scholarly journals TRAQUEOSTOMÍA TEMPRANA VS TARDÍA EN PACIENTES NEUROQUIRÚRGICOS INTERNADOS EN UNA UNIDAD DE CUIDADOS INTENSIVOS.

2020 ◽  
Vol 5 (4) ◽  
pp. 12
Author(s):  
Freiser Eceomo Cruz Mosquera ◽  
Nathaly Erazo Builes ◽  
Juan Camilo Angulo Cano ◽  
María Paula Solarte-Roa ◽  
Daniel Mauricio Muñoz Piamba ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Intensive Care Units ◽  
Total Sample ◽  
Early Tracheostomy ◽  
Neurosurgical Patients ◽  
Clinical Benefits ◽  
The City

Introducción: Los pacientes neurocríticos por lo general requieren periodos largos de ventilación mecánica, en ese contexto la traqueostomía es un procedimiento frecuente que se realiza para facilitar el destete de la ventilación y se asocia a múltiples beneficios; sin embargo, el momento de su realización sigue siendo objeto de debate. Objetivo: determinar los beneficios clínicos   de la traqueostomía temprana vs la tardía en los pacientes neurocríticos que ingresan a una unidad de cuidados intensivos (UCI) polivalente de una institución de salud de la ciudad de Cali. Metodología: investigación observacional, descriptiva, de serie de casos que incluyó pacientes neuroquirúrgicos, mayores de edad que ingresaron a una UCI durante el periodo 2016 -2018; a partir de la muestra total se estipularon dos grupos: traqueostomía temprana (≤ 9 días) y traqueostomía tardía (≥10 días).  El análisis estadístico se realizó en el programa SPSS versión 24. Resultados: Se incluyeron 20 sujetos con edad de 51.9±17 años, 10 fueron asignados al grupo de traqueostomía temprana y 10 al grupo den traqueostomía tardía. Se evidenció que los pacientes con traqueostomía temprana tienen menos días de sedación (10±2.1 vs 16±9; p=0.02) y los 3 casos que fallecieron habían sido traqueostomizados tardíamente. Conclusiones: La traqueostomía temprana puede traer beneficios clínicos a los pacientes neuroquirúrgicos que ingresan a unidades de cuidados intensivos.                                                                                                                   Palabras claves: Traqueostomía, unidades de cuidados intensivos, paciente, ventilación mecánica. ABSTRACT Introduction: Neurocritical patients generally require long periods of mechanical ventilation. In this context, tracheostomy is a frequent procedure performed to facilitate weaning from ventilation and is associated with multiple benefits; however, the timing of its implementation remains under debate. Objective: to determine the clinical benefits of early vs late tracheostomy in neurocritical patients admitted to a polyvalent intensive care unit (ICU) of a health institution in the city of Cali. Methodology: observational, descriptive investigation of a series of cases that included neurosurgical patients, of legal age who were admitted to an ICU during the period 2016 -2018; From the total sample, two groups were stipulated: early tracheostomy (≤ 9 days) and late tracheostomy (≥10 days). Statistical analysis was performed using SPSS version 24. Results: 20 subjects with an age of 51.9 ± 17 years were included, 10 were assigned to the early tracheostomy group and 10 to the late tracheostomy group. It was evidenced that patients with early tracheostomy had fewer days of sedation (10±2.1 vs 16± 9; p= 0.02) and the 3 cases that died had been tracheostomized late. Conclusions: Early tracheostomy can bring clinical benefits to neurosurgical patients admitted to intensive care units. Keywords: Tracheostomy, intensive care units, patient, mechanic ventilation.

scholarly journals Modifiable risk factors of ventilator-associated pneumonia in non-intensive care unit versus intensive care unit

2021 ◽  
Vol 15 (10) ◽  
pp. 1471-1480
Author(s):  
Patpong Udompat ◽  
Daravan Rongmuang ◽  
Ronald Craig Hershow
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Proton Pump ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Neurosurgical Patients

Introduction: Ventilator-associated pneumonia patients are treated in non-intensive care units because of a shortage of intensive care unit beds in Thailand. Our objective was to assess whether the type of unit and medications prescribed to the patient were associated with ventilator‑associated pneumonia and multidrug resistant ventilator‑associated pneumonia. Methodology: A matched case-control study nested in a prospective cohort of mechanical ventilation adult patients in a medical-surgical intensive care unit and five non-intensive care units from March 1 through October 31, 2013. The controls were randomly selected 1:1 with cases and matched based on duration and start date of mechanical ventilation. Results: 248 ventilator-associated pneumonia and control patients were analyzed. The most common bacteria were multidrug resistant Acinetobacter baumannii (82.4%). Compared with patients in the intensive care unit, those in the neurosurgical/surgical non-intensive care units were at higher risk (p = 0.278). Proton pump inhibitor was a risk factor (p = 0.011), but antibiotic was a protective factor (p = 0.054). Broad spectrum antibiotic was a risk factor (p < 0.001) for multidrug resistant ventilator-associated pneumonia. Conclusions: Post-surgical and neurosurgical patients treated in non-intensive care unit settings were at the highest risk of ventilator-associated pneumonia. Our findings suggest that alternative using proton pump inhibitors should be considered based on the risk-benefit of using this medication. In addition, careful stewardship of antibiotic use should be warranted to prevent multidrug resistant ventilator-associated pneumonia.

scholarly journals Candidemia in an intensive care unit

Medicina ◽  
2008 ◽  
Vol 45 (5) ◽  
pp. 351
Author(s):  
Dalia Adukauskienė ◽  
Aida Kinderytė ◽  
Asta Dambrauskienė ◽  
Astra Vitkauskienė
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Urinary Bladder ◽  
Intensive Care Units ◽  
Severe Disease ◽  
Candida Spp ◽  
Lethal Outcome ◽  
Bladder Catheter

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. Objective. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. Material and methods. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. Results. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). Conclusions. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.

scholarly journals Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

2019 ◽  
Vol 53 ◽  
Author(s):  
Renata Eloah de Lucena Ferretti-Rebustini ◽  
Nilmar da Silva Bispo ◽  
Winnie da Silva Alves ◽  
Thiago Negreiro Dias ◽  
Cristiane Moretto Santoro ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Group Method ◽  
Predictive Capacity ◽  
Organic Dysfunction ◽  
Intensity Of Care ◽  
Correlation Tests ◽  
The City

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Mortality ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being pre-operative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.Keywords: Intensive care unit; mortality; neurosurgery; outcome.

