scholarly journals Complexity Measure based on Sensitivity Analysis Applied to an Intensive Care Unit system

2021 ◽  
Author(s):  
Joao R. B. Paiva ◽  
Viviane M. Gomes ◽  
Poliana S. Barbosa ◽  
Fabiana R. Almeida ◽  
Gabriel A. Wainer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Sensitivity Analysis ◽  
Intensive Care ◽  
Queue Length ◽  
System Complexity ◽  
Unit System ◽  
Sensitivity Indices ◽  
Number Of Patients ◽  
System Components ◽  
System Robustness

Abstract This work proposes a system complexity metric and its application to Intensive Care Unit (ICU) system. The methodology for applying said complexity metric comprises: (i) parameters sensitivity indices calculation, (ii) mapping connections dynamics between system components, and (iii) system’s complexity calculation. After simulating the ICU computer model and using the proposed methodology, we obtained results regarding: number of admissions, number of patients in queue, length of stay, beds in use, ICU performance, and system complexity values (in regular or overloaded operation). As the number of patients in queue increased, the ICU system complexity also increased, indicating a need for policies to promote system robustness.

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals Nutritional therapy of COVID-19 disease in Intensive care units

2021 ◽  
Vol 26 (83) ◽  
pp. 27-52
Author(s):  
Biljana Damnjanović ◽  
Đuro Šijan ◽  
Ivan Rović ◽  
Igor Lazić ◽  
Saša Knežević ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Negative Impact ◽  
Current Knowledge ◽  
Virus Disease ◽  
Nutritional Therapy ◽  
Hospital Treatment ◽  
Omega 3 ◽  
Corona Virus ◽  
Number Of Patients

Since the beginning of 2020, SARS-CoV 2 (Severe Acute Respiratory Syndrome - Corona Virus 2) has been in the focus of scientific circles and beyond. Finding the most efficient therapeutic protocol in prevention and treatment of the new and unknown COVID - 19 (Corona Virus Disease - 2019) disease has been indentified as especially important. SARS-CoV 2 uses various mechanisms to lead patients to malnutrition, which is detected by a higher frequency of admission to hospital treatment, especially on admission to the Intensive Care Unit (ICU). Malnutrition has a negative impact on the course and outcome of the disease. In the pandemic, the number of patients on various types of oxygen therapy and mechanical ventilation increased, and in correlation with that, there has been a greater need for knowledge and education of staff to use different diagnostic and therapeutic modalities and different approaches in feeding critically ill patients. Nutritional therapy is the basis for maintaining body weight, supporting respiratory function, as well as helping in the overall recovery of patients. Omega 3 fatty acids, vitamins C and D have shown potentially beneficial effects against COVID-19 diseases. The aim of this paper is to consolidate the current knowledge and recommendations in the field of nutritional therapy in patients with COVID-19 treated in the Intensive Care Unit.

scholarly journals Association between early mobilization or rehabilitation and intensive care unit acquired weakness: A systematic review and meta-analysis of randomized controlled trials.

2020 ◽  
Author(s):  
Minghang Li ◽  
Mingyue Ding ◽  
Huanzhang Shao ◽  
Bingyu Qin ◽  
Xingwei Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Early Mobilization ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Care Group ◽  
China National Knowledge Infrastructure ◽  
Number Of Patients ◽  
Icu Discharge

