Prevalence and risk factors for death in sepsis- associated brain dysfunction: a retrospective study from ICU admissions

Abstract Background: The prevalence of sepsis-associated brain dysfunction (SABD) in ICU patients with critically ill remains unknown. We are to assess whether the prevalence of sepsis in ICU would present a high prevalent life- threatening SABD. Methods: We enrolled acute critically ill adults patients from ICU (from January 1, 2015, to January 1, 2017). All patients were selected from onset to ICU ≤3 hours and followed up to 30 day for sepsis patients who were treated in initial 48 hours or more in ICU. The predictors and risk of death of SABD was analyzed by multivariate models. Results: Of the 1349 ICU patients with acute critically ill, 748 were enrolled. Among these, the prevalence of sepsis was 48.4% (362/748). The prevalence of SABD accounted for 97.2% of sepsis (352/362), with fatality at initial 30 days was 73.6%. We found that the strong clinical predictors or markers for SABD were a SIRS ≥2 (OR, 3.2; 95% CI, 1.7-6.1), SOFA score ≥6 (OR, 3.0; 95% CI, 2.6-3.5), and qSOFA score ≥2 (OR, 0.34; 95% CI, 0.16-0.58). Cox logistic adjusted analysis revealed that lower mean arterial pressure (MAP) (OR, 1.5; 95% CI, 1.0-1.7)，higher SOFA score (OR, 1.8; 95% CI, 1.1- 1.9), and unused a rapid antibiotics treatment in initial 3 hours (OR, 0.7; 95% CI, 0.5-0.9) were the predictors of the risk of death among ICU patients with SABD. Conclusions: SABD is a leading life-threatening organ dysfunction following critically ill in ICU, with an high fatality. The predictors for worse survival SABD were related to the lower MAP, higher SOFA scores, and unused a rapid antibiotic treatment within initial 3 hours.

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Epidemiological and clinical characteristics of sepsis-associated encephalopathy in the ICU: a retrospective observational study

10.21203/rs.2.14475/v1 ◽

2019 ◽

Author(s):

Dao-Ming Tong ◽

Ye-Ting Zhou ◽

Shao=Dan Wang ◽

Guang-Sheng Wang ◽

Yuan-Wei Wang ◽

...

Keyword(s):

Critically Ill ◽

Sofa Score ◽

Clinical Characteristics ◽

Clinical Predictors ◽

Organ Function ◽

Icu Patients ◽

Risk Of Death ◽

Critically Ill Adults ◽

Ill Adults ◽

Function Assessment

Abstract Background Sepsis has an annual incidence of 30 million new cases around worldwide. However, the epidemiological and clinical characteristics in patients with sepsis-associated encephalopathy (SAE) remain understudy.Methods We prospectively enrolled patients with acute critically ill from ICU during 2 years period (2014-2015). The epidemiological and clinical characteristics for critically ill adults with SAE in ICU were analyzed by related statistics.Results Of the 1349 ICU patients with acute critically ill, 748 were enrolled. Among these, the prevalence of sepsis was 48.4% (362/748), with fatality at initial 30 days was 62.4%. The prevalence of SAE accounted for 97.2% of sepsis (352/362), with fatality at initial 30 days was 65.1%. We found that the two strong clinical predictors for SAE were systemic inflammatory response syndrome (SIRS) ≥2 (OR, 3.2; 95% CI, 0.304- 0.673) and sequential (sepsis-related) organ function assessment (SOFA) score ≥6 (GCS<13)(OR, 3.0; 95% CI, 0.304-0.673); the sensitivity was 67.3% and specificity was 55.3% for SIRS≥2, while the sensitivity was 99.1% and specificity was 99.0% for SOFA score≥6. Cox logistic adjusted analysis revealed that lower mean arterial pressure (OR, 1.504; 95% CI, 1.001-1.707),higher SOFA score (OR, 1.783; 95% CI, 1.145- 1.923), and no using antibiotics treatment in initial 3 hours (OR, 0.683; 95% CI, 0.492-0.947) were the powerful predictors of the risk of death among ICU patients with SAE.Conclusion SAE is a best frequent epidemiological type of sepsis in ICU, with an high hospital fatality. No using antibiotics treatment within initial 3 hours was related to the worse survival SAE.

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Observational Pain Scales in Critically Ill Adults

Critical Care Nurse ◽

10.4037/ccn2013804 ◽

2013 ◽

Vol 33 (3) ◽

pp. 68-78 ◽

Cited By ~ 57

Author(s):

Mindy Stites

Keyword(s):

Critically Ill ◽

Reliability And Validity ◽

Self Report ◽

Systematic Assessment ◽

Pain Scales ◽

Patients At Risk ◽

Life Threatening ◽

Comprehensive Search ◽

Critically Ill Adults ◽

Ill Adults

Pain is a common and distressing symptom in critically ill patients. Uncontrolled pain places patients at risk for numerous adverse psychological and physiological consequences, some of which may be life-threatening. A systematic assessment of pain is difficult in intensive care units because of the high percentage of patients who are noncommunicative and unable to self-report pain. Several tools have been developed to identify objective measures of pain, but the best tool has yet to be identified. A comprehensive search on the reliability and validity of observational pain scales indicated that although the Critical-Care Pain Observation Tool was superior to other tools in reliably detecting pain, pain assessment in individuals incapable of spontaneous neuromuscular movements or in patients with concurrent conditions, such as chronic pain or delirium, remains an enigma.

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Penetration of echinocandins into wound secretion of critically ill patients

Infection ◽

10.1007/s15010-021-01604-x ◽

2021 ◽

Author(s):

Tiziana Gasperetti ◽

René Welte ◽

Herbert Oberacher ◽

Jana Marx ◽

Ingo Lorenz ◽

...

Keyword(s):

Clinical Outcome ◽

Critically Ill ◽

Critically Ill Patients ◽

Plasma Concentrations ◽

Individual Variability ◽

Wound Infections ◽

Concentration Data ◽

Life Threatening ◽

Critically Ill Adults ◽

Ill Adults

Abstract Purpose Wound infections caused by Candida are life-threatening and difficult to treat. Echinocandins are highly effective against Candida species and recommended for treatment of invasive candidiasis. As penetration of echinocandins into wounds is largely unknown, we measured the concentrations of the echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS) in wound secretion (WS) and in plasma of critically ill patients. Methods We included critically ill adults with an indwelling wound drainage or undergoing vacuum-assisted closure therapy, who were treated with an echinocandin for suspected or proven invasive fungal infection. Concentrations were measured by liquid chromatography with UV (AFG and MFG) or tandem mass spectrometry detection (CAS). Results Twenty-one patients were enrolled. From eight patients, serial WS samples and simultaneous plasma samples were obtained within a dosage interval. AFG concentrations in WS amounted to < 0.025–2.25 mg/L, MFG concentrations were 0.025–2.53 mg/L, and CAS achieved concentrations of 0.18–4.04 mg/L. Concentrations in WS were significantly lower than the simultaneous plasma concentrations and below the MIC values of some relevant pathogens. Conclusion Echinocandin penetration into WS displays a high inter-individual variability. In WS of some of the patients, concentrations may be sub-therapeutic. However, the relevance of sub-therapeutic concentrations is unknown as no correlation has been established between concentration data and clinical outcome. Nevertheless, in the absence of clinical outcome studies, our data do not support the use of echinocandins at standard doses for the treatment of fungal wound infections, but underline the pivotal role of surgical debridement.

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