Assessment of clinicopathological parameters and outcome of critically ill patients admitted with infectious endemic diseases in a rural tertiary setup of India - An observational study

Background: To study the clinico-pathological profile and outcome of critically ill patients with infectious endemic diseases requiring intensive care management Methods: A prospective, non randomized, cross sectional, observational study of 50 critically ill patients (more than 18 years of age) admitted in the ICU setup in a rural tertiary hospital over 2 years, suffering from an endemic tropical disease, was conducted. Parameters to study the outcome of the study were indication for ICU management, evidence of multiple system involvement, common precipitating factor and associated morbidity and mortality. Findings: Our study regarding endemic infectious diseases of Western Maharashtra included 15 females (30%) and 35 males (70%). The mean age in our study was 40.52 ± 15.08 years with minimum of 19 years and maximum of 63 years. Fever (n=50) followed by jaundice (n=19) and renal failure were the most common presenting features. A qSOFA Score of 2 and 3 were common on presentation (n=23). Mean SOFA score at presentation for patients admitted in the ICU for management of endemic infectious diseases was 13.6 ± 5.3. Most common co morbidity seen was diabetes (n=10) followed by thyroid disorders (n=5) and chronic Liver Disease (n=3). Mortality in our study was 12 patients (24%). Results: It has been seen that higher SOFA scores at 24 hours of presentation led to longer duration of hospital stay. Most common organ failure was renal failure in 29 patients (28%) followed by hepatic failure in 17 patients (34%) during the course of ICU stay. Conclusion: qSOFA scores of 2 or above at the time of hospitalisation was an important predictor of mortality. Understanding the features and complications of endemic infectious diseases help to identify patients at high risk and treat them with optimal intensive care.

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Risk factors for death among critically ill patients with acute renal failure

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000500004 ◽

2006 ◽

Vol 124 (5) ◽

pp. 257-263 ◽

Cited By ~ 15

Author(s):

Geraldo Bezerra da Silva Júnior ◽

Elizabeth De Francesco Daher ◽

Rosa Maria Salani Mota ◽

Francisco Albano Menezes

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Mechanical Ventilation ◽

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Liver Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Urine Volume

CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/107602960100700409 ◽

2001 ◽

Vol 7 (4) ◽

pp. 300-304 ◽

Cited By ~ 25

Author(s):

Edelgard Lindhoff-Last ◽

Christoph Betz ◽

Rupen Bauersachs

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Infusion Rate ◽

Efficient Treatment ◽

Intensive Care Patients

The purpose of this study was to evaluate the efficacy and safety of danaparoid in the treatment of critically ill patients with acute renal failure and suspected heparin-induced thrombocytopenia (HIT) needing renal replacement therapy (RRT). We conducted a retrospective analysis of 13 consecutive intensive care patients with acute renal failure and suspected HIT who were treated with danaparoid for at least 3 days during RRT. In eight patients, continuous venovenous hemofiltration was performed. The mean infusion rate of danaparoid was 140 ± 86 U/hour. Filter exchange was necessary every 37.5 hours. In five patients, continuous venovenous hemodialysis was used. A bolus injection of 750 U danaparoid was followed by a mean infusion rate of 138 ± 122 U/hour. Filters were exchanged every 24 hours. In 7 of 13 patients, even a low mean infusion rate of 88 ± 35 U/hour was efficient. Mean anti-Xa (aXa) levels were approximately 0.4 ± 0.2 aXa U/mL. Persistent thrombocytopenia despite discontinuation of heparin treatment was observed in 9 of 13 patients, owing to disseminated intravascular coagulation (DIC). HIT was confirmed by an increase in platelet count and positive heparin-induced antibodies in 2 of 13 patients. No thromboembolic complications occurred, but major bleeding was observed in 6 of 13 patients, which could be explained by consumption of coagulation factors and platelets due to DIC in 5 of 6 patients. Nine of 13 patients died of multiorgan failure or sepsis, or both. In none of these patients was the fatal outcome related to danaparoid treatment. In critically ill patients with renal impairment and suspected HIT, a bralus injection of 750 U danaparoid followed by a mean infusion rate of 50 to 150 U/hour appears to be a safe and efficient treatment option when alternative anticoagutation is necessary.

