scholarly journals Arterial Carboxyhemoglobin Levels In COVID-19 Critically Ill Patients

2021 ◽  
Author(s):  
Paul Paccaud ◽  
Diego Castanares-Zapatero ◽  
Ludovic Gerard ◽  
Virginie Montiel ◽  
Xavier Wittebole ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Prolonged Mechanical Ventilation ◽  
Progressive Increase ◽  
University Teaching ◽  
Single Center ◽  
Parallel Increase ◽  
Over Time

Abstract Objective : Oxidative stress conditions may be responsible for an up-regulation of the expression of heme oxygenase (HO), the enzyme synthesizing carbon monoxide (CO) in cells. Elevated levels of arterial carboxyhemoglogin (aCOHb) have been found in critically ill patients, including those suffering from acute lung injury. We aimed to investigate the changes of aCOHb levels in COVID-19 critically ill patients.Design : Single center retrospective cohort study between March 1 and December 31, 2020.Setting: University teaching hospital with 900 beds including 48 ICU beds.Patients: Consecutive adults requiring ICU admission for severe COVID-19 infection.Measurements and main results : After exclusion of 23 patients who required extracorporeal membranous oxygenation (ECMO), a total of 135 patients was considered, from whom 76 required mechanical ventilation (MV) that was prolonged for more than 20 days in 28 patients. Demographics, laboratory values, treatment and outcomes were recorded. The evolution of aCOHb over time was investigated among survivors and non-survivors and among patients with or without MV. The admission and peak aCOHb values did not differ among survivors or non-survivors. In the patients with MV, there was a significant increase of aCOHb with time, with a biphasic evolution for the patients ventilated for more than 20 days: a parallel increase of aCOHb and PaCO2 followed by a trend to a plateau of aCOHb during PaCO2 recovery.Conclusions : Progressive increase in aCOHb from endogenous source is observed in COVID-19 patients requiring prolonged mechanical ventilation. Decrease of aCOHb appears slower than PaCO2 recovery.

ANEMIA AND TRANSFUSIONS AMONG CRITICALLY ILL PATIENTS ON PROLONGED MECHANICAL VENTILATION

CHEST Journal ◽  
2006 ◽  
Vol 130 (4) ◽  
pp. 212S
Author(s):  
Andrew F. Shorr ◽  
Lee S. Stern ◽  
Monika K. Raut ◽  
Lisa R. Rosenblatt ◽  
Samir Mody ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

scholarly journals Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients

2018 ◽  
Vol 7 (8) ◽  
pp. 224 ◽  
Author(s):  
Shyh-Ren Chiang ◽  
Chih-Cheng Lai ◽  
Chung-Han Ho ◽  
Chin-Ming Chen ◽  
Chien-Ming Chao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clostridium Difficile ◽  
Critically Ill ◽  
Clostridium Difficile Infection ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Comorbidity Scores ◽  
Independent Risk Factors ◽  
High Comorbidity

Objectives: Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of Clostridium difficile infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy. Methods: Taiwan’s National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7–14 days (n = 97,525), 15–21 days (n = 52,068), 22–28 days (n = 35,264), and 29–60 days (n = 70,021). The primary outcome was CDI. Results: Age (>75 years old), prolonged MV assistance (>21 days), carbapenem therapy (>15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29–60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46–5.58; p < 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15–21 days (AHR = 2.58; 95% CI = 1.12–5.91) and MV 29–60 days (AHR = 4.63; 95% CI = 1.14–10.03) subgroups than in the non-MV and non-carbapenem subgroups. Conclusions: Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI.

scholarly journals Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence–Reality Gap

2017 ◽  
Vol 34 (10) ◽  
pp. 818-827 ◽  
Author(s):  
Bronwen A. Connolly ◽  
Jessica L. Mortimore ◽  
Abdel Douiri ◽  
Joleen W. Rose ◽  
Nicholas Hart ◽  
...  
Keyword(s):  
Physical Activity ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Physical Activity Behavior ◽  
Ventilator Weaning ◽  
Physical Rehabilitation ◽  
Activity Level ◽  
University Teaching ◽  
Activity Levels

