scholarly journals Severe Maternal Morbidity: Admission Shift From Intensive Care Unit to Obstetric High-dependency Unit

2021 ◽  
Author(s):  
Ning Gu ◽  
Yaning Zheng ◽  
Yimin Dai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Apache Ii Score ◽  
High Dependency Unit ◽  
Chi Square ◽  
Icu Admission ◽  
Hypertensive Disorders ◽  
High Dependency ◽  
Obstetric Population ◽  
Length Of Icu Stay

Abstract Background: To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU).Methods: This is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU in a provincial referral center in China from January 2014 to December 2019. The collected information included maternal demographic characteristics, indications for ICU and HDU admission, the length of ICU stay, the total length of in-hospital stay and APACHE II score. Chi-square and ANOVA tests were used to determine statistical significance. The temporal changes were assessed with chi-square test for linear trend.Results: A total of 40 412 women delivered and 447 (11.1‰) women were admitted to ICU in this 6-year period. The rate of ICU admission peaked at 15.9‰ in 2016 and then dropped to 6.7‰ in 2019 with the introduction of obstetric HDU. The average APACHE II score increased significantly from 6.8 to 12.3 (P<0.001) and the average length of ICU stay increased from 1.7 to 7.1 days (P<0.001). The main indications for maternal ICU admissions were hypertensive disorders in pregnancy (39.8%), cardiac disease (24.8%), and other medical disorders (21.5%); while the most common reasons for referring to HDU were hypertensive disorders of pregnancy (46.5%) and obstetric hemorrhage (43.0%). After adjusting for the proportion of high-risk pregnancies, the establishment of HDU reduced 20% of ICU admission (aOR = 0.804, 95% CI =0.666-0.972).Conclusions: The introduction of HDU helps to reduce ICU utilization in obstetric population.

scholarly journals Why Obstetric Patients are admitted to Intensive Care Unit? A Retrospective Study

2012 ◽  
Vol 4 (2) ◽  
pp. 90-92
Author(s):  
Sunita Ghike ◽  
Prashant Asegaonkar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Maternal Mortality ◽  
South Asian ◽  
Medical Illness ◽  
High Dependency Unit ◽  
Icu Admission ◽  
High Dependency ◽  
Number Of Patients

ABSTRACT Pregnant women are often young and in their reproductive years. In majority of them, pregnancy and labor usually progresses uneventfully. Sudden complications occurring during this period may lead to maternal mortality. Though obstetric admission forms a small proportion of ICU admission, mortality among them is high. Proper antenatal care is still the mainstay of preventing complications in pregnant woman. This study was conducted to evaluate the obstetric admission to intensive care unit and causes and outcome of them. Two years retrospective review of all the obstetric admissions (Antenatal and postnatal up to 6 weeks post delivery) were done. Total number of patients admitted to ICU in this period, total number of deliveries in study period and total obstetric patients admitted to ICU were noted. The data included demographic details, obstetric history, indications for ICU admission, pre-existing medical illness and pregnancy complications necessitating ICU admissions. Total obstetric patients admitted to ICU were 1.04% of all deliveries. 48.53% women had pre-existing medical illness. 87.24% were antenatal and 12.67% were postnatal patients. 70.21% women had obstetric/medical illnesses during pregnancy which ICU admissions. Maternal mortality was observed in 31.91%. There was.changing trend in causes of maternal mortality, i.e. tropical diseases like dengue and malaria are found to be the cause of mortality in developing countries like India. Thus, there is need of obstetric high dependency unit (OHDU) at every center. How to cite this article Ghike S, Asegaonkar P. Why Obstetric Patients are admitted to Intensive Care Unit? A Retrospective Study. J South Asian Feder Obst Gynae 2012;4(2):90-92.

Primary Casualty Reception Ship: the hospital within—Operation Granby

1992 ◽  
Vol 78 (2) ◽  
pp. 55-64
Author(s):  
E. P. Dewa
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Support Services ◽  
Persian Gulf ◽  
Medical Team ◽  
High Dependency Unit ◽  
Full Support ◽  
Hospital Facility ◽  
High Dependency

SummaryAs the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RF A Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO).In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed.Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services.The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA.One hundred and five patients were treated of which 78 were returned to duty. Argus as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US.

