scholarly journals Accuracy of a Bedside Swallow Test After Extubation in ICU: A Prospective Validation of a Clinical Test Compared to a Fiberoptic Endoscopy.

2020 ◽  
Author(s):  
Adel Maamar ◽  
Valentine Parent ◽  
Emmanuel Guérot ◽  
Pauline Berneau ◽  
Aurélien Frérou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Validation Cohort ◽  
Clinical Test ◽  
Exclusion Criteria ◽  
Predictive Values ◽  
Swallowing Evaluation ◽  
Independent Risk Factors ◽  
Preliminary Study

Abstract Background: Swallowing disorders (SDs) are frequent after extubation in intensive care unit (ICU) exposing patients to aspiration pneumonia. There is no validated bedside swallowing evaluation (BSE) after extubation. We aimed to evaluate the accuracy of our BSE in comparison with fiberoptic endoscopic evaluation of swallowing (FEES) in critically ill patients after extubation, and to identify the incidence and risk factors of SD.Methods: After a preliminary study in a first center, we conducted a 1-year prospective study as a validation cohort in a second center. Patients intubated for longer than 48 hours were included. Exclusion criteria were a known laryngeal pathology, a preexisting SD and an admission for stroke. FEES of the larynx and BSE were assessed within 24 hours after extubation to compare the accuracy of the BSE to the FEES procedure.Results: One hundred and twenty eight patients were included, respectively 69 and 79 in the preliminary study and the validation cohort. Thirteen of 69 (19%) and 33/79 (42%) had SD assessed by FEES. The area under curve (AUC) reached respectively 0.86 (95% CI 0.73-0.98) and 0.83 (95% CI 0.74-0.92). Sensitivities were 77% (95% CI 0.54-0.99) and 85% (95% CI 0.73-0.94), specificities 94% (95% CI 0.87-0.98) and 80% (95% CI 0.7-0.91), and negative predictive values (NPV) were 95% and 90% in respectively preliminary study and validation cohort. Independent risk factors for SD were duration of intubation (OR=1.08; 95% CI 1.02-1.17, p=0.03) and hemodynamic failure (OR=4.46; 95% CI 1.27-21, p=0.03).Conclusion: Our BSE is accurate to detect SDs after extubation in critically ill patients and can easily be implemented in an ICU setting.

scholarly journals Risk Factors For Kidney Damage In COVID-19 Patients Admitted To The Intensive Care Unit

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Diana K. Sarkisian ◽  
Natalia V. Chebotareva ◽  
Valerie McDonnell ◽  
Armen V. Oganesyan ◽  
Tatyana N. Krasnova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Elderly Age ◽  
Total Blood ◽  
Independent Risk Factors

Background — Acute kidney injury (AKI) reaches 29% in the intensive care unit (ICU). Our study aimed to determine the prevalence, features, and the main AKI factors in critically ill patients with coronavirus disease 2019 (COVID-19). Material and Methods — The study included 37 patients with COVID-19. We analyzed the total blood count test results, biochemical profile panel, coagulation tests, and urine samples. We finally estimated the markers of kidney damage and mortality. Result — All patients in ICU had proteinuria, and 80.5% of patients had hematuria. AKI was observed in 45.9% of patients. Independent risk factors were age more than 60 years, increased C-reactive protein (CRP) level, and decreased platelet count. Conclusion — Kidney damage was observed in most critically ill patients with COVID-19. The independent risk factors for AKI in critically ill patients were elderly age, a cytokine response with a high CRP level.

scholarly journals Diabetes and Hemoglobin A1c as Risk Factors for Nosocomial Infections in Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Eirini Tsakiridou ◽  
Demosthenes Makris ◽  
Vasiliki Chatzipantazi ◽  
Odysseas Vlachos ◽  
Grigorios Xidopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Hemoglobin A1c ◽  
District Hospital ◽  
Bloodstream Infections ◽  
Inclusion Criteria ◽  
Icu Mortality ◽  
Independent Risk Factors

Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients.Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. Inclusion criteria: ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU.Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91–20.17;P=0.002) and blood transfusion 3.33 (1.23–9.02;P=0.018) were independent risk factors for VAP. BSI in ICU (P=0.044) and ICU mortality (P=0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14–5.29;P=0.022) and stroke on admission2.77 (1.12–6.88;P=0.029). Sepsis 3.34 (1.47–7.58;P=0.004) and parenteral feeding 6.29 (1.59–24.83;P=0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU.Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.

scholarly journals Plasma tryptophan and tyrosine levels are independent risk factors for delirium in critically ill patients

2009 ◽  
Vol 35 (11) ◽  
pp. 1886-1892 ◽  
Author(s):  
P. P. Pandharipande ◽  
A. Morandi ◽  
J. R. Adams ◽  
T. D. Girard ◽  
J. L. Thompson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Tryptophan ◽  
Independent Risk Factors

scholarly journals Development a Nomogram to Predict Prognosis in Severe and Critically Ill Patients with COVID-19

2020 ◽  
Author(s):  
Weiping Tan ◽  
Ying Zhu ◽  
Hui Yi ◽  
Yingyu Lin ◽  
Yumei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Severity ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Poor Prognosis ◽  
Total Bilirubin ◽  
Lung Involvement ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background: The number of deaths caused by COVID-19 are on the rising worldwide. This study focused on severe and critically ill COVID-19, aim to explore independent risk factors associated with disease severity and to build a nomogram to predict patients’ prognosis.Methods: Patients with laboratory-confirmed COVID-19 admitted to the Union Hospital, Tongji Medical College and Hankou Hospital of Wuhan, China, from February 8th to April 6th, 2020. LASSO Regression and Multivariate Analysis were applied to screen independent factors. COX Nomogram was built to predict the 7-day, 14-day and 1-month survival probability.Results: A total of 115 severe [73 (63.5%)] and critically ill [42 (36.5%)] patients were included in this study, containing 93 (80.9%) survivors and 22 (19.1%) non-survivors. For disease severity, D-dimer [OR 6.33 (95%CI, 1.27-45.57], eosinophil percentage [OR 8.02 (95%CI, 1.82-45.04)], total bilirubin [OR 12.38 (95%CI, 1.24-223.65)] and lung involvement score [OR 1.22 (95%CI, 1.08-1.40)] were the independent factors associated with critical illness. Troponin [HR 9.02 (95%CI, 3.02, 26.97)] and total bilirubin [HR 3.16 (95%CI, 1.13, 8.85)] were the independent predictors for patients’ prognosis. Troponin≥26.2 ng/L and total bilirubin＞20 μmol/L were associated with poor prognosis. The nomogram based on the independent risk factors had a C-index of 0.92 (95%CI, 0.87, 0.98) for predicting survival probability. The survival nomogram validated in the critically ill patients had a C-index of 0.83 (95%CI: 0.75, 0.94).Conclusions: In conclusion, in severe and critically ill patients with COVID-19, D-dimer, eosinophil percentage, total bilirubin and lung involvement score were the independent risk factors associated with disease severity. The proposed survival nomogram accurately predicted prognosis. The survival analysis may suggest that early incidence of multiple organ dysfunction may be an important predictor of poor prognosis.

scholarly journals The Incidence, Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients Undergoing Emergency Surgery: A Prospective Observational Study

2020 ◽  
Author(s):  
Linhui Hu ◽  
Lu Gao ◽  
Danqing Zhang ◽  
Yating Hou ◽  
Yujun Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Emergency Surgery ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Incidence Risk ◽  
Postoperative Serum ◽  
Independent Risk Factors ◽  
Postoperative Aki

