scholarly journals Prolonged muscle inactivity and evaluation of peripheral neuromuscular features in patients hospitalized in Intensive Care Units

2019 ◽  
Vol 12 (2) ◽  
pp. 50-64
Author(s):  
George Elesnitsalis ◽  
Ioannis Amiridis ◽  
Dimitrios Patikas ◽  
Ioanna Vekili ◽  
Maria Vourvou
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Conduction Velocity ◽  
Soleus Muscle ◽  
Critically Ill Patients ◽  
Tibial Nerve ◽  
H Reflex ◽  
Apache Ii Score ◽  
M Wave ◽  
Stimulation Of

Introduction: Polyneuromyopathy constitutes a common complication in critically ill patients of the Intensive Care Unit (ICU) and in the last few years it appears to be identified as a syndrome detectable in the limbs and respiratory muscles. It is associated with the difficulties during weaning from mechanical ventilation. Aim: The present study investigates the reflective reaction of the soleus muscle following an electrical stimulation of the tibial nerve in intubated critically ill patients hospitalized in ICU with no medical history prior to their admission. Methods: Thirteen (13) patients who had been hospitalized for more than five (5) days and had a high APACHE II score (>15) and 13 age-matched control subjects were asked to participate in the present study on a volunteer basis. During the study, as reflective response parameters the range of the H-reflex and M-wave of the soleus muscle, as well as the conduction velocity of the tibial nerve, after electro-stimulation of the tibial nerve at the popliteal-fossa level, were assessed Results: Statistical analysis revealed significantly lower values in the ICU patients compared to healthy controls in both H-reflex range (p<0,049) and the M-wave range (p<0,041), as well as conduction velocity (p<0,001) of the tibial nerve. Conclusions: It is concluded that the reflective response of the soleus muscle as well as the tibial nerve’s conduction velocity are affected in critically ill patients hospitalized in ICU. The study of the above neurological parameters can provide further insights into the establishment and progress of polyneuromyopathy of critically ill patients in ICUs.

scholarly journals Fatigue-incduced modulation of human soleus Hoffmann reflex under conditions of homosynaptic postactivation depression due to pair tibial nerve stimulation

2017 ◽  
Vol 74 (2) ◽  
pp. 55-59
Author(s):  
O. Kolosova
Keyword(s):  
Soleus Muscle ◽  
Tibial Nerve ◽  
Voluntary Contraction ◽  
H Reflex ◽  
Afferent Nerves ◽  
Tibial Nerve Stimulation ◽  
Static Contraction ◽  
Conditioned Responses ◽  
Postactivation Depression ◽  
Stimulation Of

The purpose of our work was to investigate in detail the influence of pair stimulation of tibial nerve (n.tibialis) on human soleus H-reflex amplitude at rest and after long-lasting voluntary contraction of calf muscle (m.m. gastrocnemius-soleus), which caused the fatigue of soleus muscle. The method of H-reflex of soleus muscle was used. Test and conditioned responses (by pair stimulation of n. tibialis) were registered. Homosynaptic postactivation depression led to inhibition of H-reflex at rest. After fatiguing voluntary static contraction the amplitudes of test and conditioned soleus H-reflex were significantly reduced. Then both H-reflex amplitudes subsequently recovered. Soleus H-reflex inhibition might be due to the activation of the groups III and IV afferent nerves under the influence of mechanical and metabolic changes in the muscle.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Silvio A. Ñamendys-Silva ◽  
María O. González-Herrera ◽  
Julia Texcocano-Becerra ◽  
Angel Herrera-Gómez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gynecological Cancer ◽  
Apache Ii ◽  
Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

Effects of Different Blood Glucose Levels on Critically Ill Patients in an Intensive Care Unit

2015 ◽  
Vol 25 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Li Kang ◽  
Juan Han ◽  
Qun-Cao Yang ◽  
Hui-Lin Huang ◽  
Nan Hao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fasting Blood Glucose ◽  
Apache Ii Score ◽  
High Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