Care of the Neurosurgical Patient in the Post Anesthetic Care Unit

2001 ◽  
Vol 2 (3-4) ◽  
pp. 14-21
Author(s):  
Melissa McNeillis
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
High Dependency Unit ◽  
Anesthetic Care ◽  
Anaesthetic Care ◽  
High Dependency ◽  
Neurosurgical Patient ◽  
Initial Care ◽  
Care Study

In this care study I will explain the care that SVB received following his admission to the Post Anaesthetic Care unit (PACU) and summarise his discharge to the Intensive Care Unit (ICU). The limitations that this case report presents are that often the care received in the PACU can be quite short in terms of total length of stay in hospital. It is not uncommon that High Dependency patients are received for initial care into the PACU following surgery and to be further discharged and nursed in either a dedicated High Dependency Unit or to the Intensive Care Unit.

Postoperative care

2019 ◽  
pp. 141-150
Author(s):  
Nuria Masip
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Paediatric Intensive Care Unit ◽  
Postoperative Nausea And Vomiting ◽  
Level Of Care ◽  
High Dependency Unit ◽  
Anaesthetic Care ◽  
High Dependency ◽  
Postoperative Problems

After surgery, and before being transferred to the ward, patients will be recovered in a specially designated area: the recovery area or post-anaesthetic care unit (PACU). In recovery, there are some postoperative problems that we need to be familiar with managing: postoperative nausea and vomiting (PONV), emergence delirium (it is important to recognize it, and be able to differentiate it from agitation) and pain. Those patients who need postoperative critical care will be admitted to a high-dependency unit (HDU) or paediatric intensive care unit (PICU), depending on their required level of care. Each time the patient is transferred to a different area, a thorough handover between the giving and receiving team is paramount. This chapter provides the reader with the means to manage common recovery problems, and an understanding of patient postoperative dependency levels.

scholarly journals Plasma-Calprotectin as an Indicator for Immediate Need of Intensive Care Treatment in Suspected Sepsis

2021 ◽  
Author(s):  
Asa Emilia Parke ◽  
Christian Unge ◽  
David Yu ◽  
Jonas Sunden-Cullberg ◽  
Kristoffer Stralin
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Intensive Care Treatment ◽  
High Dependency Unit ◽  
Suspected Sepsis ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein ◽  
Promising Tool ◽  
High Dependency

Abstract Introduction: Decisions regarding need of transfer to intensive care of patients with sepsis in the emergency department is challenging. We hypothesised that the new biomarker plasma-calprotectin could be used to help select patients who need intensive care, since it already has shown to be a promising tool in the intensive care unit. Methods: This prospective study was performed on consecutive sepsis alert patients. The alert summons a multidisciplinary team of physicians from the emergency department, the Department of Infectious Diseases, and the intensive care unit, who evaluate patients for possible infection and decide where to transfer the patient. Blood sampling was performed on consecutive sepsis alert patients. C-reactive protein, procalcitonin, neutrophils, and lymphocytes were routinely analysed, p-calprotectin was analysed from frozen plasma samples using a specific turbidimetric assay. Results: Among 367 sepsis alert patients, 335 had an infection of whom 66 were immediately transferred to the intensive care unit or high dependency unit. 269 patients were transferred to ordinary wards. Median p-calprotectin for all infected patients was 2.2 (IQR 1.2–3.9), 3.3 (IQR 1.6–5.2) among those transferred immediately to intensive care unit/ high dependency unit and 2.1 (IQR 1.1–3.5) among those transferred to wards (p = 0.0001). Analysis of area under the receiver-operating characteristic (ROC) curve for transferral to higher care level showed superiority for p-calprotectin compared to procalcitonin and neutrophil-lymphocyte-ratio, both regarding all sepsis alert cases and regarding the patients with infection (p < 0.001 for all comparisons)). The best p-calprotectin cut-off 4.0 mg/L showed sensitivity 42.5% and specificity 83% for transferral to ICU/HDU among patients with infection. Conclusion: In sepsis alert patients, p-calprotectin was significantly elevated in patients transferred immediately to intensive care. P-calprotectin was superior to traditional biomarkers as a predictor of need for intensive care. Trial registration: Not registered, as the sepsis alert was developed as a clinical supportive tool.

