications affect cognitive outcomes? This study demonstrated that 74% of adult patients with critical illness experience delirium during their hospital course. Furthermore, patients in the intensive care unit (ICU) setting commonly experience global cognition and executive function deficits at 3 and 12 months following hospitalization. These findings highlight the importance of careful delirium surveillance in ICU patients.

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Blood loss from laboratory testing, anemia, and red blood cell transfusion in the intensive care unit: a retrospective study

Transfusion ◽

10.1111/trf.15649 ◽

2019 ◽

Vol 60 (2) ◽

pp. 256-261 ◽

Cited By ~ 2

Author(s):

Nicholas L. Jackson Chornenki ◽

Tyler E. James ◽

Rebecca Barty ◽

Yang Liu ◽

Bram Rochwerg ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Blood Loss ◽

Blood Cell ◽

Red Blood Cell ◽

Laboratory Testing ◽

Red Blood Cell Transfusion

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Neurogenic vs. Myogenic Origin of Acquired Muscle Paralysis in Intensive Care Unit (ICU) Patients: Evaluation of Different Diagnostic Methods

Diagnostics ◽

10.3390/diagnostics10110966 ◽

2020 ◽

Vol 10 (11) ◽

pp. 966

Author(s):

Humberto D.J. Gonzalez Marrero ◽

Erik V. Stålberg ◽

Gerald Cooray ◽

Rebeca Corpeno Kalamgi ◽

Yvette Hedström ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critical Illness ◽

Diagnostic Methods ◽

Muscle Stimulation ◽

Muscle Paralysis ◽

Icu Patients ◽

Muscle Biopsies ◽

Electrophysiological Methods

Introduction. The acquired muscle paralysis associated with modern critical care can be of neurogenic or myogenic origin, yet the distinction between these origins is hampered by the precision of current diagnostic methods. This has resulted in the pooling of all acquired muscle paralyses, independent of their origin, into the term Intensive Care Unit Acquired Muscle Weakness (ICUAW). This is unfortunate since the acquired neuropathy (critical illness polyneuropathy, CIP) has a slower recovery than the myopathy (critical illness myopathy, CIM); therapies need to target underlying mechanisms and every patient deserves as accurate a diagnosis as possible. This study aims at evaluating different diagnostic methods in the diagnosis of CIP and CIM in critically ill, immobilized and mechanically ventilated intensive care unit (ICU) patients. Methods. ICU patients with acquired quadriplegia in response to critical care were included in the study. A total of 142 patients were examined with routine electrophysiological methods, together with biochemical analyses of myosin:actin (M:A) ratios of muscle biopsies. In addition, comparisons of evoked electromyographic (EMG) responses in direct vs. indirect muscle stimulation and histopathological analyses of muscle biopsies were performed in a subset of the patients. Results. ICU patients with quadriplegia were stratified into five groups based on the hallmark of CIM, i.e., preferential myosin loss (myosin:actin ratio, M:A) and classified as severe (M:A < 0.5; n = 12), moderate (0.5 ≤ M:A < 1; n = 40), mildly moderate (1 ≤ M:A < 1.5; n = 49), mild (1.5 ≤ M:A < 1.7; n = 24) and normal (1.7 ≤ M:A; n = 19). Identical M:A ratios were obtained in the small (4–15 mg) muscle samples, using a disposable semiautomatic microbiopsy needle instrument, and the larger (>80 mg) samples, obtained with a conchotome instrument. Compound muscle action potential (CMAP) duration was increased and amplitude decreased in patients with preferential myosin loss, but deviations from this relationship were observed in numerous patients, resulting in only weak correlations between CMAP properties and M:A. Advanced electrophysiological methods measuring refractoriness and comparing CMAP amplitude after indirect nerve vs. direct muscle stimulation are time consuming and did not increase precision compared with conventional electrophysiological measurements in the diagnosis of CIM. Low CMAP amplitude upon indirect vs. direct stimulation strongly suggest a neurogenic lesion, i.e., CIP, but this was rarely observed among the patients in this study. Histopathological diagnosis of CIM/CIP based on enzyme histochemical mATPase stainings were hampered by poor quantitative precision of myosin loss and the impact of pathological findings unrelated to acute quadriplegia. Conclusion. Conventional electrophysiological methods are valuable in identifying the peripheral origin of quadriplegia in ICU patients, but do not reliably separate between neurogenic vs. myogenic origins of paralysis. The hallmark of CIM, preferential myosin loss, can be reliably evaluated in the small samples obtained with the microbiopsy instrument. The major advantage of this method is that it is less invasive than conventional muscle biopsies, reducing the risk of bleeding in ICU patients, who are frequently receiving anticoagulant treatment, and it can be repeated multiple times during follow up for monitoring purposes.