Abstract Background The prognosis of intensive care unit acquired weakness (ICUAW) is poor and the treatment effect is not ideal. At present, some effective and safe early prevention means are urgently needed to reduce its incidence.This study evaluated the effectiveness and safety of early activities or rehabilitation in the prevention of ICUAW. Methods We searched for articles in five electronic databases, including PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) and Wanfang Med Online. All publications until June, 2020 were searched. We have selected trials investigating early mobilization or rehabilitation as compared to standard of care in critically ill adults.The extracted data included adverse events, the number of patients with ICUAW, the length of stay in the ICU (ICU-LOS) the length of mechanical ventilation (MV) etc. Results The final results showed that compared with the usual care group, early mobilization or rehabilitation reduced the prevalence of ICUAW (RR, 0.73; [0.61, 0.87]; I2 = 44%; P = 0.0006), ICU-LOS (MD, − 1.47;[2.83, 0.10]; I2 = 56%; P = 0.04), length of MV (MD, − 1.96; [2.41, 1.51]; I2 = 0%; P = 0.00001), but the mortality (RR, 0.90; [0.62, 1.32]; I2 = 3%; P = 0.60) at ICU discharge was not associated. The subgroup analysis of ICUAW prevalence and ICU-LOS based on the intervention methods showed that early combined rehabilitation could reduce the prevalence of ICUAW (RR, 0.56; [0.43, 0.74]; I2 = 34%; P = 0.0001) and shorten the ICU-LOS (MD, − 2.21; [3.28, 0.97]; I2 = 23%; P = 0.0003). EGDM was not associated with a decrease in ICUAW prevalence (RR, 0.85; [0.65, 1.09]; I2 = 26%; P = 0.20), but it reduced the ICU-LOS (MD, − 2.27; [3.86, 0.68]; I2 = 0%; P = 0.005).Early in-bed cycling was not associated with reduced ICUAW prevalence(RR, 1.25; [0.73, 2.13]; I2 = 0%; P = 0.41) and ICU-LOS(MD, 2.27; [0.27, 4.80]; I2 = 0%; P = 0.08) . Conclusions Early mobilization or rehabilitation was associated with a shorter length of MV and ICU-LOS, but not mortality. Of course, not all early activities or forms of rehabilitation are effective. The early combined rehabilitation model is effective for the prevention of ICUAW. However, EGDM and early in-bed cycling were not effective in preventing ICUAW.

ABICUS: Aberdeen Intensive Care Unit System

1990 ◽  
Vol 7 (2) ◽  
pp. 69-81 ◽  
Author(s):  
Donald G. Ross ◽  
Pradeep Ramayya ◽  
Vivek Kulkarni
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Unit System

Overestimation of Bispectral Index in Sedated Intensive Care Unit Patients Revealed by Administration of Muscle Relaxant

2003 ◽  
Vol 99 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Benoît Vivien ◽  
Sophie Di Maria ◽  
Alexandre Ouattara ◽  
Olivier Langeron ◽  
Pierre Coriat ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Bispectral Index ◽  
Muscle Relaxant ◽  
Muscular Activity ◽  
Electromyographic Activity ◽  
Adductor Pollicis Muscle ◽  
Number Of Patients ◽  
Before And After

Background Electromyographic activity has previously been reported to elevate the Bispectral Index (BIS) in patients not receiving neuromuscular blockade while under sedation in the intensive care unit. This study aimed to investigate the magnitude of the decrease of BIS following administration of muscle relaxant in sedated intensive care unit patients. Methods The authors prospectively investigated 45 patients who were continuously sedated with midazolam and sufentanil to achieve a Sedation-Agitation Scale value equal to 1 and who required administration of muscle relaxant. BIS (BIS version 2.10), electromyography, and acceleromyography at the adductor pollicis muscle were recorded simultaneously before and after neuromuscular blockade. Sixteen of these 45 patients were also studied simultaneously with the new BIS XP. Results After administration of a muscle relaxant, BIS (67 +/- 19 vs. 43 +/- 10, P &lt; 0.001) and electromyographic activity (37 +/- 9 vs. 27 +/- 3 dB, P &lt; 0.001) significantly decreased. Multiple regression analysis showed that the decrease of BIS following administration of myorelaxant was significantly correlated to BIS and electromyographic baseline values. Using standard BIS range guidelines, the number of patients under light or deep sedation versus general anesthesia or deep hypnotic state was markedly overestimated before administration of myorelaxant (53 vs. 2%, P &lt; 0.001). Conclusions The BIS in sedated intensive care unit patients may be lower with paralysis for an equivalent degree of sedation because of high muscular activity. The magnitude of BIS overestimation is significantly correlated to both BIS and electromyographic activity before neuromuscular blockade. The authors conclude that clinicians who determine the amount of sedation in intensive care unit patients only from BIS monitoring may expose them to unnecessary oversedation.

