scholarly journals Global Muscle Strength But Not Grip Strength Predicts Mortality and Length of Stay in a General Population in a Surgical Intensive Care Unit

2012 ◽  
Vol 92 (12) ◽  
pp. 1546-1555 ◽  
Author(s):  
Jeanette J. Lee ◽  
Karen Waak ◽  
Martina Grosse-Sundrup ◽  
Feifei Xue ◽  
Jarone Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Manual Muscle Testing ◽  
Surgical Intensive Care Unit ◽  
Muscle Testing

Background Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design This investigation was a prospective, observational study. Methods One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles=3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.

scholarly journals The Impact of Hyperoxia on Outcome of Patients Treated with Noninvasive Respiratory Support

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Seyhan Pala Cifci ◽  
Yasemin Urcan Tapan ◽  
Bengu Turemis Erkul ◽  
Yusuf Savran ◽  
Bilgin Comert
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
High Flow Oxygen ◽  
The Impact

Objective. Oxygen therapy is one of the most common treatment modalities for hypoxemic patients, but target goals for normoxemia are not clearly defined. Therefore, iatrogenic hyperoxia is a very common situation. The results from the recent clinical researches about hyperoxia indicate that hyperoxia can be related to worse outcomes than expected in some critically ill patients. According to our literature knowledge, there are not any reports researching the effect of hyperoxia on clinical course of patients who are not treated with invasive mechanical ventilation. In this study, we aimed to determine the effect of hyperoxia on mortality, and length of stay and also possible side effects of hyperoxia on the patients who are treated with oxygen by noninvasive devices. Materials and Methods. One hundred and eighty-seven patients who met inclusion criteria, treated in Dokuz Eylul University Medical Intensive Care Unit between January 1, 2016, and October 31, 2018, were examined retrospectively. These patients’ demographic data, oxygen saturation (SpO2) values for the first 24 hours, APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, whether they needed intubation, if they did how many days they got ventilated, length of stay in intensive care unit and hospital, maximum PaO2 values of the first day, oxygen treatment method of the first 24 hours, and the rates of mortality were recorded. Results. Hyperoxemia was determined in 62 of 187 patients who were not treated with invasive mechanic ventilation in the first 24 hours of admission. Upon further investigation of the relation between comorbid situations and hyperoxia, hyperoxia frequency in patients with COPD was detected to be statistically low (16% vs. 35%, p<0.008). Hospital mortality was significantly high (51.6% vs. 35.2%, p<0.04) in patients with hyperoxia. When the types of oxygen support therapies were investigated, hyperoxia frequency was found higher in patients treated with supplemental oxygen (nasal cannula, oronasal mask, high flow oxygen therapy) than patients treated with NIMV (44.2% vs. 25.5%, p<0.008). After exclusion of 56 patients who were intubated and treated with invasive mechanical ventilation after the first 24 hours, hyperoxemia was determined in 46 of 131 patients. Mortality in patients with hyperoxemia who were not treated with invasive mechanical ventilation during hospital stay was statistically higher when compared to normoxemic patients (41.3% vs 15.3%, p<0.001). Conclusion. We report that hyperoxemia increases the hospital mortality in patients treated with noninvasive respiratory support. At the same time, we determined that hyperoxemia frequency was lower in COPD patients and the ones treated with NIMV. Conservative oxygen therapy strategy can be suggested to decrease the hyperoxia prevalence and mortality rates.

scholarly journals Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study

2021 ◽  
Vol 9 ◽  
pp. 205031212110308
Author(s):  
Santiago Cegarra Garcia ◽  
Michael Toolis ◽  
Max Ubels ◽  
Taha Mollah ◽  
Eldho Paul ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Intensive Care Unit Mortality ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Index Of Severity

Objectives: To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. Methods: Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. Results: A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p  < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. Conclusion: Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.

scholarly journals Volume based feeding versus rate based feeding in the critically ill: A UK study

2019 ◽  
Vol 20 (4) ◽  
pp. 299-308
Author(s):  
Mina Bharal ◽  
Sally Morgan ◽  
Tariq Husain ◽  
Katerina Hilari ◽  
Charlie Morawiec ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Glycaemic Control ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Protein Delivery ◽  
Surgical Intensive Care Unit ◽  
Gastrointestinal Tolerance ◽  
Intensive Care Patients

Background Underfeeding in intensive care patients on enteral nutrition is commonplace and multifactorial. This can be exacerbated by interruptions caused by routine fasting for procedures and investigations. Our study aims to demonstrate that a volume based feeding protocol can overcome the barriers of underfeeding and safely increase energy and protein delivery in UK intensive care patients, potentially improving clinical outcomes. Methods In this single centre cohort study, data were collected from adult mechanically ventilated patients. We compared the standard care of rate based feeding, from an International Nutrition Survey (2014/15) to the new intervention of volume based feeding, in a mixed medical and surgical intensive care unit. The primary outcomes were the proportion of energy and protein daily targets delivered. Secondary outcomes compared the effects on gastrointestinal tolerance, glycaemic control, mortality, mechanical ventilation days, length of stay in intensive care unit and hospital. Results From a total of 82 patients (rate based feeding = 27, volume based feeding = 55), volume based feeding patients received significantly more prescribed energy (52% versus 81%; p < 0.001) and protein (40% versus 74%; p < 0.001). There was no significant difference in gastrointestinal symptoms such as gastric residual volumes (p = 0.62), glycaemic control (p = 0.94) or insulin usage (p = 0.75). Although there was an improvement in energy and protein delivery, there were no differences in mechanical ventilation days (p = 0.12), mortality (p = 0.06), length of stay in intensive care unit (p = 0.93) and hospital (p = 0.72) between the groups. Conclusion Compared to rate based feeding, volume based feeding significantly improved energy and protein provision with no adverse effects on glycaemic control or gastrointestinal tolerance, clinical outcomes were not affected.