Some more parameters of utilization of intensive care units in Hungary

2011 ◽  
Vol 152 (45) ◽  
pp. 1813-1817
Author(s):  
Miklós Gresz
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Institutional Level ◽  
National Network ◽  
Direct Discharge ◽  
Ventilated Patients

According to the “Semmelweis plan for saving health care”, „the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present”. In an earlier report the author showed, on the basis of data reported to the health insurance that not in a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary, because patients occupying these beds were discharged to their homes directly from the intensive care unit. This study examines the functioning of intensive care units partly at the institutional level. The author shows how the number of days using mechanical ventilation and the number of direct discharges to the home of patients have changed, and proves that those institutions where the proportion of direct discharge to home so overnursing of patients was high, the rate of mechanically ventilated patients was low. Orv. Hetil., 2011, 152, 1813–1817.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Advice ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being preoperative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.

Early versus late tracheostomy in patients who require prolonged mechanical ventilation

2000 ◽  
Vol 9 (5) ◽  
pp. 352-359 ◽  
Author(s):  
AD Brook ◽  
G Sherman ◽  
J Malen ◽  
MH Kollef
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Medical Intensive Care Unit ◽  
Prolonged Mechanical Ventilation ◽  
Early Tracheostomy ◽  
Total Cost ◽  
Medical Intensive Care

OBJECTIVES: To compare the clinical outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. METHODS: A prospective observational study was done. The sample was a cohort of 90 patients who had tracheostomy in the medical intensive care unit of a university-affiliated teaching hospital. Primary outcome measures were duration of mechanical ventilation and total cost of hospitalization. Tracheostomy was defined as early if performed by day 10 of mechanical ventilation and late if performed thereafter. RESULTS: Fifty-three patients had early tracheostomy (mean +/- SD = day 5.9 +/- 7.2 of ventilation), and 37 patients had late tracheostomy (mean +/- SD = day 16.7 +/- 2.9) (P &lt; .001). The mean (+/- SD) duration of mechanical ventilation was 28.3 +/- 28.2 days in the early-tracheostomy group versus 34.4 +/- 17.8 days in the late-tracheostomy group (P = .005). Total cost of hospitalization was significantly lower in the early-tracheostomy group (mean +/- SD = $86,189 +/- $53,570) than in the late-tracheostomy group (mean +/- SD = $124,649 +/- $54,282) (P = .001). Male sex (adjusted odds ratio = 3.84; 95% CI = 2.32-6.34; P = .007) and higher ratios of PaO2 to fraction of inspired oxygen (adjusted odds ratio = 1.01; 95% CI = 1.00-1.01; P = .03) were associated with early tracheostomy. The timing of tracheostomy was not associated with hospital mortality. CONCLUSION: Early tracheostomy is associated with shorter lengths of stay and lower hospital costs than is late tracheostomy among patients in the medical intensive care unit. Prospective clinical trials are necessary to determine the optimal timing of tracheostomy in that setting.

Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care

2009 ◽  
Vol 18 (3) ◽  
pp. 212-221 ◽  
Author(s):  
Christiane Perme ◽  
Rohini Chandrashekar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Units ◽  
New Technologies ◽  
Cost Of Care ◽  
Term Survival ◽  
Early Mobility ◽  
Walking Program ◽  
Therapeutic Exercises

New technologies in critical care and mechanical ventilation have led to long-term survival of critically ill patients. An early mobility and walking program was developed to provide guidelines for early mobility that would assist clinicians working in intensive care units, especially clinicians working with patients who are receiving mechanical ventilation. Prolonged stays in the intensive care unit and mechanical ventilation are associated with functional decline and increased morbidity, mortality, cost of care, and length of hospital stay. Implementation of an early mobility and walking program could have a beneficial effect on all of these factors. The program encompasses progressive mobilization and walking, with the progression based on a patient’s functional capability and ability to tolerate the prescribed activity. The program is divided into 4 phases. Each phase includes guidelines on positioning, therapeutic exercises, transfers, walking reeducation, and duration and frequency of mobility sessions. Additionally, the criteria for progressing to the next phase are provided. Use of this program demands a collaborative effort among members of the multidisciplinary team in order to coordinate care for and provide safe mobilization of patients in the intensive care unit.

Parameters of bed occupancy of intensive care units in Hungary

2011 ◽  
Vol 152 (24) ◽  
pp. 946-950 ◽  
Author(s):  
Miklós Gresz
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Insurance ◽  
Intensive Care Units ◽  
Emergency Care ◽  
Present Author ◽  
Bed Occupancy ◽  
National Network ◽  
Bed Capacity

According to the Semmelweis Plan for Saving Health Care, ”the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present”. Author shows on the basis of data reported to the health insurance that not on a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary because patients occupying these beds were discharged to their homes directly from the intensive care unit. The data indicate that on the whole bed capacity is not low, only in some institutions insufficient. Thus, in order to improve emergency care in Hungary, the rearrangement of existing beds, rather than an increase of bed capacity is needed. Orv. Hetil., 2011, 152, 946–950.

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