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Pharmacokinetics of Anidulafungin in Critically Ill Intensive Care Unit Patients with Suspected or Proven Invasive Fungal Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01894-16 ◽

2016 ◽

Vol 61 (2) ◽

Cited By ~ 15

Author(s):

R. J. M. Brüggemann ◽

V. Middel-Baars ◽

D. W. de Lange ◽

A. Colbers ◽

A. R. J. Girbes ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Fungal Infections ◽

Geometric Mean ◽

Volume Of Distribution ◽

Time Curve ◽

Icu Patients ◽

Minimum Concentration ◽

Median Volume

ABSTRACT Echinocandins, such as anidulafungin, are the first-line treatment for candidemia or invasive candidiasis in critically ill patients. There are conflicting data on the pharmacokinetic properties of anidulafungin in intensive care unit (ICU) patients. Adult ICU patients (from 3 hospitals) receiving anidulafungin for suspected or proven fungal infections were included in the present study. Patients were considered evaluable if a pharmacokinetic curve for day 3 could be completed. Twenty-three of 36 patients (7 female and 16 male) were evaluable. The median (range) age and body weight were 66 (28 to 88) years and 76 (50 to 115) kg, respectively. Pharmacokinetic sampling on day 3 (n = 23) resulted in a median anidulafungin area under the concentration-time curve from 0 to 24 h (AUC0–24) of 72.1 (interquartile range [IQR], 61.3 to 94.0) mg · h · liter−1, a median daily trough concentration (C 24) of 2.2 (IQR, 1.9 to 2.9) mg/liter, a median maximum concentration of drug in serum (C max) of 5.3 (IQR, 4.1 to 6.0) mg/liter, a median volume of distribution (V) of 46.0 (IQR, 32.2 to 60.2) liters, and a median clearance (CL) of 1.4 (IQR, 1.1 to 1.6) liters · h−1. Pharmacokinetic sampling on day 7 (n = 13) resulted in a median AUC0–24 of 82.7 (IQR, 73.0 to 129.5) mg · h · liter−1, a median minimum concentration of drug in serum (C min) of 2.8 (IQR, 2.2 to 4.2) mg/liter, a median C max of 5.9 (IQR, 4.6 to 8.0) mg/liter, a median V of 39.7 (IQR, 32.2 to 54.4) liters, and a median CL of 1.2 (IQR, 0.8 to 1.4) liters · h−1. The geometric mean ratio for the AUCday7/AUCday3 term was 1.13 (90% confidence interval [CI], 1.03 to 1.25). The exposure in the ICU patient population was in accordance with previous reports on anidulafungin pharmacokinetics in ICU patients but was lower than that for healthy volunteers or other patient populations. Larger cohorts of patients or pooled data analyses are necessary to retrieve relevant covariates. (This study has been registered at ClinicalTrials.gov under identifier NCT01438216.)

