scholarly journals Incidence of Muscle Wasting in the Critically Ill: A Prospective Observational Cohort Study

2021 ◽  
Author(s):  
Ondrej Hrdy ◽  
Kamil Vrbica ◽  
Marek Kovar ◽  
Tomas Korbicka ◽  
Radka Stepanova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Patient Age ◽  
Patient Âgé ◽  
Secondary Outcomes ◽  
Clinically Significant

Abstract Background: Loss of muscle mass occurs rapidly during critical illness. It can often lead to weakness and fatigue, and it negatively affects quality of life. Despite the importance of understanding the incidence of clinically significant muscle wasting in critically ill patients, there have been few reports on this subject. This study aimed to assess the incidence of and identify risk factors associated with clinically significant loss of muscle mass in this patient population. Methods: This was a single-center observational study. Informed consent was obtained from all patients. We used ultrasound to determine the rectus femoris cross-sectional area (RFcsa) of each patient on their first and seventh days of treatment in the intensive care unit (ICU). The primary outcome of the study was the incidence of significant muscle wasting, which was defined as a greater or equal to 10% reduction in RFcsa from day 1 to day 7. SOFA score on day 7, length of artificial ventilation, ICU length of stay and twenty-eight-day mortality were evaluated as secondary outcomes. We used a logistic regression model to determine whether patient age, sex, BMI, frailty score, or medical history were significant risk factors for muscle wasting.Results: We screened an initial cohort of 1,293 patients and recruited 186 as study participants. Ultrasound measurements were completed in 104 patients. Sixty-two of these patients (59.6%) showed ≥10% decreases in RFcsa. Logistic regression analysis identified patient age as the sole risk factor associated with significant muscle wasting. While we detected no statistically significant differences associated with the secondary outcomes, the 28-day mortality rate almost doubled in the group of patients with significant wasting (30.6% versus 16.7%; p=0.165).Conclusions: Clinically significant muscle wasting was frequently observed in our cohort of critically ill adult patients. Patient age was identified as a risk factor for muscle wasting. The results of this study could be used to plan future studies that evaluate strategies to prevent muscle wasting and to improve the outcomes of critically ill patients.Trial registration: clinicaltrials.gov, NCT 03865095, date of registration: March 6, 2019.

Hemmkörperentwicklung bei Hämophilie-Patienten nach Präparate wechsel

2012 ◽  
Vol 32 (S 01) ◽  
pp. S39-S42 ◽  
Author(s):  
S. Kocher ◽  
G. Asmelash ◽  
V. Makki ◽  
S. Müller ◽  
S. Krekeler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
Frequent Change ◽  
Patient Age ◽  
Treatment Regimens ◽  
Patient Âgé ◽  
The Relationship ◽  
Observation Period

SummaryThe retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn’t lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

scholarly journals The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: The EACG study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110180
Author(s):  
Yu Chen ◽  
Fang Feng ◽  
Xue-ni Chang ◽  
Dong Liu ◽  
Yuan Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
White Blood Cells ◽  
Kidney Injury ◽  
Gansu Province ◽  
Incidence And Mortality

To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province. This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Univariate and multivariate logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. (2) Logistic regression analysis showed that sex, age, AKI stage, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time, and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury ( p < 0.05). Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Trial registration: the Chinese Clinical Trial Registry number is ChiCTR1800016945. Date of registration: 4 July 2018.

POCUS Findings in Critically Ill Patients in Emergency Department

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S54-S58
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Vena Cava ◽  
Admission Rate ◽  
Point Of Care Ultrasound ◽  
True Positive ◽  
Medical Department ◽  
Patient Age ◽  
Patient Disposition ◽  
Patient Âgé