<b><i>Aims:</i></b> We explore the infection incidence and possible prognostic outcome relevance for patients with different blood glucose levels in an intensive care unit (ICU). <b><i>Methods:</i></b> A total of 98 cases were enrolled and divided into three groups based on average fasting blood glucose levels (group A: ≤6.1 mmol/l; group B: 6.1-10 mmol/l; group C: ≥10 mmol/l). <b><i>Results:</i></b> There were no statistical differences in the time to ICU admission, the indwelling durations of gastric tubes, urinary or deep vein catheters, tracheal intubations and tracheotomies, or the length of ventilator use (all p > 0.05). No evident difference in the multiple organ dysfunction syndrome rate was found between the three groups (p = 0.226). The infection and mortality rates between the groups showed significant differences (all p < 0.05). Furthermore, the difference of respiratory system infections was statistically significant among the three groups (p = 0.008), yet no such statistical difference was observed among groups regarding nonrespiratory system infections (p = 0.227). <b><i>Conclusions:</i></b> Critically ill patients with a high blood glucose level were positively correlated with a relatively high APACHE II score and more serious degree of disease, as well as a higher incidence of respiratory infection during their ICU stay than those with lower blood glucose levels (<10 mmol/l).

A Prospective Study of Continuous Venovenous Hemodiafiltration in Critically Ill Patients with Acute Renal Failure

1995 ◽  
Vol 10 (4) ◽  
pp. 187-192 ◽  
Author(s):  
Rinaldo Bellomo ◽  
Michael Farmer ◽  
Neil Boyce
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii Score ◽  
Continuous Venovenous Hemodiafiltration

We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution. Intervention included assessment of illness severity by APACHE II score on admission and by organ failure score prior to initiation of renal replacement therapy; treatment of patients with continuous venovenous hemodiafiltration; and measurement of biochemical variables prior to and after therapy. Outcome assessment included incidence of complications, duration of oliguria, duration of intensive care and hospital stays, and survival to hospital discharge. Measurements and main results included the following: mean patient age was 60.9 years (range 21–81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594–648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.

Increased H-Reflex Response Induced by Intramuscular Electrical Stimulation of Latent Myofascial Trigger Points

2009 ◽  
Vol 27 (4) ◽  
pp. 150-154 ◽  
Author(s):  
Hong-You Ge ◽  
Mariano Serrao ◽  
Ole K Andersen ◽  
Thomas Graven-Nielsen ◽  
Lars Arendt-Nielsen
Keyword(s):  
Electrical Stimulation ◽  
Conduction Velocity ◽  
Tibial Nerve ◽  
Trigger Points ◽  
H Reflex ◽  
Reflex Response ◽  
Muscle Spindle Afferents ◽  
Myofascial Trigger Points ◽  
Reflex Threshold ◽  
Stimulation Of

Background Myofascial trigger points (MTrPs) present with mechanical hyperalgesia and allodynia. No electrophysiological evidence exists as to the excitability of muscle spindle afferents at myofascial trigger points MTrPs. The purpose of this current study was to explore whether an H-reflex response could be elicited from intramuscular electrical stimulation. If so, to assess the possibility of increased reflex response at MTrPs. Methods The H-reflex latency and the conduction velocity were first determined from electrical stimulation of the tibial nerve in 13 healthy subjects. Then an intramuscular monopolar needle electrode was inserted randomly into a latent MTrP or a non-MTrP in the gastrocnemius muscle. Electrical stimuli at different intensities were delivered via the intramuscular recording electrode to the MTrP or non-MTrP. Results The average conduction velocity (44.3 ± 1.5 m/s) of the electrical stimulation of tibial nerve was similar (p>0.05) with the conduction velocity (43.9 ± 1.4 m/s) of intramuscular electrical stimulation. The intramuscular H-reflex at MTrPs was higher in amplitude than non-MTrPs (p<0.001). The reflex threshold was lower for MTrPs than non-MTrPs (p<0.001). Conclusion The current study provides first electrophysiological evidence that intramuscular electrical stimulation can evoke H-reflex, and that higher H-reflex amplitude and lower H-reflex threshold exist at MTrPs than non-MTrPs respectively, suggesting that muscle spindle afferents may be involved in the pathophysiology of MTrPs.