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Microbiome in Critical illness: An Unconventional and Unknown Ally

Current Medicinal Chemistry ◽

10.2174/0929867328666210915115056 ◽

2021 ◽

Vol 28 ◽

Author(s):

Christian Zanza ◽

Tatsiana Romenskaya ◽

Duraiyah Thangathurai ◽

Veronica Ojetti ◽

Angela Saviano ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Pathogenic Bacteria ◽

Fecal Microbiota Transplantation ◽

Bacterial Flora ◽

The Body ◽

Cochrane Library ◽

Icu Patients ◽

Infection Spread

Background: The digestive tract represents an interface between the external environment and the body where the interaction of a complex polymicrobial ecology has an important influence on health and disease. The physiological mechanisms that are altered during the hospitalization and in the intensive care unit (ICU) contribute to the pathobiota’s growth. Intestinal dysbiosis occurs within hours of being admitted to ICU. This may be due to different factors, such as alterations of normal intestinal transit, administration of variuos medications or alterations in the intestinal wall which causes a cascade of events that will lead to the increase of nitrates and decrease of oxygen concentration, liberation of free radicals. Objective: This work aims to report the latest updates on the microbiota’s contribution to developing sepsis in patients in the ICU department. In this short review were reviewed the latest scientific findings on the mechanisms of intestinal immune defenses performed both locally and systemically. In addition, we considered it necessary to review the literature to report the current best treatment strategies to prevent the infection spread which can bring systemic infections in patients admitted to ICU. Material and Methods: This review has been written to answer at three main questions: what are the main intestinal flora’s defense mechanisms that help us to prevent the risk of developing systemic diseases on a day-to-day basis? What are the main dysbiosis’ systemic abnormalities? What are the modern strategies that are used in the ICU patients to prevent the infection spread? Using the combination of following keywords: microbiota and ICU, ICU and gut, microbiota and critical illness, microbiota and critical care, microbiota and sepsis, microbiota and infection, gastrointestinal immunity,in the Cochrane Controlled Trials Register, the Cochrane Library, medline and pubmed, google scholar, ovid/wiley. Finally, we reviewed and selected 72 articles. We also consulted the site ClinicalTrials.com to find out studies that are recently conducted or ongoing. Results: The critical illness can alter intestinal bacterial flora leading to homeostasis disequilibrium. Despite numerous mechanisms, such as epithelial cells with calciform cells that together build a mechanical barrier for pathogenic bacteria, the presence of mucous associated lymphoid tissue (MALT) which stimulates an immune response through the production of interferon-gamma (IFN-y) and THN-a or by stimulating lymphocytes T helper-2 produces anti-inflammatory cytokines. But these defenses can be altered following a hospitalization in ICU and lead to serious complications such as acute respiratory distress syndrome (ARDS), health care associated pneumonia (HAP) and ventilator associated pneumonia (VAP), Systemic infection and multiple organ failure (MOF), but also in the development of coronary artery disease (CAD). In addition, the microbiota has a significant impact on the development of intestinal complications and the severity of the SARS-COVID-19 patients. Conclusion: The microbiota is recognized as one of the important factors that can worsen the clinical conditions of patients who are already very frailty in intensive care unit. At the same time, the microbiota also plays a crucial role in the prevention of ICU associated complications. By using the resources, we have available, such as probiotics, symbiotics or fecal microbiota transplantation (FMT), we can preserve the integrity of the microbiota and the GUT, which will later help maintain homeostasis in ICU patients.

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Introduction: Neuromuscular and Musculoskeletal Disorders Following Critical Illness

10.1093/med/9780199653461.003.0023 ◽

2014 ◽

Author(s):

Ali Naeem

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Musculoskeletal Disorders ◽

Icu Patients ◽

Wide Range ◽

Physical Effects ◽

Post Intensive Care Syndrome

Chapter 23 provides an outline to neuromuscular and musculoskeletal disorders following critical illness. It describes post-intensive care syndrome in relation to its potential physical effects on a patient’s %uality of life. The connections between mechanical ventilation and ICU ac%uired weaknesses (ICUAW) are explored, as are the wide range of possible physical deficits in ICU patients.

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