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Nutritional status plays a crucial role in the mortality of critically ill patients with acute renal failure

Journal of Investigative Medicine ◽

10.1136/jim-2017-000518 ◽

2017 ◽

Vol 66 (2) ◽

pp. 309-318 ◽

Cited By ~ 2

Author(s):

Haiyan Zhang ◽

Xiaodong Zhang ◽

Lei Dong

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Nutritional Status ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Statistical Significance ◽

Nutrition Intervention ◽

Icu Discharge

We aimed to clarify associations between nutritional status and mortality in patients with acute renal failure. De-identified data were obtained from the Medical Information Mart for Intensive Care III database comprising more than 40,000 critical care patients treated at Beth Israel Deaconess Medical Centerbetween 2001 and 2012. Weight loss and body mass index criteria were used to define malnutrition. Data of 193 critically ill patients with acute renal failure were analyzed, including demographics, nutrition intervention, laboratory results, and disease severity. Main outcomes were in-hospital and 1-year mortality. The 1-year mortality was significantly higher in those with malnutrition than in those without malnutrition (50.0% vs 29.3%, p=0.010), but differences in in-hospital survival were not significant (p=0.255). Significant differences in mortality were found between those with malnutrition and without starting at the 52nd day after intensive care unit (ICU) discharge (p=0.036). No significant differences were found between men and women with malnutrition in in-hospital mortality (p=0.949) and 1-year mortality (p=0.051). Male patients requiring intervention with blood products/colloid supplements had greater risk of 1-year mortality, but without statistical significance. Nutritional status is a predictive factor for mortality among critically ill patients with acute renal failure, particularly 1-year mortality after ICU discharge.

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Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

10.21203/rs.3.rs-17042/v1 ◽

2020 ◽

Author(s):

Viveka Björck ◽

Lisa I Påhlman ◽

Mikael Bodelsson ◽

Ann_Cathrine Petersson ◽

Thomas Kander

Keyword(s):

Septic Shock ◽

Renal Failure ◽

Severe Sepsis ◽

Intensive Care ◽

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Saps 3 ◽

Group A ◽

Lower Mortality Risk

Abstract Background Group A streptococci (GAS) are known to cause serious invasive infections but little is known about outcomes when patients with these infections are admitted to intensive care. We wanted to describe critically ill patients with severe sepsis or septic shock due to invasive GAS (iGAS) and compare them with other patients with severe sepsis or septic shock. Methods Adult patients admitted to a general intensive care unit (ICU) in Sweden (2007-2019) were screened for severe sepsis or septic shock according to Sepsis 2 definition. Individuals with iGAS infection were identified. The outcome variables were mortality, days alive and free of vasopressors and invasive mechanical ventilation, maximum acute kidney injury score for creatinine, use of continuous renal replacement therapy and maximum sequential organ failure assessment score during the ICU stay. Age, simplified acute physiology score (SAPS 3) and iGAS were used as independent, explanatory variables in regression analysis. Cox regression was used for survival analyses. Results iGAS was identified in 53 of 1021 (5.2%) patients. Patients with iGAS presented lower median SAPS 3 score (62 [56–72]) vs 71 [61–81]), p < 0.001), had a higher frequency of cardiovascular cause of admission to the ICU (38 [72%] vs 145 [15%], p < 0.001) and had a higher median creatinine score (173 [100–311] vs 133 [86–208] µmol/L, p < 0.019). Of the GAS isolates, 50% were serotyped emm 1/T1 and this group showed signs of more pronounced circulatory and renal failure than patients with non- emm 1/T1, ( p = 0.036 and p = 0.007, respectively). After correction for severity of illness (SAPS 3) and age, iGAS infection was associated with lower mortality risk; 95% confidence interval (CI) of hazard ratio (HR) 0.204–0.746, p < 0.001. Morbidity analyses demonstrated that iGAS patients were more likely to develop renal failure. Conclusion Critically ill patients with iGAS infection had a lower mortality risk but a higher degree of renal failure compared to similarly ill sepsis patients. emm 1/T1 was found to be the most dominant serotype and patients with emm1 /T1 demonstrated more circulatory and renal failure than patients with other serotypes of iGAS.