Background: Physical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU. Methods: Single-center, prospective observational study in a university teaching hospital. Patient observations, conducted Monday through Sunday from 08:30 am to 08:00 pm and for 1 minute every 10 minutes, included data points of patient location, people in attendance, and highest level of activity. Descriptive statistics were utilized to analyze and report data. Results: Forty-two ICU and 11 VWU patients were recruited, with 2646 and 693 observations, respectively, recorded. In the ICU, patients spent a median (interquartile range) of 100% (96%-100%) of the day (10.5 [10.0-10.5] hours) located in bed, with minimal/no activity for 99% (96%-100%) of the day (10.4 [9.7-10.5] hours). Nursing staff were most frequently observed in attendance with patients irrespective of ventilation or sedation status, although patients still spent approximately two-thirds of the day alone. Bed-to-chair transfer was the highest activity level observed. In the VWU, patients spent 94% (73%-100%) of the day (9.9 [7.7-10.5] hours) in bed and 56% (43%-60%) of time alone. Physical activity levels were higher and included ambulation. All physical activities occurred during physical rehabilitation sessions. Conclusions: These profiles of low physical activity behavior across both patients in the ICU and VWU highlight the need for targeted strategies to improve levels beyond therapeutic rehabilitation and support for a culture shift toward providing patients with, and engaging them in, a multidisciplinary, multiprofessional environment that optimizes overall physical activity.

IMPACT OF TRANSFUSION ON OUTCOMES IN CRITICALLY ILL PATIENTS REQUIRING PROLONGED MECHANICAL VENTILATION.

2006 ◽  
Vol 34 ◽  
pp. A136
Author(s):  
A F Shorr ◽  
L S Stern ◽  
L C Rosenblatt ◽  
S K Hendlish ◽  
J J Doyle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation

Cytokines in Chronically Critically Ill Patients After Activity and Rest

2007 ◽  
Vol 8 (4) ◽  
pp. 261-271 ◽  
Author(s):  
Chris Winkelman ◽  
Patricia A. Higgins ◽  
Yea Jyh Kathy Chen ◽  
Alan D. Levine
Keyword(s):  
Physical Activity ◽  
Mechanical Ventilation ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Serum Levels ◽  
Inflammatory Factors ◽  
Chronically Critically Ill ◽  
Critically Ill Adults

Inflammation, a common problem for patients in the intensive care unit (ICU), frequently is associated with serious and prolonged critical illnesses. To date, no study has examined whether physical activity influences inflammatory factors in critically ill adults. The objectives of this study were to (a) examine the relationships between type and duration of physical activity and serum levels of interleukin 6 (IL-6), a proinflammatory cytokine; IL-10, an anti-inflammatory cytokine; and their ratio and (b) determine if there are associations between cytokines or their ratio and activity or outcomes. This descriptive feasibility study investigated the approaches to measuring levels of physical activity and its relationship to serum levels of IL-6 and IL-10 and the ratio between them in patients with prolonged mechanical ventilation during periods of activity and rest. Measurements included serum IL-6 and IL-10 levels, direct observation and actigraphy, and prospective chart review. Ten critically ill patients who were mechanically ventilated for an average of 10 days in a large, urban, teaching hospital were enrolled. The average ratio of IL-6 to IL-10 improved after an average of 14.7 min of passive physical activity, typically multiple in-bed turns associated with hygiene. IL-6, IL-10, and their ratio were not associated with patient outcomes of weaning success or length of stay. High levels of IL-6 were associated with mortality. Cytokine balance may be improved by low levels of activity among patients with prolonged critical illness. The pattern of cytokines produced after activity may improve patients' recovery from prolonged critical illness and mechanical ventilation.

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