scholarly journals Immunological Effects of Glutamine Supplementation in Polytrauma Patients in Intensive Care Unit.

2021 ◽  
Author(s):  
Antonella Cotoia ◽  
Leonarda Pia Cantatore ◽  
Renata Beck ◽  
Alessandra De Gregorio ◽  
Flavia Marchese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
B Lymphocytes ◽  
Glutamine Supplementation ◽  
Control Group ◽  
Cell Mediated Immunity ◽  
T Helper ◽  
Icu Patients ◽  
T Helper Lymphocytes ◽  
Suppressor Lymphocytes

Abstract Background In polytrauma intensive care unit (ICU) patients, glutamine (GLN) become a "conditionally essential" amino acid; its role has been extensively studied in numerous clinical trials but their results are inconclusive. We evaluated the IgA–mediated humoral immunity after GLN supplementation in polytrauma ICU patients. Results All consecutive patients with polytrauma who required mechanical ventilation and enteral nutrition (EN) provided within 24 hours since the admission in ICU at the University Hospital of Foggia from September 2016 to February 2017 were included. Thereafter, two groups were identified: patients treated by conventional EN (25 kcal/kg/die) and patients who have received conventional EN enriched with 50 mg/kg/ideal body weight of alanyl-GLN 20% intravenously. We analyzed plasmatic concentration of IgA, CD3+/CD4+ T Helper Lymphocytes, CD3+/CD8+ T suppressor Lymphocytes, CD3+/CD19+ B Lymphocytes, IL-4 and IL-2 at admission, at 4, 8 days. We identified 30 patients, with 15 subjects per group. IgA levels increased significantly in GLN vs control group at T0, T4 and T8.CD3+/CD4+ T helper lymphocytes and CD3+/CD8+ T suppressor lymphocytes levels significantly increased in GLN vs control group at T4 and T8. CD3+/CD19+ B lymphocytes levels increased significantly in GLN vs control group only at T8.IL-2 and IL-4 levels showed no significant differences when comparing GLN with control group. Conclusions Our study showed that there was an improvement in humoral and cell-mediated immunity with GLN supplementation in polytrauma ICU patients using recommended doses.

scholarly journals The Effect of the Dreamer Spiritual Therapies on Saliva Cortisol Hormone and Pain Score Patients in the Intensive Care Unit: A True-experimental Study

2021 ◽  
Vol 9 (G) ◽  
pp. 281-287
Author(s):  
Iwan Purnawan ◽  
Sri Setiyarini ◽  
Probosuseno Probosuseno ◽  
Yunita Widyastuti
Keyword(s):  
Intensive Care Unit ◽  
Experimental Study ◽  
Intensive Care ◽  
Pain Score ◽  
Wilcoxon Test ◽  
Control Group ◽  
Icu Patients ◽  
Pain Scores ◽  
Spiritual Therapy ◽  
Paired T Test

BACKGROUND: Patients’ conditions can worsen if stress and pain are not appropriately managed. Conventional therapy ignores psychological and spiritual aspects. Both influence the body’s response to various stimuli. AIM: This study aimed to assess how Dreamer’s spiritual therapy can affect the cortisol and pain in the intensive care unit (ICU) patients. METHODS: It involved 86 ICU patients in a true-experimental study. Respondents were divided into the intervention and the control group randomly. The intervention group received Dreamer spiritual therapy (DST) for 30 min but not for the control group. Saliva samples and pain scores were taken from both groups before and after treatment. The comparison of two groups cortisol decreases using Wilcoxon test. Differences in pre- and post-pain scores in each group were analyzed using paired t-test. RESULTS: According to Levene’s test, the two groups were homogeneous (p > 0.05). The Wilcoxon test revealed a statistically significant difference in cortisol level reduction between the intervention (3.88 ng/mL) and control (3.82 ng/ml) groups (p = 0.024), with a large effect size (Cohen’s d value = 59.5). The paired t-test revealed a statistically significant decrease in the intervention group’s pain score from 2.6 to 1.95 (p = 0.001), with a moderate effect size (Cohen’s d value = 0.49). The control group’s pain score did not significantly decrease (p = 0.75). CONCLUSIONS: A DST is effective in reducing salivary cortisol levels and pain scores of ICU patients.

scholarly journals Comparison of Intravenous Enoxaparin with Subcutaneous Enoxaparin in Preventing Venous Thromboembolism in Patients Admitted to Intensive Care Unit

2020 ◽  
Author(s):  
Masoum Khoshfetrat ◽  
Majid Khorram ◽  
Aliakbar Keykha ◽  
Hossein Ansari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Intervention Group ◽  
Factor Xa ◽  
Control Group ◽  
Icu Patients ◽  
Active Factor ◽  
Significant Difference ◽  
Subcutaneous Enoxaparin

Background: The use of subcutaneous enoxaparin is a usual method for preventing venous thromboembolism (VTE) in the intensive care unit (ICU) patients, but adequate absorption of the drug is not reliable due to the illness intensity, existing edema and hypoperfusion in these patients. The aim of this study was to compare the effect of intravenous enoxaparin with subcutaneous enoxaparin to prevent VTE in ICU patients. Methods: The current double-blind Randomized clinical trial was performed on 64 patients admitted to the ICU at Khatam- Al- Anbia Hospital in Zahedan, southeast of Iran. The patients were randomly assigned into each of the subcutaneous enoxaparin and the intravenous enoxaparin groups. The blood sampling was performed aseptically and then active factor Xa level was measured. Next, the intervention group received 0.5 mg/kg of intravenous enoxaparin for 10 days and the control group was injected subcutaneously the same dosage of drug. Four hours after the first injection and 12 hours after the last injection on the tenth day, the factor Xa level and the frequency of VTE incidence was measured again. Results: In all three measurement times, the active factor Xa level in the intravenous enoxaparin group was lower than that of the subcutaneous group, but no significant difference was observed between the two groups and different times (P> 0.05). Conclusion: The results of this study showed that the use of intravenous enoxaparin is an effective way to prevent the VTE development in the ICU patients.

