scholarly journals Association of early-onset constipation and diarrhea with patient outcomes in critically ill ventilated patients: a retrospective observational cohort study

2021 ◽  
Author(s):  
Gen Aikawa ◽  
Akira Ouchi ◽  
Hideaki Sakuramoto ◽  
Tetsuya Hoshino ◽  
Yuki Enomoto ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Onset ◽  
Multivariable Analysis ◽  
Icu Admission ◽  
Icu Stay ◽  
Normal Defecation ◽  
Poor Outcomes ◽  
Length Of Icu Stay ◽  
Ventilated Patients

Abstract Constipation and diarrhea are both associated with poor outcomes in critically ill patients. Although constipation and diarrhea are closely related, few studies have examined them simultaneously. The purpose of this study was to describe patient defecation status after intensive care unit (ICU) admission and determine the association of early-onset constipation and diarrhea after ICU admission with outcomes for critically ill ventilated patients. Critically ill patients were retrospectively investigated and their defecation status was assessed during the first week after admission. The patients were divided into three groups: normal defecation, constipation, and diarrhea, and multiple comparison tests were performed. Additionally, multivariable analysis was performed for mortality and length of stay. Of the 85 critically ill ventilated patients, 47 (55%) experienced constipation, and 12 (14%) experienced diarrhea during the first week of ICU admission. Patients with normal defecation and diarrhea increased from the fourth and fifth day of ICU admission. Diarrhea was significantly associated with the length of ICU stay (B=7.534, 95% confidence interval: 0.116-14.951). Early-onset constipation and diarrhea were common in critically ill ventilated patients, and early-onset diarrhea was associated with the length of ICU stay. Prevention of constipation and diarrhea before the fifth day of ICU admission is essential.

Insulin Treatment Is Associated With Increased Mortality in Critically Ill Patients With Type 2 Diabetes in the Intensive Care Unit

2021 ◽  
Author(s):  
Rongping Fan ◽  
Xuemin Peng ◽  
Bo Yu ◽  
Jiaojiao Huang ◽  
Xuefeng Yu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Treatment ◽  
Icu Mortality ◽  
Icu Admission ◽  
Icu Stay ◽  
Before And After ◽  
Length Of Icu Stay

Abstract Aims: Although insulin treatment is widely used in critically ill patients with type 2 diabetes mellitus in the intensive care unit (ICU), the clinical outcomes of insulin treatment remain unclear. This retrospective study aimed to explore the impact of insulin treatment on mortality and ICU stay among patients with type 2 diabetes. Methods: We consecutively recruited 578 ICU patients with type 2 diabetes, from 2011 to 2021. According to their medication history regarding insulin use before and after ICU admission, these patients were categorized into three groups: N-N (treated without insulin before and after ICU admission), N-I (treated without insulin before and with insulin after ICU admission) and I-I (treated with insulin before and after ICU admission). Clinical characteristics were analyzed, and clinical outcomes including mortality and the length of ICU stay were compared between the groups. Propensity score matching was performed to obtain comparable subpopulation and the Kaplan-Meier survival curves were graphed to describe the survival trend of different groups. Results: Compared with the N-N group, the N-I and I-I groups had significantly higher ICU mortality rates [20.0% (N-I) and 24.6% (I-I) vs. 0.0% (N-N); p < 0.001; respectively] and longer lengths of ICU stay [ 8.5 (N-I), 9 (I-I) vs. 6 (N-N), p < 0.05, respectively]. After propensity score matching, the N-I group had a significantly higher ICU mortality (15.4% vs. 0.0%, p = 0.025) and poorer survival rates (log-rank p = 0.040) than the N-N group. The length of ICU stay was significantly longer in the I-I group than in the N-N group (10 vs. 7, p = 0.026). Conclusions: Insulin treatment was associated with increased ICU mortality rate and longer length of ICU stay among critically ill patients with type 2 diabetes. Caution is warranted for the regular application of insulin in critical patients with type 2 diabetes.

scholarly journals Sepsis Is Associated with a Preferential Diaphragmatic Atrophy