scholarly journals Analgosedation: The use of Fentanyl Compared to Hydromorphone

2021 ◽  
Vol 7 (3) ◽  
pp. 192-198
Author(s):  
Hahnl Choi ◽  
Sara Radparvar ◽  
Samuel L. Aitken ◽  
Jerry Altshuler
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Continuous Infusion ◽  
Surgical Intensive Care Unit ◽  
Icu Length Of Stay ◽  
Primary Endpoints ◽  
Fentanyl Group

Abstract Background: The 2018 Society of Critical Care Medicine guidelines on the “Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU” advocate for protocol-based analgosedation practices. There are limited data available to guide which analgesic to use. This study compares outcomes in patients who received continuous infusions of fentanyl or hydromorphone as sedative agents in the intensive care setting. Methods: This retrospective cohort study evaluated patients admitted into the medical intensive care unit, the surgical intensive care unit, and the cardiac intensive care unit from April 1, 2017, to August 1, 2018, who were placed on continuous analgesics. Patients were divided according to receipt of fentanyl or hydromorphone as a continuous infusion as a sedative agent. The primary endpoints were ICU length of stay and time on mechanical ventilation. Results: A total of 177 patients were included in the study; 103 received fentanyl as a continuous infusion, and 74 received hydromorphone as a continuous infusion. Baseline characteristics were similar between groups. Patients in the hydromorphone group had deeper sedation targets. Median ICU length of stay was eight days in the fentanyl group compared to seven days in the hydromorphone group (p = 0.11) and median time on mechanical ventilation was 146.47 hours in the fentanyl group and 122.33 hours in the hydromorphone group (p = 0.31). There were no statistically significant differences in the primary endpoints of ICU length of stay and time on mechanical ventilation between fentanyl and hydromorphone for analgosedation purposes. Conclusion: No statistically significant differences were found in the primary endpoints studied. Patients in the hydromorphone group required more tracheostomies, restraints, and were more likely to have a higher proportion of Critical Care Pain Observation Tool (CPOT) scores > 2.

The surgical intensive care unit optimal mobility score predicts mortality and length of stay*

2012 ◽  
Vol 40 (4) ◽  
pp. 1122-1128 ◽  
Author(s):  
George Kasotakis ◽  
Ulrich Schmidt ◽  
Dana Perry ◽  
Martina Grosse-Sundrup ◽  
John Benjamin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mobility Score

scholarly journals Timing of Admission to the Surgical Intensive Care Unit is Associated with in-Hospital Mortality

2021 ◽  
Author(s):  
Mi Kyoung Kim ◽  
Eun-Joo Jung ◽  
Seulkee Park ◽  
Im-kyung Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Outcome Measurement ◽  
Work Hours ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
After Hours ◽  
The Times ◽  
Unplanned Admissions

Abstract Background: Knowledge about the relationship between timing of admission to the intensive care unit (ICU) and mortality among surgical patients admitted for acute care is limited.Objective: We aimed to investigate whether admission to the surgical intensive care unit (SICU) during after-hours (all the times when intensivists were not staffed in the ICU) was associated with in-hospital mortality.Methods: This retrospective cohort study was conducted at a tertiary academic hospital, in which we analyzed data of 571 patients admitted to the SICU whose complete medical records were available. The work-hours were defined as 07:00-19:00 from Monday to Friday during which intensivists were staffed in the ICU. The after-hours were defined as all other times during which intensivists were not staffed in the SICU. The primary outcome measurement was in-hospital mortality according to the time of SICU admission.Results: In all, 333 and 238 patients were admitted to the SICU during work-hours and after-hours, respectively. Unplanned admissions (33.3% vs. 47.1%, p<0.001), Acute Physiology and Chronic Health Evaluation II score ≥25 (11.1% vs. 23.9%, p<0.001), ventilator support (17.4% vs. 34.0%, p<0.001), and use of inotropics (33.3% vs. 50.0%, p<0.001) were significantly higher in the after-hours group than in the work-hours group. In the multivariate analyses of the association between the time of SICU admission and in-hospital mortality, the timing of SICU admission was an independent factor for in-hospital mortality (OR=2.526; 95% CI=1.010-6.320, p=0.048). Conclusions: In this study, we found that admission to the SICU during after-hours was associated with increased in-hospital mortality.

Profile of muscle weakness in a medical-surgical intensive care unit

2017 ◽  
Vol 42 ◽  
pp. 406
Author(s):  
José Aires de Araújo Neto ◽  
Roberta Fernandes Bomfim ◽  
Fernando Beserra Lima ◽  
Aline Carvalho Gouveia ◽  
Alda Silva Lopes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Muscle Weakness ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

scholarly journals Intensive Care Unit Outcomes Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results–Medicare Registry

2012 ◽  
Vol 30 (14) ◽  
pp. 1686-1691 ◽  
Author(s):  
Christopher G. Slatore ◽  
Laura M. Cecere ◽  
Jennifer L. LeTourneau ◽  
Maya E. O'Neil ◽  
Jonathan P. Duckart ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Surgical Resection ◽  
Cox Regression ◽  
Patient Characteristics ◽  
Patient Centered ◽  
End Results

Purpose Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality. Results Of the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P < .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively. Conclusion Most patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.

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