COST OF INTENSIVE CARE IN INDIA

2016 ◽  
Vol 32 (4) ◽  
pp. 241-245 ◽  
Author(s):  
John Victor Peter ◽  
Kurien Thomas ◽  
Lakshmanan Jeyaseelan ◽  
Bijesh Yadav ◽  
Thomas Isiah Sudarsan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Indirect Cost ◽  
Direct Medical Cost ◽  
Critically Ill ◽  
Medical Cost ◽  
Critically Ill Patients ◽  
Apache Ii Score ◽  
Next Of Kin ◽  
Tertiary Teaching ◽  
The Cost

Objectives: The majority of patients in India access private sector providers for curative medical services. However, there is scanty information on the cost of treatment of critically ill patients in this setting. The study evaluates the cost and extent of financial subsidy required for patients admitted to an intensive care unit (ICU) in India.Methods: Data on direct medical, direct nonmedical, and indirect cost were prospectively collected from critically ill patients admitted to a tertiary teaching hospital in India. Willingness-to-pay (WTP) amount was obtained from the next-of-kin following admission and the actual cost paid by the family at discharge was recorded.Results: The main diagnoses (n = 499) were infection (26 percent) and poisoning (21 percent). The mean APACHE-II score was 13.9 (95 percent confidence interval [CI], 13.3–14.5); 86 percent were ventilated. ICU stay was 7.8 days (95 percent CI, 7.3–8.3). Hospital mortality was 27.9 percent. Direct medical cost accounted for 77 percent (US$ 2164) of the total treatment cost (US$ 2818). Indirect cost and direct nonmedical cost contributed to 19 percent (US$ 547.5) and 4 percent (US$ 106.5), respectively. Average total and daily ICU cost were US$ 1,897 and US$ 255, respectively. Although the family's WTP was 53 percent (US$ 1146; 95 percent CI, 1090–1204) of direct medical cost, their final contribution was 67.7 percent (US$ 1465; 95 percent CI, 1327–1604).Conclusions: The cost of an ICU admission in our setting is US$ 2818. Although the family's contribution to expenses exceeded their initial WTP, a substantial subsidy (33 percent) is still required. Alternate financing strategies for the poor and optimization of ICU resources are urgently required.

scholarly journals Correlation of Thyroid Hormones in the Prognosis of Critically Ill Patients

2021 ◽  
Vol 73 (3) ◽  
pp. 161-166
Author(s):  
Sneha R. Chavanda ◽  
Rajendra R. Mane
Keyword(s):  
Intensive Care ◽  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Hormone Levels ◽  
Thyroid Hormone Levels ◽  
Thyroid Profile

Objective: Non-thyroidal illness syndrome (NTIS) is associated with outcomes in Intensive Care Unit(ICU) patients. The objectives of the study were to assess the prognostic value of complete thyroid profile in critically ill patients and to determine the effect of thyroid hormone level in predicting mortality when used along with acute physiology and chronic health evaluation (APACHE) II score.Methods: The observational study was conducted at a tertiary care centre in Kolhapur, India. Critically ill adult patients admitted to intensive care units with APACHE II >10 was included(n=50). Relevant clinical investigations along with thyroid profile evaluation was carried out and APACHE II was calculated.  Baseline characteristics of patients were compared.  Performance of variables in predicting mortality was analysed. Correlation of APACHE II score with thyroid was also assessed in R software v-3.6.1.Results: The survival rate at ICU discharge was 54%. Mean T3, FT3, and T4 levels were significantly low in non-survivors(p=0.006758, p=0.0245 and p=0.00070 respectively).  Mean APACHE II score was significantly high in non- survivor(p=2.94E-06). APACHE II score was significantly associated with the severity of disease (p=0.0235). APACHE II scores and FT3 were better predictors of mortality compared to other thyroid hormones (AUC =0.8519±0.0535). FT3 showed high correlation with APACHE II score(r=-0.4083; p=0.0032). Inclusion of thyroid hormone levels with APACHE II scores improved the prediction of mortality in critically ill patients by 5.63%.Conclusion: Among thyroid hormones, FT3 is a better predictor of mortality. Use of thyroid hormone levels in conjunction with APACHE II scores improves the prognostication.