2014 ◽  
Vol 120 (5) ◽  
pp. 1182-1191 ◽  
Author(s):  
Boris Jung ◽  
Stephanie Nougaret ◽  
Matthieu Conseil ◽  
Yannaël Coisel ◽  
Emmanuel Futier ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Analysis ◽  
Lumbar Vertebra ◽  
Psoas Muscle ◽  
Cross Sectional ◽  
Icu Admission ◽  
Icu Stay ◽  
Peripheral Muscle ◽  
And Control

Abstract Background: Diaphragm and psoas are affected during sepsis in animal models. Whether diaphragm or limb muscle is preferentially affected during sepsis in the critically ill remains unclear. Methods: Retrospective secondary analysis study including 40 patients, comparing control (n = 17) and critically ill patients, with (n = 14) or without sepsis (n = 9). Diaphragm volume, psoas volume, and cross-sectional area of the skeletal muscles at the third lumbar vertebra were measured during intensive care unit (ICU) stay using tridimensional computed tomography scan volumetry. Diaphragm strength was evaluated using magnetic phrenic nerve stimulation. The primary endpoint was the comparison between diaphragm and peripheral muscle volume kinetics during the ICU stay among critically ill patients, with or without sepsis. Results: Upon ICU admission, neither diaphragm nor psoas muscle volumes were significantly different between critically ill and control patients (163 ± 53 cm3vs. 197 ± 82 cm3 for the diaphragm, P = 0.36, and 272 ± 116 cm3vs. to 329 ± 166 cm3 for the psoas, P = 0.31). Twenty-five (15 to 36) days after admission, diaphragm volume decreased by 11 ± 13% in nonseptic and by 27 ± 12% in septic patients, P = 0.01. Psoas volume decreased by 11 ± 10% in nonseptic and by 19 ± 13% in septic patients, P = 0.09. Upon ICU admission, diaphragm strength was correlated with diaphragm volume and was lower in septic (6.2 cm H2O [5.6 to 9.3]) than that in nonseptic patients (13.2 cm H2O [12.3 to 15.6]), P = 0.01. Conclusions: During the ICU stay, both diaphragm and psoas volumes decreased. In septic patients, the authors report for the first time in humans preferential diaphragm atrophy compared with peripheral muscles.

scholarly journals Dose–response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039875
Author(s):  
Meiping Wang ◽  
Bo Zhu ◽  
Li Jiang ◽  
Ying Wen ◽  
Bin Du ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Dose Response ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Fluid Overload ◽  
Multivariable Analysis ◽  
Main Diagnosis ◽  
Icu Admission ◽  
Increased Risk

ObjectivesFluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose–response relationship between FO and in-hospital mortality in critically ill patients.DesignMulticentre, prospective, observational study.SettingEighteen intensive care units (ICUs) of 16 tertiary hospitals in China.ParticipantsCritically ill patients in the ICU for more than 3 days.Primary outcome measures and analysesFO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis.ResultsA total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose–response association between maximum FO and in-hospital mortality.ConclusionsBoth higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients.Trial registration numberChiCTR-ECH-13003934.

Prevalence and Incidence of Arterial and Venous Thrombosis in Critically Ill Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2201-2201
Author(s):  
Wendy Lim ◽  
Mark A. Crowther ◽  
P. J. Devereaux ◽  
Deborah J. Cook
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Diagnostic Tests ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Surgical Intensive Care Unit ◽  
Ultrasound Screening ◽  
Icu Admission ◽  
Icu Stay

