scholarly journals Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation among Critically ill Adults in the Intensive Care Unit

2021 ◽  
Author(s):  
Apinya Koontalay ◽  
Wanich Suksatan ◽  
Kantapong Prabsangob
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Nutrition Status ◽  
Nutritional Factors ◽  
Duration Of Hospitalization ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Dyspnea Assessment

Background: Malnutrition is associated with a complication problem affecting critically ill patients throughout the trajectory of their illness and which may increase the duration of hospitalization and mechanical ventilation and mortality. To explore nutritional factors impact on the duration of mechanical ventilation in critically ill patients. Methods: In this single-center, prospective observational study in a critical care unit. The sample of the study consisting of a total of 100 critically ill patients who were included in the regression analyzed by purposive sampling, performed to address the research objectives. The data were collected for each patient who participated in the study for 2 consecutive days with SGA, Dyspnea assessment form, APACHE II, and time to initial EN on the 24 hours of hospital admitted and the daily calories target requirement on the seven days. Results: At the end of monitoring, the nutrition status, time to initial EN, and calories, target requirements were moderate positive statistically significant related to the duration of mechanical ventilation (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, the severity of illness, and dyspnea scales were not related to the duration of mechanical ventilation (p> 0.05). Therefore, nutrition status and calory target requirements could be a predictor of the duration of mechanical ventilation. The predictive power was 28.0 percent of variance (R2 = 0.28, p< 0.01). Conclusion: The finding supports which assessment of the nutritional status and calory target requirement within 7 days revealed with reducing the duration of mechanical ventilation in critically ill patients.

scholarly journals Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Priscila Bellaver ◽  
Ariell F. Schaeffer ◽  
Diego P. Dullius ◽  
Marina V. Viana ◽  
Cristiane B. Leitão ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glycemic Variability ◽  
Stress Hyperglycemia ◽  
Critically Ill Adults ◽  
Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

scholarly journals Analysis of the impact of secondary prophylaxis on Clostridioides difficile recurrence in critically ill adults

2020 ◽  
Vol 8 ◽  
pp. 205031212093089
Author(s):  
Kathryn A Connor ◽  
Kelly M Conn
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Secondary Prophylaxis ◽  
Infection Prophylaxis ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Infection Recurrence

Introduction: Clostridioides (formerly Clostridium) difficile infection recurrence in patients re-exposed to antibiotics for treatment of a non- Clostridioides difficile infection is high at approximately 33%. Low-dose per os vancomycin (e.g. 125 mg q12 h) or metronidazole (e.g. 500 mg intravenous/per osq8 h) may help prevent recurrences, but study of secondary prophylaxis in critically ill patients is needed. Objectives: To determine whether critically ill adults receiving low-dose per os vancomycin for secondary Clostridioides difficile infection prophylaxis have fewer recurrences of Clostridioides difficile infection in 90 days compared with patients receiving metronidazole for secondary Clostridioides difficile infection prophylaxis or control (no secondary prophylaxis). Methods: This was a retrospective, two-center, observational study in a large academic medical center and affiliated community hospital. Included patients had a history of Clostridioides difficile infection within 1 year of receiving antibiotics for clinical care. We compared patients receiving secondary prophylaxis with vancomycin or metronidazole and control patients; in addition, an unplanned fourth group (vancomycin/metronidazole combination) was identified and analyzed. The primary outcome was Clostridioides difficile infection recurrence within 90 days of a course of broad-spectrum antibiotic therapy. Fisher’s exact, analysis of variance, and Kruskal–Wallis tests were used to compare Clostridioides difficile infection recurrence with prophylaxis group and additional contributing factors. Results: Eighty-two patients were included: 38 control (46.3%), 20 metronidazole (24.4%), 17 vancomycin (20.7%), and 7 combination (8.5%). Ten of 82 patients (12.2%) had at least one Clostridioides difficile infection recurrence; 8/38 patients in the control group (21.1%), 1/7 patients in the combination group (14.3%), 1/17 patients in the per os vancomycin group (5.9%), and 0/20 in the metronidazole group (0%; p = 0.073). As a post hoc secondary analysis, the three prophylaxis groups were coalesced into one group and compared with control (4.5% vs 21%; p = 0.039). Additional factors (e.g. age, obesity, immunosuppression, acid suppression) were not significantly associated with Clostridioides difficile infection recurrence or with prophylaxis group. Conclusion: There was no difference in Clostridioides difficile infection recurrence between prophylaxis groups, however, given the low recurrence rate, prospective evaluation with a larger sample of critically ill patients is necessary.

