scholarly journals Utilisation of tracheostomy in patients with COVID-19 in England: patient characteristics, timing and outcomes

2021 ◽  
Author(s):  
Annakan Navaratnam ◽  
William Gray ◽  
Josh Wall ◽  
Arun Takhar ◽  
Taran Tatla ◽  
...  
Keyword(s):  
Critical Care ◽  
Length Of Stay ◽  
Multilevel Modelling ◽  
Patient Characteristics ◽  
Exploratory Analysis ◽  
Administrative Dataset ◽  
History Of ◽  
Hospital Administrative ◽  
Multivariable Modelling ◽  
Critical Care Patients

Objectives: We aimed to characterise the use of tracheostomy procedures for all COVID-19 critical care patients in England and to understand how patient factors and timing of tracheostomy affected outcomes. Design: A retrospective observational study using exploratory analysis of hospital administrative data. Setting: All 500 National Health Service hospitals in England. Participants: All hospitalised COVID-19 patients aged ≥ 18 years in England between March 1st and October 31st, 2020 were included. Main outcomes and measures: This was a retrospective exploratory analysis using the Hospital Episode Statistics administrative dataset. Multilevel modelling was used to explore the relationship between demographic factors, comorbidity and use of tracheostomy and the association between tracheostomy use, tracheostomy timing and the outcomes. Results: In total, 2,200 hospitalised COVID-19 patients had a tracheostomy. Tracheostomy utilisation varied substantially across the study period, peaking in April-June 2020. In multivariable modelling, for those admitted to critical care, tracheostomy was most common in those aged 40-79 years, in males and in people of Black and Asian ethnic groups and those with a history of cerebrovascular disease. In critical care patients, tracheostomy was associated with lower odds of mortality (OR: 0.514 (95% CI 0.443 to 0.596), but greater length of stay (OR: 41.143 (95% CI 30.979 to 54.642). In patients that survived, earlier timing of tracheostomy (≤ 14 days post admission to critical care) was significantly associated with shorter length of stay. Conclusions: Tracheostomy is safe and advantageous for critical care COVID-19 patients. Early tracheostomy may be associated with better outcomes, such as shorter length of stay, compared to late tracheostomy.

scholarly journals Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries?

2018 ◽  
Vol 48 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Giorgia Dimitri ◽  
Domenico Giacco ◽  
Michael Bauer ◽  
Victoria Jane Bird ◽  
Lauren Greenberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychiatric Inpatient ◽  
Patient Characteristics ◽  
Clinical Severity ◽  
Face To Face ◽  
History Of ◽  
The Given ◽  
Inpatient Units ◽  
Previous Admission ◽  
Complex Influence

AbstractBackgroundPrevious studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries.MethodsProspective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS.ResultsAverage LoS varied from 17.9 days in Italy to 55.1 days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries.ConclusionsThe same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

2015 ◽  
Vol 35 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Ryan M. Rivosecchi ◽  
Pamela L. Smithburger ◽  
Susan Svec ◽  
Shauna Campbell ◽  
Sandra L. Kane-Gill
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Hospital Costs ◽  
Evidence Based ◽  
Inpatient Settings ◽  
Stay Hospital ◽  
Critical Care Patients

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study (Preprint)

2021 ◽  
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the <i>χ<sup>2</sup></i> test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, <i>χ</i><sup>2</sup><sub>1</sub>=8.43, <i>P</i>=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, <i>P</i>=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure &lt;50 mmHg (OR 0.179, 95% CI 0.072-0.416, <i>P</i>&lt;.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, <i>P</i>=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

Factors affecting ED length-of-stay in surgical critical care patients

1995 ◽  
Vol 13 (5) ◽  
pp. 495-500 ◽  
Author(s):  
Barbara Davis ◽  
Sara Sullivan ◽  
Amy Levine ◽  
John Dallara
Keyword(s):  
Critical Care ◽  
Length Of Stay ◽  
Factors Affecting ◽  
Surgical Critical Care ◽  
Critical Care Patients

Predictors of Pressure Ulcers in Adult Critical Care Patients

2011 ◽  
Vol 20 (5) ◽  
pp. 364-375 ◽  
Author(s):  
Jill Cox
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Critical Care Patients

BackgroundPressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available.ObjectiveTo determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions.MethodsA retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009.ResultsAccording to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers.ConclusionCurrent risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study

10.2196/29757 ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. e29757
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

Background Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. Objective The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. Methods This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the χ2 test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. Results A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, χ21=8.43, P=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, P=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure <50 mmHg (OR 0.179, 95% CI 0.072-0.416, P<.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, P=.008). Conclusions Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

Perspectives on the Electronic ICU

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Young Ahn ◽  
Robert M. Jasmer ◽  
Thomas Shaughnessy
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Length Of Stay ◽  
Third Party ◽  
Patient Acceptance ◽  
High Severity ◽  
Icu Length Of Stay ◽  
High Acuity ◽  
Critical Care Patients ◽  
Growing Population

Electronic ICUs (eICUs) have arisen as an effort to improve the intensive care medical coverage still unavailable to many patients. The overriding issue is the ongoing shortage of critical care medicine physicians and an ever-growing population of critical care patients. However, it has been difficult to conclusively define the outcome benefits in terms of mortality or ICU length of stay following establishment of an eICU program. Successful outcomes have been demonstrated in ICU settings ranging from academic to rural, but eICUs may have the most impact in ICUs that ( a) begin with a deficit ofintensivist coverage, ( b) have high severity-adjusted mortality and long length of stay rates, ( c) are located remotely where safe transfer of high acuity patients is not possible, and ( d) are part of an organizational structure that support the tele-ICU intensivist’s management of the patient. Acceptance of telepresence technology and particularly the acceptance of a remote intensivist managing patients can encounter strong resistance by many bedside clinicians. Third-party payers have traditionally not paid for intensivists to provide patient care via real-time telemedicine systems. There may also be vulnerability to liability to all those involved in ICU care if communication between bedside and eICU practitioners break down. This review describes the various components of an eICU program and discuss the barriers we encountered in developing an eICU program in a large, multihospital health care system.

Sign in / Sign up

Export Citation Format

Share Document