scholarly journals The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

2020 ◽  
Vol 11 (01) ◽  
pp. 182-189
Author(s):  
Ellen T. Muniga ◽  
Todd A. Walroth ◽  
Natalie C. Washburn
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Number Of Patients ◽  
Order Sets ◽  
Critical Care Admission ◽  
The Impact ◽  
Order Set

Abstract Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

scholarly journals Patient length of stay and mortality prediction: A survey

2017 ◽  
Vol 30 (2) ◽  
pp. 105-120 ◽  
Author(s):  
Aya Awad ◽  
Mohamed Bader–El–Den ◽  
James McNicholas
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Length Of Hospital Stay ◽  
Hospital Performance ◽  
Mortality Prediction ◽  
Cost Of Care ◽  
Resource Utilisation ◽  
Number Of Patients

Over the past few years, there has been increased interest in data mining and machine learning methods to improve hospital performance, in particular hospitals want to improve their intensive care unit statistics by reducing the number of patients dying inside the intensive care unit. Research has focused on prediction of measurable outcomes, including risk of complications, mortality and length of hospital stay. The length of stay is an important metric both for healthcare providers and patients, influenced by numerous factors. In particular, the length of stay in critical care is of great significance, both to patient experience and the cost of care, and is influenced by factors specific to the highly complex environment of the intensive care unit. The length of stay is often used as a surrogate for other outcomes, where those outcomes cannot be measured; for example as a surrogate for hospital or intensive care unit mortality. The length of stay is also a parameter, which has been used to identify the severity of illnesses and healthcare resource utilisation. This paper examines a range of length of stay and mortality prediction applications in acute medicine and the critical care unit. It also focuses on the methods of analysing length of stay and mortality prediction. Moreover, the paper provides a classification and evaluation for the analytical methods of the length of stay and mortality prediction associated with a grouping of relevant research papers published in the years 1984 to 2016 related to the domain of survival analysis. In addition, the paper highlights some of the gaps and challenges of the domain.

scholarly journals Opportunistic diseases in patients with HIV infection in the intensive care unit

2018 ◽  
Vol 90 (11) ◽  
pp. 13-17
Author(s):  
G M Kozhevnikova ◽  
S L Voznesenskiy ◽  
T N Ermak ◽  
E V Petrova ◽  
V P Golub ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Chronic Hepatitis ◽  
Intensive Care ◽  
Hiv Infection ◽  
Comparative Study ◽  
Opportunistic Infections ◽  
Pneumocystis Pneumonia ◽  
Hiv Patients ◽  
Number Of Patients ◽  
Secondary Diseases

The aim of the study was to analyze the incidence and prevalence of opportunistic diseases and comorbidities in patients admitted in the intensive care unit. Materials and methods. A specialized intensive care unit (ICU) for patients with severe HIV infection was set up in 2014 at the infectious diseases 2nd state hospital Moscow. It provides intensive care and treatments for HIV patients with severe co-morbidities and opportunistic infections. Retrospective analysis of medical records from 2014-2016 was carried out. Also carried out was a comparative study of the most common presentation of secondary diseases with available data of HIV patients in Russia from 1993-1997. Results. The number of patients treated increased from 455 to 852, and the death rate in the department decreased from 64.8 to 50.2% since it began operating. The opportunistic infections noted were cytomegalovirus, pneumocystis pneumonia, esophageal candidiasis, tuberculosis and toxoplasmosis of the brain. The most common comorbidities were chronic hepatitis C and mixed form of chronic hepatitis with cirrhosis complications. Despite the vast diagnostic possibilities, bacterial pneumonia and encephalitis of unknown origin significantly occurred. Comparative study of secondary disease since the early 1990s revealed a significant increase in cerebral toxoplasmosis (from 1.7 to 10.4%), pneumocystis pneumonia (from 5.2 to 16.0%) and encephalitis of unspecified etiology (from 13.8 to 39.4%) Conclusion. Disease severity among HIV patients is increasing. CMV and pneumocystis pneumonia were predominant opportunistic diseases. There were significant changes in the presentation of secondary diseases compared to data from 1993-1997.

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