scholarly journals Reduction of Intra-abdominal Hypertension Is Associated with Increase of Cardiac Output in Critically Ill Patients Undergoing Mechanical Ventilation

2018 ◽  
Vol 3 (2) ◽  
pp. 90-97
Author(s):  
Claudiu Puiac ◽  
Theodora Benedek ◽  
Lucian Puscasiu ◽  
Nora Rat ◽  
Emoke Almasy ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Abdominal Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Abdominal Hypertension ◽  
Group 2 ◽  
Ventilated Patients ◽  
Group 1

Abstract Objective: To demonstrate the relationship between intra-abdominal hypertension (IAH) and cardiac output (CO) in mechanically ventilated (MV), critically ill patients. Material and methods: This was a single-center, prospective study performed between January and April 2016, on 30 mechanically ventilated patients (mean age 67.3 ± 11.9 years), admitted in the Intensive Care Unit (ICU) of the Emergency County Hospital of Tîrgu Mureș, Romania, who underwent measurements of intra-abdominal pressure (IAP). Patients were divided into two groups: group 1 – IAP <12 mmHg (n = 21) and group 2 – IAP >12 mmHg (n = 9). In 23 patients who survived at least 3 days post inclusion, the variation of CO and IAP between baseline and day 3 was calculated, in order to assess the variation of IAP in relation to the hemodynamic status. Results: IAP was 8.52 ± 1.59 mmHg in group 1 and 19.88 ± 8.05 mmHg in group 2 (p <0.0001). CO was significantly higher in group 1 than in the group with IAH: 6.96 ± 2.07 mmHg (95% CI 6.01–7.9) vs. 4.57 ± 1.23 mmHg (95% CI 3.62–5.52) (p = 0.003). Linear regression demonstrated an inverse correlation between CO and IAP (r = 0.48, p = 0.007). Serial measurements of CO and IAP proved that whenever accomplished, the decrease of IAP was associated with a significant increase in CO (p = 0.02). Conclusions: CO is significantly correlated with IAP in mechanically ventilated patients, and IAH reduction is associated with increase of CO in these critically ill cases.

scholarly journals Selection strategy for sedation depth in critically ill patients on mechanical ventilation

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Longxiang Su ◽  
Chun Liu ◽  
Fengxiang Chang ◽  
Bo Tang ◽  
Lin Han ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dimensionality Reduction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Sedation And Analgesia ◽  
Ventilated Patients

Abstract Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

scholarly journals Effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients: A randomized clinical trial

2018 ◽  
Vol 5 (7) ◽  
pp. 2528-2537
Author(s):  
Akram Kooshki ◽  
Zaher Khazaei ◽  
Azam Zarghi ◽  
Mojtaba Rad ◽  
Hadi Gholam Mohammadi ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Routine Care ◽  
Fenugreek Seeds ◽  
Mechanically Ventilated ◽  
Fenugreek Seed ◽  
Group 2 ◽  
Group 1

Background: Enteral nutrition (EN) intolerance is a common complication in critically ill patients that contributes to morbidity and mortality. Based on the evidence of curing effects of fenugreek seeds in some gastrointestinal disorders, this study aimed to determine the effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients. Materials & Methods: A randomized, double-blinded clinical trial of 5-day duration was conducted on 60 mechanically ventilated patients divided in 2 groups (n=30). Group 1 was given fenugreek seed powder by gavage, twice a day in addition to routine care, while Group 2 received only routine care. Enteral nutrition tolerance and clinical outcomes were measured throughout the study. Demographic and clinical data were recorded and clinical responses to the primary outcome (enteral nutrition tolerance) and secondary outcome (other clinical factors) were interpreted. Data were analyzed using the independent t-test, Chi-squared test, covariance analysis, and repeated measure ANOVA via SPSS statistical software (v. 20); statistical significance was set at p< 0.05. Results: Patients who were fed with the fenugreek seed powder showed a significant improvement in enteral nutrition tolerance, as well as some complications of mechanical ventilation for Group 1, as compared with Group 2. The mortality rates were not different between the two groups. Conclusion: This study shows the beneficial effects of fenugreek seeds on food intolerance in critically ill patients and that the seed powder can be used as an add-on therapy with other medications. Thus, the use of fenugreek seeds to treat mechanically ventilated patients is recommended.

scholarly journals Serial measurements in COVID-19-induced acute respiratory disease to unravel heterogeneity of the disease course: design of the Maastricht Intensive Care COVID cohort; MaastrICCht

2020 ◽  
Author(s):  
◽  
Jeanette Tas ◽  
Rob J.J. van Gassel ◽  
Serge J.H. Heines ◽  
Mark M.G. Mulder ◽  
...  
Keyword(s):  
Intensive Care ◽  
Data Collection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Natural Course ◽  
Disease Course ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Serial Measurements ◽  
Ventilated Patients