scholarly journals Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Asli Okbay Gunes ◽  
Emre Dincer ◽  
Nilgun Karadag ◽  
Sevilay Topcuoglu ◽  
Guner Karatekin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Breast Milk ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Control Group ◽  
Study Group ◽  
Intake Rate ◽  
Informed Consent Form ◽  
Group 2

Abstract Objectives To find out if the expressed breast milk delivery rate to neonatal intensive care unit (NICU) for babies who were hospitalized for any reason other than COVID-19, and exclusive breastfeeding (EB) rates between discharge date and 30th day of life of those babies were affected by COVID-19 pandemic. Methods Babies who were hospitalized before the date first coronavirus case was detected in our country were included as control group (CG). The study group was divided into two groups; study group 1 (SG1): the mothers whose babies were hospitalized in the period when mother were asked not to bring breast milk to NICU, study group 2 (SG2): the mothers whose babies were hospitalized after the date we started to use the informed consent form for feeding options. The breast milk delivery rates to NICU during hospitalization and EB rates between discharge and 30th day of life were compared between groups. Results Among 154 mother-baby dyads (CG, n=50; SG1, n=46; SG2, n=58), the percentage of breast milk delivery to NICU was 100%, 79% for CG, SG2, respectively (p<0.001). The EB rate between discharge and 30th day of life did not change between groups (CG:90%, SG1:89%, SG2:75.9; p=0.075). Conclusions If the mothers are informed about the importance of breast milk, the EB rates are not affected by the COVID-19 pandemic in short term, even if the mothers are obligatorily separated from their babies. The breast milk intake rate of the babies was lowest while our NICU protocol was uncertain, and after we prepared a protocol this rate increased.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

scholarly journals Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tessa L. Steel ◽  
Shewit P. Giovanni ◽  
Sarah C. Katsandres ◽  
Shawn M. Cohen ◽  
Kevin B. Stephenson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Alternative Measure ◽  
Icu Patients ◽  
Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

Topical Lidocaine Patch for Postthoracotomy and Poststernotomy Pain in Cardiothoracic Intensive Care Unit Adult Patients

2019 ◽  
Vol 39 (5) ◽  
pp. 51-57 ◽  
Author(s):  
Michael Liu ◽  
Mabel Wai ◽  
James Nunez
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Standard Care ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Control Group ◽  
Lidocaine Group ◽  
Lengths Of Stay ◽  
Topical Lidocaine

Background Transdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit. Methods A single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone. Results The primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47). Conclusions Adjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and post-sternotomy patients in the cardiothoracic intensive care unit.

scholarly journals Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

2021 ◽  
Vol 9 (7) ◽  
pp. 1505
Author(s):  
Claire Roger ◽  
Benjamin Louart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Convulsive Status Epilepticus ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Drug Induced ◽  
Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

scholarly journals Contamination of Propofol Infusions in the Intensive Care Unit: Incidence and Clinical Significance

1998 ◽  
Vol 26 (2) ◽  
pp. 162-164 ◽  
Author(s):  
S. A. R. Webb ◽  
B. Roberts ◽  
F. X. Breheny ◽  
C. L. Golledge ◽  
P. D. Cameron ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Nosocomial Infection ◽  
Wound Infection ◽  
Clinical Significance ◽  
Low Grade ◽  
Clinical Infection ◽  
Icu Patients

Epidemics of bacteraemia and wound infection have been associated with the infusion of bacterially contaminated propofol administered during anaesthesia. We conducted an observational study to determine the incidence and clinical significance of administration of potentially contaminated propofol to patients in an ICU setting. One hundred patients received a total of 302 infusions of propofol. Eighteen episodes of possible contamination of propofol syringes were identified, but in all cases contamination was by a low-grade virulence pathogen. There were no episodes of clinical infection or colonization which could be attributed to the administration of contaminated propofol. During the routine use of propofol to provide sedation in ICU patients the risk of nosocomial infection secondary to contamination of propofol is extremely low.

Comparing Vitamin A and Moist Chamber in Preventing Ocular Surface Disorders

2017 ◽  
Vol 27 (6) ◽  
pp. 714-729 ◽  
Author(s):  
Hassan Babamohamadi ◽  
Monir Nobahar ◽  
Jalaladin Razi ◽  
Raheb Ghorbani
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Vitamin A ◽  
Ocular Surface ◽  
Slight Reduction ◽  
Moist Chamber ◽  
Icu Patients ◽  
Schirmer’S Test

The present study was conducted to determine the effectiveness of vitamin A eye ointment (VAEO) and moist chamber (MC) in preventing ocular surface disorders (OSD) in intensive care unit (ICU) patients. A total of 38 eligible patients were selected for participation in the present clinical trial. All the patients were randomly administered VAEO in one eye every 6 hr for 5 days and had a polyethylene cover (PC) placed on their other eye to create an MC that was replaced every 12 hr as well. The results of Schirmer’s test also increased by 2.06 mm in the VAEO group ( p < .001), while they showed a slight reduction by 0.15 mm in the MC group ( p = .669). VAEO was more effective in preventing OSD in ICU patients than MC and is, therefore, recommended to be used as a method of preventing OSD.

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