scholarly journals Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - a meta-analysis of randomized controlled trials with trial sequential analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoyang Zhou ◽  
Hanyuan Fang ◽  
Jianfei Xu ◽  
Peifu Chen ◽  
Xujun Hu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Sequential Analysis ◽  
Stress Ulcer ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Gi Bleeding ◽  
Ulcer Prophylaxis ◽  
Critically Ill Adults ◽  
Ill Adults

Abstract Background Proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) have been widely used as stress ulcer prophylaxis (SUP) in critically ill patients, however, its efficacy and safety remain unclear. This study aimed to assess the effect of SUP on clinical outcomes in critically ill adults. Methods Literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane database of clinical trials for randomized controlled trials (RCTs) that investigated SUP, with PPI or H2RA, versus placebo or no prophylaxis in critically ill patients from database inception through 1 June 2019. Study selection, data extraction and quality assessment were performed in duplicate. The primary outcomes were clinically important gastrointestinal (GI) bleeding and overt GI bleeding. Conventional meta-analysis with random-effects model and trial sequential analysis (TSA) were performed. Results Twenty-nine RCTs were identified, of which four RCTs were judged as low risk of bias. Overall, SUP could reduce the incident of clinically important GI bleeding [relative risk (RR) = 0.58; 95% confidence intervals (CI): 0.42–0.81] and overt GI bleeding (RR = 0.48; 95% CI: 0.36–0.63), these results were confirmed by the sub-analysis of trials with low risk of bias, TSA indicated a firm evidence on its beneficial effects on the overt GI bleeding (TSA-adjusted CI: 0.31–0.75), but lack of sufficient evidence on the clinically important GI bleeding (TSA-adjusted CI: 0.23–1.51). Among patients who received enteral nutrition (EN), SUP was associated with a decreased risk of clinically important GI bleeding (RR = 0.61; 95% CI: 0.44–0.85; TSA-adjusted CI: 0.16–2.38) and overt GI bleeding (RR = 0.64; 95% CI: 0.42–0.96; TSA-adjusted CI: 0.12–3.35), but these benefits disappeared after adjustment with TSA. Among patients who did not receive EN, SUP had only benefits in reducing the risk of overt GI bleeding (RR = 0.37; 95% CI: 0.25–0.55; TSA-adjusted CI: 0.22–0.63), but not the clinically important GI bleeding (RR = 0.27; 95% CI: 0.04–2.09). Conclusions SUP has benefits on the overt GI bleeding in critically ill patients who did not receive EN, however, its benefits on clinically important GI bleeding still needs more evidence to confirm.

Delirium Assessment Tools for Use in Critically Ill Adults: A Psychometric Analysis and Systematic Review

2018 ◽  
Vol 38 (1) ◽  
pp. 38-49 ◽  
Author(s):  
Céline Gélinas ◽  
Mélanie Bérubé ◽  
Annie Chevrier ◽  
Brenda T. Pun ◽  
E. Wesley Ely ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Assessment Tools ◽  
Cognitive Test ◽  
Delirium Assessment ◽  
Nursing Delirium Screening Scale ◽  
Detection Score ◽  
Critically Ill Adults ◽  
Ill Adults

BACKGROUNDDelirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial.OBJECTIVETo analyze the development and psychometric properties of delirium assessment tools for critically ill adults.METHODSDatabases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (&gt;18 years old). Search terms were delirium, scales, critically ill patients, adult, validity, and reliability. Thirty-six manuscripts were identified, encompassing 5 delirium assessment tools (Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Cognitive Test for Delirium, Delirium Detection Score, Intensive Care Delirium Screening Checklist (ICDSC), and Nursing Delirium Screening Scale). Two independent reviewers analyzed the psychometric properties of these tools by using a standardized scoring system (range, 0–20) to assess the tool development process, reliability, validity, feasibility, and implementation of each tool.RESULTSPsychometric properties were very good for the CAM-ICU (19.6) and the ICDSC (19.2), moderate for the Nursing Delirium Screening Scale (13.6), low for the Delirium Detection Score (11.2), and very low for the Cognitive Test for Delirium (8.2).CONCLUSIONSThe results indicate that the CAM-ICU and the ICDSC are the most valid and reliable delirium assessment tools for critically ill adults. Additional studies are needed to further validate these tools in critically ill patients with neurological disorders and those at various levels of sedation or consciousness.

scholarly journals ICU and ventilator mortality among critically ill adults with COVID-19

2020 ◽  
Author(s):  
Sara C. Auld ◽  
Mark Caridi-Scheible ◽  
James M. Blum ◽  
Chad Robichaux ◽  
Colleen Kraft ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Preliminary Data ◽  
Early Experience ◽  
Mortality Rates ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Overall Mortality

SummaryWe report preliminary data from a cohort of adults admitted to COVID-designated intensive care units from March 6 through April 17, 2020 across an academic healthcare system. Among 217 critically ill patients, mortality for those who required mechanical ventilation was 29.7% (49/165), with 8.5% (14/165) of patients still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 25.8% (56/217), and 40.1% (87/217) patients have survived to hospital discharge. Despite multiple reports of mortality rates exceeding 50% among critically ill adults with COVID-19, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.

scholarly journals Factors associated with ABCDE bundle adherence in critically ill adults requiring mechanical ventilation: An observational design

2020 ◽  
Vol 60 ◽  
pp. 102873
Author(s):  
Jacqueline M. DeMellow ◽  
Tae Youn Kim ◽  
Patrick S. Romano ◽  
Christiane Drake ◽  
Michele C. Balas
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Factors Associated ◽  
Observational Design ◽  
Critically Ill Adults ◽  
Abcde Bundle ◽  
Ill Adults

scholarly journals 112. Physiological Signature of Bloodstream Infection in Critically Ill Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S87-S88
Author(s):  
Alex Zimmet ◽  
Matthew Clark ◽  
Shrirang M Gadrey ◽  
Taison Bell ◽  
J Randall Moorman ◽  
...  
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Positive Blood Culture ◽  
Critically Ill Patients ◽  
Vital Sign ◽  
Physiological Data ◽  
Surgical Trauma ◽  
Critically Ill Adults ◽  
Ill Adults

Abstract Background Bloodstream infection (BSI) is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This uncertainty results in frequent blood culture testing, which exposes patients to additional costs and the potential harms of unnecessary antibiotics. Accordingly, we aimed to identify signatures in physiological data from critically ill adults that characterize BSI. Methods We reviewed all blood culture, vital sign, laboratory, and cardiorespiratory monitoring (CRM) data from patients admitted to the medical and surgical/trauma ICUs at the University of Virginia Medical Center from February 2011 to June 2015. Blood culture results were categorized as positive, negative, or contaminant. For the BSI population, we included data obtained within 12 hours before or 24 hours after the acquisition of a positive blood culture. The control population included data greater than 12 hours before or 24 hours after the acquisition of a positive blood culture, and all data from patients without BSI. We used multivariable logistic regression to identify the physiological characteristics of BSI. Results We analyzed 9,955 ICU admissions with 144 patient-years of vital sign and CRM data (1.3M hourly measurements). The average age was 59 years; the population was mostly Caucasian (81%) and male (56%). There were 5,671 (57%) admissions with ≥1 blood culture, and 744 (7%) had a BSI. The in-hospital mortality rate for patients with BSI was 28% vs. 12% for all others. The physiological signature of BSI was characterized by abnormalities in 12 parameters (Figure 1)—e.g., BSI was more likely in patients with a higher pulse and lower platelets. Several associations were nonlinear—e.g., temperature and WBC had U-shaped relationships with BSI. The internally validated C-statistic was 0.77. Conclusion Statistical modeling revealed a clinically sensible physiological signature of BSI that could assist with bedside decisions regarding the utility of blood culture testing in critically ill adults. Disclosures All authors: No reported disclosures.

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