scholarly journals Feasibility of Routine Data Collection on Intensive Care Unit Performance and Activity in Resource Limited Settings

2019 ◽  
Author(s):  
Syed Muhammad Muneeb Ali ◽  
Muhammad Iqbal Memon ◽  
Shahzad Hussain Waqar ◽  
Salman Shafi koul ◽  
Vincent Ioos ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Demographic Data ◽  
Routine Data ◽  
Population Characteristics ◽  
Standardized Mortality Ratio ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Number Of Patients ◽  
Mortality Ratio

Background: Routine collection and analysis of data allows a critical care department to highlight the outcomes of the interventions done and to identify the grounds for improvement. Data on characteristic and outcomes of patients admitted in intensive care units (ICUs) are lacking. Methods: A software (ICU e-monitoring®) was designed to enter for each patient demographic data, SAPS3 on admission, Nine Equivalent Manpower Use Score, presence of medical devices and episodes of hospital acquired infections. We report data collected during 2014 with comparison to data collected with the same methodology in 2008 [1]. Objective: To determine the standardized mortality ratio, the mean length of ICU stay, mean length of mechanical ventilation and ICU acquired infection incidence rate. Study design: Descriptive Place of study: Medical ICU, Pakistan Institute of Medical Sciences Islamabad Results: A total of 196 admissions were recorded during the year 2014 vs 354 in 2008. 47.2% were males and 52.8% were females. Mean age was 32.1 years ± 15.3 SD (37.7 ± 18.9 SD in 2008). A total of 65 (33%) deaths were recorded during the year and standardized mortality ratio was found to be 0.71 vs 1.09 in 2008. Mean Length of stay was 15.9 Days ± 12.9 SD (9.3 days ± 8.9 in 2008) and mean duration of mechanical ventilation was found to be 12.04 Days (8.7 in 2008). Overall ventilator associated pneumonia (VAP) rate was 42.3 cases per 1000 ventilator days. Rate of Catheter Related Blood Stream Infections (CRBSI) was found to be 17.2 cases per 1000 CVC days. Conclusion: Major changes in our patient population characteristics were seen between 2008 and 2013: number of patients and standardized mortality was decreased while incidence of VAP and CRBSI was increased. It is possible to collect meaningful data on ICU performance and activity in resource limited settings.

Five-Year Outcomes After Implementing a Pain, Agitation, and Delirium Protocol in a Mixed Intensive Care Unit

2021 ◽  
pp. 088506662110634
Author(s):  
Jeffrey T. Fish ◽  
Jared T. Baxa ◽  
Ryan R. Draheim ◽  
Matthew J. Willenborg ◽  
Jared C. Mills ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Academic Medical Center ◽  
Admission Diagnosis ◽  
Surgical Intensive Care Unit ◽  
Standardized Mortality Ratio ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mortality Ratio ◽  
Apache Iv

Objective: Assess for continued improvements in patient outcomes after updating our institutional sedation and analgesia protocol to include recommendations from the 2013 Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium (PAD) guidelines. Methods: Retrospective before-and-after study in a mixed medical/surgical intensive care unit (ICU) at an academic medical center. Mechanically ventilated adults admitted from September 1, 2011 through August 31, 2012 (pre-implementation) and October 1, 2012 through September 30, 2017 (post-implementation) were included. Measurements included number of mechanically ventilated patients, APACHE IV scores, age, type of patient (medical or surgical), admission diagnosis, ICU length of stay (LOS), hospital LOS, ventilator days, number of self-extubations, ICU mortality, ICU standardized mortality ratio, hospital mortality, hospital standardized mortality ratio, medication data including as needed (PRN) analgesic and sedative use, and analgesic and sedative infusions, and institutional savings. Results: Ventilator days (Pre-PAD = 4.0 vs. Year 5 post = 3.2, P < .0001), ICU LOS (Pre-PAD = 4.8 days vs. Year 5 post = 4.1 days, P = .0004) and hospital LOS (Pre-PAD = 14 days vs. Year 5 post = 12 days, P < .0001) decreased after protocol implementation. Hospital standardized mortality ratio (Pre-PAD = 0.69 vs. Year 5 post = 0.66) remained constant; while, APACHE IV scores (Pre-PAD = 77 vs. Year 5 post = 89, P < .0001) and number of intubated patients (Pre-PAD = 1146 vs. Year 5 post = 1468) increased over the study period. Using the decreased ICU and hospital LOS estimates, it is projected the institution saved $4.3 million over the 5 years since implementation. Conclusions: Implementation of an updated PAD protocol in a mixed medical/surgical ICU was associated with a significant decrease in ventilator time, ICU LOS, and hospital LOS without a change in the standardized mortality ratio over a five-year period. These favorable outcomes are associated with a significant cost savings for the institution.