scholarly journals Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy

2012 ◽  
Vol 130 (2) ◽  
pp. 77-83 ◽  
Author(s):  
João Manoel da Silva Junior ◽  
Ederlon Rezende ◽  
Cristina Prada Amendola ◽  
Rafael Tomita ◽  
Daniele Torres ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii Score ◽  
Transfusion Strategy ◽  
Acute Hemorrhage ◽  
Restrictive Transfusion ◽  
Coronary Syndrome ◽  
Icu Stay ◽  
Restrictive Transfusion Strategy

CONTEXT AND OBJECTIVE: Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. DESIGN AND SETTING: Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. METHODS: All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. RESULTS: The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. CONCLUSIONS: In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.

scholarly journals Reproducibility of Protected Brush Catheter Specimen Cultures in Critically Ill Patients with Suspected Nosocomial Pneumonia

1995 ◽  
Vol 2 (3) ◽  
pp. 173-178 ◽  
Author(s):  
George A Fox ◽  
David J Leasa ◽  
William J Sibbald ◽  
David G McCormack
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Excellent Agreement ◽  
Nosocomial Pneumonia ◽  
Critically Ill Patients ◽  
Significant Relationship ◽  
Kappa Statistic ◽  
Central Nervous System Disease ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia

OBJECTIVE: To determine the reproducibility of two protected brush catheter (PBC) specimens obtained during the same bronchoscopy in critically ill patients with suspected ventilator associated pneumonia.DESIGN: Prospective, observational study.SETTING: Two university-affiliated multidisciplinary intensive care un its with a combined total of 50 beds.PATIENTS: A total of 75 (50 male. 25 female) patients with 84 episodes of suspected ventilator associated pneumonia were studied be tween January 1, 1991 and June 30, 1992. Age was 60.7±1.9 (mean ± SEM) years, and mean APACHE II score was 22.4±2.0. Twenty-four patients were admitted from various medical services, 19 from surgical services including the operating room, 16 with central nervous system disease and 16 following multiple trauma. Twenty patients were transferred directly to the intensive care unit from peripheral hospitals.INTERVENTIONS: All patients had lower respiratory tract secretions obtained for culture by both aspiration through the endotracheal n1be (tracheal aspirates) and flexible bronchoscopy, with separate samples obtained by two PBCs (PBC-A and PBC-8).MAIN RESULTS: The overall proportion of agreement between the results of t he two PBC specimens was 0.928, with a calculated kappa statistic (κ) = 0.853 (P<0.01 versus κ=0.4, 95% CL 0.692, 1.014) indicating excellent agreement between the two specimens. Both PBC specimens had significant (ie, more than 103colony-forming units/mL) growth (positive/positive) in 33 cases, nonsignificant growth in 45 cases (negative/negative) and discordant results in six (positive/negative, n=3 or negative/positive, n=3 ). There was a significant relationship (P<0.05) between the concurrent use of antibiotics and a negative PBC result. However, after exclusion of patients on antibiotics, the overall proportion of agreement between the two PBCs was 0.94 with κ=0.875 (P<0.01 versus κ=0.4, 95% CL 0.721, 1.029), which also indicates excellent agreement between the two tests.CONCLUSIONS: Although discordant results were observed in 7.2% cases, the overall reproducibility of the PBC results appears to be high. The significant relationship between concurrent antibiotic use and a negative PBC result is of concern clinically since many patients arc being treated with antibiotics al the time of bronchoscopy. Therefore, when the diagnosis of nosocomial pneumonia in critically ill patients is established, the PBC result should be considered only in association with all the other clinical data, particularly in patients receiving concurrent antibiotics.

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