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Pengkajian Nyeri pada Pasien Kritis dengan Menggunakan Critical Pain Observation Tool(CPOT) di Intensive Care Unit(ICU)

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v4i2.239 ◽

1970 ◽

Vol 4 (2) ◽

Author(s):

Ayu Prawesti Priambodo ◽

Kusman Ibrahim ◽

Nursiswati N

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pain Intensity ◽

Critically Ill ◽

Critically Ill Patients ◽

Sampling Technique ◽

Pain Scale ◽

Kappa Index ◽

Cross Sectional ◽

Consecutive Sampling

Penggunaan alat ukur pengkajian nyeri yang sistematik dan terstandar pada pasien kritis yang tidak mampu untuk melaporkan rasa nyeri adalah suatu hal yang perlu diperhatikan. Behavioural pain scales(BPS) adalah alat ukur yang lebih dini dan banyak digunakan di area keperawatan kritis. Critical pain observation tools(CPOT) adalah alat yang dikembangkan menggunakan unsur-unsur rasa nyeri yang ada pada beberapa alat ukur pengkajian nyeri, termasuk BPS, namun CPOT belum banyak dikenal dan digunakan. Tujuan penelitian adalah melihat kesesuaian alat ukur CPOT dengan alat ukur BPS. Penelitian ini bersifat observasional analitik dengan rancangan Crosssectional dengan sampel pasien GICU (General Intensive Care Unit) dengan penurunan kesadaran dan menggunakan ventilasi mekanik sebanyak 48 pasien. Teknik pengambilan sampel dengan consecutive sampling. Pengkajian dilakukan dengan observasi skala nyeri menggunakan BPS dan CPOT pada saat pasien kondisi istirahat dan positioninguntuk melihat keandalan alat ukur nyeri. Hasil uji beda dan korelasi pada hasil pengukuran nyeri pada BPS dan CPOT adalah bermakna. Hal ini menunjukkan bahwa BPS dan CPOT dapat mengukur perbedaan intensitas nyeri saat istirahat dengan saat positioning. Hasil uji kesesuaian (kappa) pengukuran BPS dengan CPOT memiliki nilai kesesuaian yang bermakna, dengan nilai kesesuaian (kappa) BPS-CPOT pada kondisi istirahat sebesar 0,937, sedangkan nilai kesesuaian (Kappa)BPS-CPOT pada kondisi positioning sebesar 0,265. BPS dan CPOT adalah alat penilaian nyeri yang dapat digunakan dalam menilai rasa sakit dan meningkatkan manajemen nyeri pada pasien kritis. CPOT lebih mudah digunakan dan aplikatif karena memiliki definisi operasional yang jelas. Kata kunci : Behavioural pain scale, Critical pain observation tool, pasien kritis.Pain Assessment among Critically Ill Patients using the Critical Pain Observation Tool (CPOT) in the Intensive Care Unit AbstractA systematic and standardised tool to assess pain experienced by critically ill patients has been previously highlighted. The BPS is the common tool used in the intensive care setting which can be used. But, the Critical Pain Observation Tool (COPT) has not been used extensively in the hospital. Thus, the efficacy of this tool needs to be examined. This descriptive observational study aimed to find an agreement of CPOT with BPS using a cross-sectional method recruited 48 participants with consecutive sampling technique. Pain assessment was performed during a resting and positioning period to check the agreement of the tools. Data was analysed using Cohen’s Kappa index analysis. Findings demonstrated a significance difference of pain intensity measured by BPS and CPOT during the period of resting (κ = 0.937) and positioning (κ = 0.265). Thus, BPS and CPOT are reliable scales to measure pain intensity. It is expected that those tools can help nurses to improve pain management for critically ill patients. However, CPOT is considered more applicable and user-friendly compared to the BPS.Keywords: Behavioral Pain Scale, Critical Pain Observation Tool, critical nursing care

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Study of incidence of acute renal failure and its associated factors and complications amongst patients admitted in intensive care unit of a tertiary care teaching hospital

Medpusle International Journal of Medicine ◽

10.26611/102111210 ◽

2021 ◽

Vol 11 (2) ◽

pp. 108-111

Author(s):

Rameshwar A Warkad ◽

Keyword(s):

Intensive Care Unit ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Intensive Care ◽

