Knowledge, attitude, and practice toward the daily management of PICC in critically ill cancer patients discharged from intensive care units

e24001 Background: An important aspect of improving outcomes for patients with malignancy is the provision of critical care during periods of acute deterioration. Decisions regarding whether advanced cancer patients should be admitted to the ICU is based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We set to describe demographic, clinical, and survival data and to identify factors associated with short- and long-term mortality in critically ill advanced cancer patients with non-elective admissions to general ICUs. Methods: Critically ill adult (≥18-year-old) cancer patients non-electively admitted to the intensive care units at the American University of Beirut Medical Center (AUBMC) between August 1st, 2015, and March 1st, 2019, were included. Demographic, clinical, and laboratory data was prospectively collected from first day of ICU admission up to 30 days after discharge. This study was strictly observational and clinical decisions were left to the discretion of the ICU team and attending physician. Results: Two hundred seventy-two patients were enrolled in the study between August 1st, 2015, and March 31st, 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. Mean length of stay in our ICU was 14 days with an interquartile range of 1 to 120 days with a median overall survival of 22 days since date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). COX regression analysis showed that sepsis, uncontrolled malignancy, ARDS, multi-organ failure, use of vasopressors, use of mechanical ventilation are major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) (p = 0.014). Additionally, mortality in patients with solid malignancies (47.6%) was higher than those with hematologic malignancies (34.1%) (p = 0.0048). Conclusions: Patients admitted to the ICU in a tertiary care center in the MENA region are at high risk for short term mortality.

Download Full-text

Outcomes of Patients with Malignancy Admitted to the Intensive Care Units: A Prospective Study

Critical Care Research and Practice ◽

10.1155/2021/4792309 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Hazem I. Assi ◽

Nour Abdul Halim ◽

Ibrahim Alameh ◽

Jessica Khoury ◽

Vicky Nahra ◽

...

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Intensive Care Units ◽

Critically Ill ◽

Advanced Cancer ◽

Laboratory Data ◽

Advanced Cancer Patients ◽

Cox Regression Analysis ◽

Icu Admission ◽

Icu Discharge

Introduction. Decisions regarding whether advanced cancer patients should be admitted to the ICU are based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We aimed to describe demographic, clinical, and survival data and to identify factors associated with mortality in critically ill advanced cancer patients with nonelective admissions to general ICUs. Materials and Methods. Critically ill adult (≥18 years old) cancer patients nonelectively admitted to the intensive care units at the American University of Beirut Medical Center between August 1st 2015 and March 1st 2019 were included. Demographic, clinical, and laboratory data were prospectively collected from the first day of ICU admission up to 30 days after discharge. This study was strictly observational, and clinical decisions were left to the discretion of the ICU team and attending physician. Results. 272 patients were enrolled in the study between August 1st 2015 and March 1st 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. The mean length of stay in our ICU was 14 days (IQR: 1–120) with a median overall survival of 22 days since the date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). Cox regression analysis revealed 7 major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) ( p = 0.014 ). Conclusion. Our study has shown that being directly admitted to the ICU from the ED rather than being transferred from regular wards, developing AKI, sepsis, MOF, and ARDS, or having an uncontrolled malignancy are all predictive factors for short-term mortality in critically ill cancer patients nonelectively admitted to the ICU. Vasopressor use and mechanical ventilation were also predictors of mortality.

Download Full-text

Knowledge, attitude, and practice of intensive care units nurses about nosocomial Infections control in hospitals of Bojnurd in 2012.

Journal of North Khorasan University of Medical Sciences ◽

10.29252/jnkums.5.5.s5.943 ◽

2014 ◽

Vol 5 (5) ◽

pp. 943-950 ◽

Cited By ~ 3

Author(s):

M Yaghubi ◽

SH Sharifi ◽

H Abbaspour

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Infections ◽

Attitude And Practice ◽

Knowledge Attitude And Practice

Download Full-text

Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320962 ◽

2021 ◽

pp. archdischild-2020-320962

Author(s):

Ruchi Sinha ◽

Angela Aramburo ◽

Akash Deep ◽

Emma-Jane Bould ◽

Hannah L Buckley ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Clinical Care ◽

Adult Patients ◽

Paediatric Intensive Care ◽

Critically Ill Adults ◽

Care Capacity ◽

Ill Adults ◽

Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

Download Full-text

ICU admissions: Consequences after discharge

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738020932613 ◽

2020 ◽

Vol 13 (9) ◽

pp. 550-556

Author(s):

Minal Karavadra ◽

Ricky Bell

Keyword(s):

Intensive Care ◽

Cognitive Decline ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Psychiatric Disturbance ◽

Intensive Care Department ◽

Previous Level ◽

The Uk

The intensive care department may seem a long way from the GP's consulting room, but every year tens of thousands of critically ill patients are admitted to intensive care units (ICUs) across the UK. Patients are often left with long term sequelae that may require GP input. Physical weakness, psychiatric disturbance and cognitive decline are not uncommon after an illness that requires a stay in an ICU. These hinder a patient’s return to their previous level of function and impact caregivers after discharge. This article aims to highlight the chronic symptoms patients can acquire during ICU admission that may come to the attention of GPs for their advice and treatment.

Download Full-text