Background: Point of care ultrasound (POCUS) has been shown to improve diagnostic accuracy and has been used in a variety of contexts. However, the utility of POCUS as applied to critically ill patients has not been well studied. Materials and Methods: This was a retrospective descriptive study of critically ill patients who had received POCUS at Srinagarind Hospital’s Emergency Medical Department between July 2019 and June 2020. Data was collected from one year of POCUS studies and included ultrasound clips and images, patient age and sex, chief complaint, final diagnosis, and patient disposition. The data was described using descriptive statistics, including medians, counts and percentages. Results: POCUS data was collected from 2,500 studies performed on 369 patients. Median patient age was 62.7 years; 51.6% of patients were female. Top indications of POCUS scans were of respiratory (34.42%) and cardiovascular system (23.58%) presentations. The most frequent study types performed were cardiac, lung, and inferior vena cava examinations. Abnormal ultrasound findings were found in 258 patients (69.92%). True-positive ultrasound results were found in 162 patients (43.9%). The admission rate of critically ill patients was highest among patients who had true-positive results. Conclusion: The prevalence of positive POCUS results was quite high in critically ill patients. Moreover, POCUS showed high accuracy. The number of admitted patients was highest among patients who had true-positive ultrasound results. Keywords: Ultrasonography, Critical illness, Emergency medicine

scholarly journals QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection

2022 ◽  
Vol 27 ◽  
pp. 107424842110694
Author(s):  
Wasim S. El Nekidy ◽  
Khalid Almuti ◽  
Hazem ElRefaei ◽  
Bassam Atallah ◽  
Lana M. Mohammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Qt Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Factors Associated ◽  
Qt Interval Prolongation ◽  
History Of ◽  
Clinically Significant

Background: Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population. Methods: We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms). Results: Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation ( P = .004 for the likelihood-ratio test). Conclusion: The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.

Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients

2018 ◽  
pp. 187-191
Author(s):  
Miguel Cobas ◽  
Melissa Grillo
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multicenter Cohort Study ◽  
Hemodynamic Compromise ◽  
Potential Risk Factors ◽  
Independent Risk Factors ◽  
Clinically Significant ◽  
Ulcer Prophylaxis

The efficacy of stress ulcer prophylaxis for the prevention of gastrointestinal bleeding in the critically ill has led to its widespread use. Side effects and cost of prophylaxis necessitate targeting the therapy to those patients most likely to benefit. A prospective multicenter cohort study was conducted to evaluate potential risk factors for stress ulceration in patients admitted to intensive care units. Two strong independent risk factors for bleeding were identified: respiratory failure and coagulopathy. Since few critically ill patients have clinically significant gastrointestinal bleeding (defined as overt bleeding in association with hemodynamic compromise or the need for blood transfusion), prophylaxis can safely be withheld unless they require mechanical ventilation or have a coagulopathy.

scholarly journals Comparison of Length of Stay and Deep Vein Thrombosis (DVT) Incidents in Dr. Soetomo Hospital

2018 ◽  
Vol 54 (4) ◽  
pp. 278
Author(s):  
Elizeus Hanindito ◽  
Prananda Surya Airlangga ◽  
Soni Sunarso Sulistiawan ◽  
Bambang Pujo Semedi ◽  
Lucky Andriyanto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Significant Risk ◽  
Vein Thrombosis ◽  
Length Of Treatment ◽  
Deep Vein

Vein thrombosis may occur both in deep and superficial vein of all extremities. Ninety percent of vein thrombosis may progress into pulmonary embolism which is lethal. Deep vein thrombosis (DVT) is frequently found in critically ill patients in ICU, especially patients who are treated for a long time. This study aims to analyse the comparison between length of stay and DVT incidents in critically ill patients. A cross-sectional study was employed. We include all patients who were 18 years or older and  were treated in ICU of Dr Soetomo public hospital for at least 7 days. The patients were examined with Sonosite USG to look for any thrombosis in iliac, femoral, popliteal, and tibial veins and Well’s criteria were also taken. This study showed that length of stay is not the only risk factor for DVT in patients treated in ICU. In our data, we found out that the length of treatment did not significantly cause DVT. Other risk factors such as age and comorbidities in patients who are risk factors may support the incidence of DVT events. The diagnosis of DVT is enforced using an ultrasound performed by an expert in the use of ultrasound to locate thrombus in a vein. Length of treatment is not a significant risk factor for DVT. Several other factors still need to be investigated in order for DVT events to be detected early and prevented.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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