ABSTRACTBackgroundThe course of the disease in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort; MaastrICCht. We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with SARS-CoV-2 infection.Study populationMechanically ventilated patients admitted to the Intensive Care with SARS- CoV-2 infection.Main messageWe will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, electrocardiograms, echocardiography as well as other imaging modalities to assess heterogeneity of the natural course of SARS-CoV-2 infection in critically ill patients. The MaastrICCht cohort is, also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national Intensive Care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence.ConclusionThe spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS- CoV-2 infection in mechanically ventilated patients. Our design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht cohort.Strengths and limitations of this studySerial measurements that characterize the disease course of SARS-CoV-2 infection in mechanically ventilated patientsData collection and analysis according to a predefined protocolFlexible, evolving design enabling the study of multiple aspects of SARS-CoV-2 infection in mechanically ventilated patientsSingle centre, including only ICU patients

scholarly journals Nurses' Use of Non?pharmacological Interventions in Managing Common Risk Factors of Delirium in Critically Ill Patients

2021 ◽  
Vol 7 (3) ◽  
pp. 01-04
Author(s):  
Nahla Khalil
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Burn Patients ◽  
Pharmacological Interventions ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Common Risk Factors ◽  
Ventilated Patients

Incidence of delirium represented 32.3% since long in ICU settings, it might be higher. Other research showed the prevalence of delirium as high as 77% in ventilated burn patients. Incidence of delirium represented 32.3% since long in ICU settings, it might be higher. Other research showed the prevalence of delirium as high as 77% in ventilated burn patients. The incidence of delirium in the ICU ranged from 45% to 87%, this ratio appeared be different to the studied population exclusively to mechanically ventilated patients.

scholarly journals Intra-Abdominal Hypertension and Gastrointestinal Symptoms in Mechanically Ventilated Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Annika Reintam Blaser ◽  
Pille Parm ◽  
Reet Kitus ◽  
Joel Starkopf
Keyword(s):  
Small Group ◽  
Gastrointestinal Symptoms ◽  
Abdominal Pressure ◽  
Icu Mortality ◽  
Lethal Outcome ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Abdominal Hypertension ◽  
Gi Symptoms ◽  
Ventilated Patients

Background. We aimed to describe the incidence of intra-abdominal hypertension (IAH) and gastrointestinal (GI) symptoms and related outcome in mechanically ventilated (MV) patients.Methods. Intra-abdominal pressure (IAP) and gastric residual volumes were measured at least twice daily. IAH was defined as a mean daily value ofIAP≥12 mmHg.Results. 398 patients were monitored for all together 2987 days. GI symptom(s) occurred in80.2%patients. 152 (38.2%) patients developed IAH. Majority (93.4%) of patients with IAH had GI symptoms. The more severe IAH was associated with the higher number of concomitant GI symptoms (P<.001). 142 (35.7%) patients developed both IAH and at least one GI symptom at any time in ICU, and in 77 patients they occurred simultaneously on the same day. This subgroup had the highest ICU mortality (21.8%). In contrast, the small group of patients presenting only IAH, but not GI symptoms (10 patients), had no lethal outcome. Three patients (4.4%) died without showing either IAH or GI symptoms.Conclusions. GI symptoms and IAH often, but not always, occur together. The patients having IAH solely without developing GI symptoms have rather good outcome.

scholarly journals An examination of sedation requirements and practices for mechanically ventilated critically ill patients with COVID-19