Abstract Background: Critically ill patients have multiple risk factors for developing thrombosis, yet little is known about the prevalence and incidence of arterial and venous thrombotic events in this patient population. The development of thrombosis is likely to be frequently unrecognized and thus untreated, which may affect clinical outcomes. Purpose: To document the prevalence and incidence of clinically recognized thrombotic events in critically ill adult patients. Methods: We undertook a retrospective chart review of 208 patients from a cohort of 261 critically ill patients admitted to a medical-surgical intensive care unit (ICU) who were enrolled in a prospective cohort study evaluating the prevalence and incidence of deep vein thrombosis (DVT) using twice weekly ultrasound screening. All other thrombotic events were diagnosed based on clinical suspicion and confirmed by conventional diagnostic tests. Data extraction: We reviewed daily medical records during the patient’s ICU admission for signs and symptoms of thrombosis, and abstracted laboratory and radiologic data. Results: At the time of ICU admission, ultrasound screening revealed DVT in 7 of 261 patients (prevalence 2.7%, 95% CI 1.1–5.4%) but only 3 cases (42.9%) were clinically suspected. During the ICU stay, 25 patients developed DVT (incidence 9.6%, 95% CI 6.3–13.8%), but only 3 (12.0%) were clinically suspected. Pulmonary embolism was clinically recognized on admission in 4 of 208 patients (prevalence 1.9%, 95% CI 0.5–4.9%); and was diagnosed in 1 patient during ICU stay (incidence 0.5%, 95% CI 0.0–2.6%). For arterial events, 3 of 208 patients were admitted with ischemic stroke, and 3 developed this complication in the ICU (prevalence and incidence 1.4%, 95% CI 0.3–4.2%). Cardiac troponin I was measured at least once in the first 24 hours of admission in 90% of patients. Elevated cardiac troponin I levels were observed in 69 of 208 patients on admission to ICU (prevalence 33.2%, 95% CI 26.8–40.0%) and 15 patients developed elevations in cardiac troponin I during their ICU stay (incidence 7.2%, 95% CI 4.1–11.6%). A diagnosis of an acute coronary syndrome (ACS) (based on troponin I level, and either ECG changes or initiation of treatment for myocardial ischemia) was made in 54 of 208 patients (prevalence 26.0%, 95% CI 20.1–32.5%). Fifteen patients (7.2%, 95% 4.1–11.6%) had elevated cardiac troponin I levels without any further testing. During the ICU stay, the incidence of ACS was 5.3% (95% CI 2.7–9.3%) and isolated elevated troponin I levels were found in 1.9% (95% CI 0.5–4.9%). Conclusions: Thrombotic events in critically ill patients occurs frequently and may often be unrecognized. Typical diagnostic tests for thromboembolism have not been properly evaluated in the critically ill; moreover, the predictive value for the diagnosis of myocardial infarction has not been determined in these patients. Additional studies evaluating the long term outcome and efficacy of interventions for critically ill patients with thrombotic events is required.

Preemptive Therapy in Nonneutropenic Patients with Candida Infection Using the Japanese Guidelines

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1137-1143 ◽  
Author(s):  
Ryosuke Tsuruta ◽  
Hidekazu Mizuno ◽  
Tadashi Kaneko ◽  
Yasutaka Oda ◽  
Kotaro Kaneda ◽  
...  
Keyword(s):  
Critically Ill ◽  
Antifungal Therapy ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Candida Infection ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Stay ◽  
Length Of Icu Stay ◽  
Japanese Guidelines

Background: The Japanese Guidelines for the Diagnosis and Treatment of Deep-Seated Mycosis were established in 2003. Proven Candida infection (CI) is defined as at least one positive blood culture yielding a Candida species. Clinically documented CI requires documentation of more than 2 sites of colonization and a positive plasma β-O-glucan test. Possible CI is diagnosed by one of the above criteria in febrile, nonneutropenic critically ill patients. Objective: To assess the use of definitions of clinically documented and possible CI for guiding preemptive antifungal therapy in critically ill patients. Methods: The patients treated in our intensive care unit (ICU) for at least 48 hours between 2000 and 2004 were investigated. The administration of antifungal agents and ICU mortality were compared among proven, clinically documented, and possible CI groups for age, sex, APACHE II score, diagnosis, length of ICU stay, treatment, number of colonization sites, and plasma β-D-glucan level. Results: Six patients were diagnosed with proven CI, 25 were diagnosed with clinically documented CI, and 104 with possible CI. The patients with clinically documented CI were compared with those with possible CI, and statistically significant differences were found in the following variables: APACHE II score (p = 0.018), length of ICU stay (p < 0.01), use of ventilator (p = 0.027), tracheotomy (p = 0.027), number of colonization sites (p < 0.001), plasma β-D-glucan level (p < 0.001), and administration of antifungal agents (p < 0.001); incidence of mortality was not statistically significant (p = 0.33). The shorter length of ICU stay, use of ventilator, and continuous hemodiafiltration were risk factors for death after adjusting for APACHE II score, admission before/after 2003, antifungal therapy, and other factors. Although the frequency of the administration of preemptive antifungal therapy was higher after 2003 than before, the mortality rate did not differ significantly, Conclusions: The use of the definitions of clinically documented and possible CI may be beneficial for determining when it is appropriate to initiate preemptive antifungal therapy. However, use of the guidelines did not lead to prevention of possible CI proceeding to clinically documented CI or to improved mortality.