Critically Ill ◽

Teaching Hospital ◽

Critically Ill Patients ◽

Tertiary Care ◽

Tertiary Care Teaching Hospital

Background: Impairment of renal function is a serious complication in critically ill patients. Mortality of acute renal failure remains high ranging from 35% to 86% despite haemodialysis therapy and substantial improvement of dialysis techniques. Therefore attention must be paid to the conditions favouring deterioration of renal function in order to prevent acute renal failure or to intervene in an early phase when less invasive therapies might be even more promising. Methods: This prospective study was conducted in a tertiary care teaching hospital in Mumbai from 1st January 2006 to 31st December 2006. All patients consecutively admitted in intensive care unit were studied. Results: Total number of patients admitted during the said period to the Intensive care Unit was 406, of which 50 had evidence of acute renal failure. The incidence of acute renal failure in the critically ill patients included in our study was 12.31%. There was a statistically significant difference in the incidence of fluid overload, oliguria and hyperkalemia between the pre-renal and renal failure groups. Conclusion: The incidence of acute renal failure in the critically ill patients was 12.31% and commonest predisposing factors associated with acute renal failure were acute insults like hypotension, sepsis and risk factors like age >50 years and pre-existing renal disease.

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Exercise is delayed in critically ill patients: a five year observational study in an Australian tertiary intensive care unit

Australian Critical Care ◽

10.1016/j.aucc.2017.02.029 ◽

2017 ◽

Vol 30 (2) ◽

pp. 119-120

Author(s):

Marc Nickels ◽

Leanne Aitken ◽

James Walsham ◽

Lisa Watson ◽

Steven McPhail

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients

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The Deferred Consent Model in a Prospective Observational Study Evaluating Myocardial Injury in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066616680772 ◽

2016 ◽

Vol 33 (8) ◽

pp. 475-480 ◽

Cited By ~ 7

Author(s):

Kimia Honarmand ◽

Emilie P. Belley-Cote ◽

Diana Ulic ◽

Abubaker Khalifa ◽

Andrew Gibson ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Informed Consent ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

A Priori ◽

Low Risk ◽

Cardiac Biomarkers ◽

Deferred Consent

Background: Informed consent is a hallmark of ethical clinical research. An inherent challenge in critical care research is obtaining consent when patients lack decision-making capacity. One solution is deferred consent, which is often used for studies that are low risk or involve emergency interventions. Our objective was to describe a deferred consent model in a low-risk critical care study. Methods: Prognostic Value of Elevated Troponins in Critical Illness Study was a prospective, pilot observational study of critically ill patients in 3 intensive care units, involving serial electrocardiograms and cardiac biomarkers. Newly admitted patients were enrolled over 1 month. When possible, informed consent was obtained a priori from the patient or substitute decision maker (SDM); otherwise, consent was deferred until the patient regained consent capacity or until their SDM was available. Logistic regression analysis was used to determine the association between patient’s sex, Acute Physiology and Chronic Health Evaluation II score, study center, person providing consent (patient vs SDM), method of consent (telephone vs in person), and the provision or not of informed consent. Results: The overall consent rate was 80.1% (213 of 266 persons approached). Of the 53 persons declining consent, 37 (69.8%) agreed to the use of data collected up until that point. Over half of all consent encounters were with patients rather than SDMs. Median interval delay between enrollment and the consent encounter was 1 day. On multivariate analysis, the only variable associated with consent was male sex of the patient (odds ratio for males 2.59, confidence interval: 1.19-5.63). Conclusion: Deferred consent facilitates implementation of time-sensitive research protocols until a consent encounter is possible. As a feasible alternative to exclusive a priori consent, the deferred consent model can be useful in low-risk studies in critically ill patients.

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Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

10.21203/rs.3.rs-17042/v2 ◽

2020 ◽

Author(s):

Viveka Björck ◽

Lisa I Påhlman ◽

Mikael Bodelsson ◽

Ann_Cathrine Petersson ◽

Thomas Kander

Keyword(s):

Septic Shock ◽

Renal Failure ◽

Severe Sepsis ◽

Intensive Care ◽

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Saps 3 ◽

Group A ◽

Lower Mortality Risk

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Chasing the Bucket: A Nursing view of Continuous Arterio-Venous Haemofiltration/Dialysis

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-75-153 ◽

1989 ◽

Vol 75 (3) ◽

pp. 153-158

Author(s):

G. E. Watkinson

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Critically Ill ◽

Nursing Staff ◽

Critically Ill Patients ◽

Major Advance ◽

Intensive Care Patients ◽

Intensive Care Nursing ◽

Care Nursing

AbstractHaemofiltration was developed to meet the needs of intensive care patients with acute renal failure. It is a major advance in the management of these critically ill patients, as it is carried out at the bedside by the intensive care nursing staff

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