2021 ◽  
Author(s):  
Aditi Balakrishna ◽  
Elisa C Walsh ◽  
Arzo Hamidi ◽  
Sheri Berg ◽  
Daniel Austin ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Massachusetts General Hospital ◽  
Academic Medical Center ◽  
Clinical Impression ◽  
Study Cohort ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Abstract Purpose Preliminary reports suggest that critically ill patients with coronavirus disease 2019 (COVID-19) infection requiring mechanical ventilation may have markedly increased sedation needs compared with non–mechanically ventilated patients. We conducted a study to examine sedative use for this patient population within multiple intensive care units (ICUs) of a large academic medical center. Methods A retrospective, single-center cohort study of sedation practices for critically ill patients with COVID-19 during the first 10 days of mechanical ventilation was conducted in 8 ICUs at Massachusetts General Hospital, Boston, MA. The study population was a sequential cohort of 86 critically ill, mechanically ventilated patients with COVID-19. Data characterizing the sedative medications, doses, drug combinations, and duration of administration were collected daily and compared to published recommendations for sedation of critically ill patients without COVID-19. The associations between drug doses, number of drugs administered, baseline patient characteristics, and inflammatory markers were investigated. Results Among the study cohort, propofol and hydromorphone were the most common initial drug combination, with these medications being used on a given day in up to 100% and 88% of patients, respectively. The doses of sedative and analgesic infusions increased for patients over the first 10 days, reaching or exceeding the upper limits of published dosage guidelines for propofol (48% of patients), dexmedetomidine (29%), midazolam (7.7%), ketamine (32%), and hydromorphone (38%). The number of sedative and analgesic agents simultaneously administered increased over time for each patient, with more than 50% of patients requiring 3 or more agents by day 2. Compared with patients requiring 3 or fewer agents, as a group patients requiring more than 3 agents were of younger age, had an increased body mass index, increased serum ferritin and lactate dehydrogenase concentrations, had a lower PaO2:FIO2 (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen), and were more likely to receive neuromuscular blockade. Conclusion Our study confirmed the clinical impression of elevated sedative use in critically ill, mechanically ventilated patients with COVID-19 relative to guideline-recommended sedation practices in other critically ill populations.

scholarly journals Transcranial color-coded duplex sonography assessment of cerebrovascular reactivity to carbon dioxide: an interventional study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie Klinzing ◽  
Federica Stretti ◽  
Alberto Pagnamenta ◽  
Markus Bèchir ◽  
Giovanna Brandi
Keyword(s):  
Acute Phase ◽  
Duplex Sonography ◽  
Cerebrovascular Reactivity ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Group 3 ◽  
Group 2 ◽  
Color Coded Duplex Sonography ◽  
Ventilated Patients ◽  
Group 1

Abstract Background The investigation of CO2 reactivity (CO2-CVR) is used in the setting of, e.g., traumatic brain injury (TBI). Transcranial color-coded duplex sonography (TCCD) is a promising bedside tool for monitoring cerebral hemodynamics. This study used TCCD to investigate CO2-CVR in volunteers, in sedated and mechanically ventilated patients without TBI and in sedated and mechanically ventilated patients in the acute phase after TBI. Methods This interventional investigation was performed between March 2013 and February 2016 at the surgical ICU of the University Hospital of Zurich. Ten volunteers (group 1), ten sedated and mechanically ventilated patients (group 2), and ten patients in the acute phase (12–36 h) after severe TBI (group 3) were included. CO2-CVR to moderate hyperventilation (∆ CO2 -5.5 mmHg) was assessed by TCCD. Results CO2-CVR was 2.14 (1.20–2.70) %/mmHg in group 1, 2.03 (0.15–3.98) %/mmHg in group 2, and 3.32 (1.18–4.48)%/mmHg in group 3, without significant differences among groups. Conclusion Our data did not yield evidence for altered CO2-CVR in the early phase after TBI examined by TCCD. Trial registration Part of this trial was performed as preparation for the interventional trial in TBI patients (clinicaltrials.gov NCT03822026, 30.01.2019, retrospectively registered).

The Relationship Between Sedatives, Sedative Strategy, and Healthcare-Associated Infection: A Systematic Review

2016 ◽  
Vol 37 (10) ◽  
pp. 1234-1242 ◽  
Author(s):  
Daniel A. Caroff ◽  
Paul M. Szumita ◽  
Michael Klompas
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Infection Risk ◽  
Healthcare Associated Infection ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Observational Series ◽  
Healthcare Associated ◽  
Ventilated Patients

BACKGROUNDHealthcare-associated infections (HAIs) cause significant morbidity in critically ill patients. An underappreciated but potentially modifiable risk factor for infection is sedation strategy. Recent trials suggest that choice of sedative agent, depth of sedation, and sedative management can influence HAI risk in mechanically ventilated patients.OBJECTIVETo better characterize the relationships between sedation strategies and infection.METHODSSystematic literature review.RESULTSWe found 500 articles and accepted 70 for review. The 3 most common sedatives for mechanically ventilated patients (benzodiazepines, propofol, and dexmedetomidine) have different pharmacologic and immunomodulatory effects that may impact infection risk. Clinical data are limited but retrospective observational series have found associations between sedative use and pneumonia whereas prospective studies of sedative interruptions have reported possible decreases in bloodstream infections, pneumonia, and ventilator-associated events.CONCLUSIONInfection rates appear to be highest with benzodiazepines, intermediate with propofol, and lowest with dexmedetomidine. More data are needed but studies thus far suggest that a better understanding of sedation practices and infection risk may help hospital epidemiologists and critical care practitioners find new ways to mitigate infection risk in critically ill patients.Infect Control Hosp Epidemiol 2016;1–9

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