Attributable Morbidity and Mortality of Catheter-Related Septicemia in Critically Ill Patients: a Matched, Risk-Adjusted, Cohort Study

1999 ◽  
Vol 20 (6) ◽  
pp. 396-401 ◽  
Author(s):  
Lilia Soufir ◽  
Jean-François Timsit ◽  
Cédric Mahe ◽  
Jean Carlet ◽  
Bernard Regnier ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Morbidity And Mortality ◽  
Attributable Mortality ◽  
Icu Admission ◽  
Saps Ii ◽  
Icu Stay ◽  
Severity Scores

Objective:To determine the attributable risk of death due to catheter-related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensive-care unit (ICU) stay but before CRS.Design:Pairwise-matched (1:2) exposed-unexposed study.Setting:10-bed medical-surgical ICU and an 18-bed medical ICU.Patients:Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables.Methods:Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS II, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox's models for the exposed-unexposed study, with adjustment on matching variables and prognostic factors of mortality.Results:CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.08-3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR, 1.41; CI95, 0.76-2.61; P=.27).Conclusion:CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS-attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients.

scholarly journals Tocilizumab is associated with reduced risk of ICU admission and mortality in patients with SARS-CoV-2 infection

2020 ◽  
Author(s):  
Estela Moreno-García ◽  
Verónica Rico ◽  
Laia Albiach ◽  
Daiana Agüero ◽  
Juan Ambrosioni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multivariable Analysis ◽  
Oxygen Demand ◽  
Icu Admission ◽  
Early Stages ◽  
Inflammatory Parameters ◽  
Attending Physician ◽  
To Receive

AbstractBackgroundIn some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management worldwide; therefore, clinical strategies to avoid ICU admission are needed.ObjectiveWe aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients.MethodsA retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first.Results77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P= 0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0·1, P=0.0001) of ICU admission or death.ConclusionTocilizumab in the early stages of the inflammatory flare, could reduce ICU admissions and mechanical ventilation use. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports.Clinical implicationOur results suggest that tocilizumab administered to non-critically ill patients could reduce ICU admissions and mortality.Capsule summaryTocilizumab administered to non-critically ill patients with SARS-CoV-2 infection in the early stages of the inflammatory flare, could reduce an important number of ICU admissions and mechanical ventilation use.

scholarly journals Ultrasound for Non-invasive Assessment and Monitoring of Quadriceps Muscle Thickness in Critically Ill Patients With Acute Kidney Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Alice Sabatino ◽  
Umberto Maggiore ◽  
Giuseppe Regolisti ◽  
Giovanni Maria Rossi ◽  
Francesca Di Mario ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Kidney Injury ◽  
Muscle Thickness ◽  
Quadriceps Muscle ◽  
Apache Ii Score ◽  
Icu Admission ◽  
Icu Stay

Background and aims: Critically ill patients with acute kidney injury (AKI) undergo major muscle wasting in the first few days of ICU stay. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass, both for the determination of nutritional status at admission, and for monitoring. In this regard, the present study aims to ascertain if ultrasound (US) is able to detect changes in quadriceps muscle thickness of critically ill patients with acute kidney injury (AKI) over short periods of time.Methods: This is a prospective observational study with a follow-up at 5 days. All adult patients with AKI hospitalized at the Renal ICU of the Parma University Hospital over 12 months, with a hospital stay before ICU admission no longer than 72 h, and with a planned ICU stay of at least 5 days, were eligible for the study. An experienced investigator assessed quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) at baseline and after 5 days of ICU stay.Results: We enrolled 30 patients with 74 ± 11 years of age and APACHE II score of 22 ± 5. Muscle thickness decreased by 15 ± 13% within the first 5 days of ICU stay (P &lt; 0.001 for all sites as compared to ICU admission). Patients with more severe muscle loss had lower probability of being discharged home (OR: 0.04, 95%CI: 0.00–0.74; P = 0.031).Conclusions: In critically ill patients with AKI, bedside muscle US identifies patients with accelerated muscle wasting.

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