Abstract P17: Delirium in the Cardiovascular Intensive Care Unit: Implementation of a Screening Tool, Prevalence and Lessons Learned

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
John A McPherson ◽  
Chad E Wagner ◽  
Leanne Boehm ◽  
Kathy Burns ◽  
Leanna Miller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Negative Binomial ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Chi Square ◽  
Restraint Use ◽  
Attitudes And Knowledge ◽  
The Impact ◽  
Cardiovascular Intensive Care

Background: Delirium is common among critically ill patients (pts) and can lead to significant morbidity and mortality; yet the impact of delirium in a medical/surgical cardiovascular intensive care unit (CVICU) is unknown. Objectives: We sought to (1) determine the prevalence and risk factors for delirium in a CVICU using the Confusion Assessment method for the ICU (CAM-ICU); and (2) measure the effect of educating and implementing CAM-ICU in routine assessment on attitudes and knowledge gaps regarding delirium among CVICU staff. Methods: CVICU nurses were educated on delirium and trained in bedside CAM-ICU assessment. The CAM-ICU was performed at least once per shift, and reported during rounds. A survey assessed CVICU nurse attitudes and knowledge of delirium pre-and post-CAM-ICU implementation. Detailed clinical data were then prospectively obtained on 200 consecutive CVICU pts. Dementia or expected lengths of stay (LOS) < 1 day were exclusions. Results: Median CVICU LOS was 3 days (IQR 2, 5), the median APACHE II score was 23 (IQR 11, 28), and CVICU mortality was 4%. The prevalence of delirium was 26%; similar among medical (n=96) and surgical (n=104) pts. Compared with pre-implementation, post-implementation surveys demonstrated improvements in CAM-ICU use (53% vs 98%), knowledge of delirium and outcomes, and importance of CAM-ICU data for patient care. Using a negative binomial model, the prior use of statins (p = 0.01), dexmedetomidine (p = 0.05), and benzodiazepines (p = 0.05) were associated with the development of delirium, with a trend toward increasing age (p = 0.17). No association with cardiac output, on-pump surgery, or APACHE II score was observed. In addition, restraint use (chi-square 5.2; p = 0.02) or statins (chi-square 4.4; p = 0.04) during the previous 24 hours were associated with the daily prevalence of delirium. Conclusions: A detailed education intervention implementing routine CAM-ICU assessment increased knowledge of delirium and its clinical importance. Delirium is common in the CVICU, and is associated with the restraint use, dexmedetomidine, and benzodiazepines, likely representing a need for sedation. The association of delirium with prior statin use may reflect a higher burden of cardiovascular disease in these pts.

scholarly journals Depressive and Anxiety Symptoms in Relatives of Intensive Care Unit Patients and the Perceived Need for Support

2018 ◽  
Vol 09 (04) ◽  
pp. 522-528 ◽  
Author(s):  
Maria Bolosi ◽  
Vaios Peritogiannis ◽  
Petros Tzimas ◽  
Athanasios Margaritis ◽  
Konstantinos Milios ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Anxiety Symptoms ◽  
Apache Ii Score ◽  
Icu Admission ◽  
Perceived Need ◽  
Need For Support

ABSTRACT Background: Admission of a patient in the Intensive Care Unit (ICU) and the recovery process may be stressful for family members. Objectives: This study aimed to explore the families’ psychological symptoms and their evolution over the 1st week of patients’ ICU stay. Additional objectives were the estimation of the families’ need for support and the estimation of satisfaction regarding the information provided by ICU physicians. Methods: A total of 108 individuals were participated in the study. Participants were interviewed with the Hamilton Anxiety Rating Scale and filled the Beck Depression Scale II on days 1 and 7 of patients’ ICU admission. They also filled a self-reported questionnaire which was created by the investigators, involving decision-making procedures; the satisfaction of the families of the patients’ care; and the support of the families by medical and nursing staff. Results: Anxiety levels were not significantly different among 2-time points, whereas rates of depressive symptoms raised significantly from 38% (day 1) to 58.3% (day 7). In cases of anxiety changes, age, education, closeness of relationship, and APACHE II score were the factors been associated. Changes in depressive symptoms were not associated with any of those factors. Over a week, there were significant differences in relatives’ views on participating in the decision-making procedure, and on expressing their opinion and concerns regarding the treatment process. Their attitudes about receiving support by the ICU personnel and even by mental health specialists, such as psychologists also changed. Conclusions: Over the 1st week of ICU admission, depressive symptoms in patients’ relatives were gradually evolving, while anxiety symptoms fluctuated and they were affected by the severity of the patients’ condition. Attitudes toward treatment procedures and the perceived need for support also changed. These findings should be taken into account by the ICU personnel.

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