Current practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings

2018 ◽  
Vol 46 ◽  
pp. 44-49 ◽  
Author(s):  
Nattachai Srisawat ◽  
Nattaya Sintawichai ◽  
Win Kulvichit ◽  
Nuttha Lumlertgul ◽  
Patita Sitticharoenchai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Current Practice ◽  
Kidney Injury ◽  
Resource Limited Settings ◽  
Diagnosis And Management ◽  
Resource Limited

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

scholarly journals Critical Care Demand and Intensive Care Supply for Patients in Japan with COVID-19 at the Time of the State of Emergency Declaration in April 2020: A Descriptive Analysis

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 530
Author(s):  
Yosuke Fujii ◽  
Kiichi Hirota
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Descriptive Analysis ◽  
State Of Emergency ◽  
Medical Institutions ◽  
Number Of Patients ◽  
Care Capacity

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic is overwhelming Japan’s intensive care capacity. This study aimed to determine the number of patients with COVID-19 who required intensive care and to compare the numbers with Japan’s intensive care capacity. Materials and Methods: Publicly available datasets were used to obtain the number of confirmed patients with COVID-19 undergoing mechanical ventilation and extracorporeal membrane oxygenation (ECMO) between 15 February and 19 July 2020 to determine and compare intensive care unit (ICU) and attending bed needs for patients with COVID-19, and to estimate peak ICU demands in Japan. Results: During the epidemic peak in late April, 11,443 patients (1.03/10,000 adults) had been infected, 373 patients (0.034/10,000 adults) were in ICU, 312 patients (0.028/10,000 adults) were receiving mechanical ventilation, and 62 patients (0.0056/10,000 adults) were under ECMO per day. At the peak of the epidemic, the number of infected patients was 651% of designated beds, and the number of patients requiring intensive care was 6.0% of ICU beds, 19.1% of board-certified intensivists, and 106% of designated medical institutions in Japan. Conclusions: The number of critically ill patients with COVID-19 continued to rise during the pandemic, exceeding the number of designated beds but not exceeding ICU capacity.

scholarly journals Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

2019 ◽  
pp. 31-68
Author(s):  
Alfred Papali ◽  
Neill K. J. Adhikari ◽  
Janet V. Diaz ◽  
Arjen M. Dondorp ◽  
Martin W. Dünser ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Resource Limited Settings ◽  
Resource Limited

scholarly journals Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021719 ◽  
Author(s):  
Sonia Rodríguez-Fernández ◽  
Encarnación Castillo-Lorente ◽  
Francisco Guerrero-Lopez ◽  
David Rodríguez-Rubio ◽  
Eduardo Aguilar-Alonso ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intracerebral Haemorrhage ◽  
Demographic Data ◽  
Intraventricular Haemorrhage ◽  
Apache Ii ◽  
Mortality Ratio ◽  
Ich Score ◽  
Data Location

ObjectiveValidation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU).MethodsA multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated.ResultsA total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50–70) years. APACHE-II: 21(15–26) points, GCS: 7 (4–11) points, ICH score: 2 (2–3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79).ConclusionsICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.

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