Abstract BackgroundPostoperative acute kidney injury (AKI) is associated with higher morbidity, mortality, and economic burden. However, there is a lack of evaluation of postoperative AKI in highly heterogeneous critically ill patients undergoing emergency surgery. To explore the incidence, risk factors, and prognosis, to clarify the epidemiological status, and to improve the early identification and diagnosis of postoperative AKI, this study was taken.MethodsA prospective observational study was conducted in the general intensive care units of Guangdong Provincial People's Hospital from January 2014 to March 2018. Preoperative variables, intraoperative variables, postoperative variables, and postoperative prognosis data were collected. The diagnosis and staging of postoperative AKI were based on the Kidney Disease: Improving Global Outcomes criteria. They were divided into two groups according to whether postoperative AKI occurred: AKI group and non-AKI group. The baseline characteristics, postoperative AKI incidence, AKI stage, and in-hospital prognosis in all enrolled patients were analyzed prospectively. Multivariate logistic forward stepwise (odds ratio, OR) regression was used to determine the independent risk factors of postoperative AKI. Results were presented using the OR with 95% confidence intervals (CIs).ResultsA total of 383 critically ill patients undergoing emergency surgery, 151 (39.4%) patients among them developed postoperative AKI. Postoperative reoperation, postoperative Acute Physiology and Chronic Health Evaluation (APACHE II) score, postoperative serum lactic acid (LAC), postoperative serum creatinine (sCr) were independent risk factors for postoperative AKI in critically ill patients undergoing emergency surgery, with the adjusted OR (ORadj) of 1.854 ( 95% CI, 1.091 - 3.152), 1.059 ( 95% CI, 1.018 - 1.102), 1. 239 (95% CI, 1.047 - 1.467), and 3.934 (95% CI, 2.426 - 6.382), respectively. Duration of mechanical ventilation, renal replacement therapy, ICU and hospital mortality, ICU and hospital length of stay, total ICU and hospital costs were higher in the AKI group than in the non-AKI group.ConclusionsThe independent risk factors which included postoperative reoperation, postoperative APACHE II score, postoperative LAC, and postoperative sCr could improve the early diagnosis and prevention of postoperative AKI and identify the higher risk of adverse outcomes in critically ill patients undergoing emergency surgery.

Pathophysiology of glucose control

2016 ◽  
Author(s):  
Ulrike Madl
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Control ◽  
Neuronal Damage ◽  
Cardiovascular Effects ◽  
Diabetic Patients ◽  
Negative Effects ◽  
Independent Risk Factors ◽  
Glucose Fluctuations

Hyperglycaemia is a frequent phenomenon in critically-ill patients, associated with increased morbidity and mortality. Hyperglycaemia results in cellular glucose overload and toxic adverse effects of glycolysis and oxidative phosphorylation, especially in tissues with insulin-independent glucose uptake, and acute hyperglycaemia can exert a variety of negative effects. It is the main side effect of intensive insulin therapy. Both severe and moderate hypoglycaemia are independent risk factors of mortality in critically-ill patients. Prolonged hypoglycaemia induces neuronal damage, but may also have adverse cardiovascular effects. Several risk factors predispose critically-ill patients to hypoglycaemic events. Rapid glucose fluctuations may induce oxidative stress and lead to vascular damage. Glucose complexity is a marker of endogenous glucose regulation. Association between hyperglycaemia and outcome is weaker in diabetic critically-ill patients than in non-diabetic patients. Pre-admission glucose control in diabetic critically-ill patients plays a role in the response to glucose control and mortality.

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 Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients

2021 ◽  
Vol 7 (4) ◽  
pp. 267-271
Author(s):  
Alvin Saverymuthu ◽  
Rufinah Teo ◽  
Jaafar Md Zain ◽  
Saw Kian Cheah ◽  
Aliza Mohamad Yusof ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Creatinine Kinase ◽  
Injury Group ◽  
Independent Risk Factors ◽  
Prolonged Surgery

Abstract Introduction Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. Aim To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. Methods All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Results Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001]. Conclusions One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.

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