scholarly journals Risk factors for determining length of intensive care unit and hospital stays following correction of cervical deformity: evaluation of early severe adverse events

2020 ◽  
pp. 1-12
Author(s):  
Rushikesh S. Joshi ◽  
Darryl Lau ◽  
Alexander F. Haddad ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Adverse Events ◽  
Cervical Deformity ◽  
Female Sex ◽  
Hospital Stays ◽  
The Mean ◽  
Severe Adverse Events

OBJECTIVECorrection of rigid cervical deformities can be associated with high complication rates and result in prolonged intensive care unit (ICU) and hospital stays. In this study, the authors aimed to examine the risk factors contributing to length of stay (LOS) in both the hospital and ICU following adult cervical deformity (ACD) surgery and to identify severe adverse events that occurred in this setting.METHODSA retrospective review of ACD patients who underwent posterior-based osteotomies for deformity correction from 2010 to 2019 was performed. Inclusion criteria were cervical kyphosis > 20° and/or cervical sagittal vertical axis (cSVA) > 4 cm. Multivariate analysis was used to identify risk factors independently associated with ICU and hospital LOS.RESULTSA total of 107 patients were included. The mean age was 63.5 years, and 61.7% were female. Over half (52.3%) underwent 3-column osteotomies, while 47.7% underwent posterior column osteotomies. There was significant correction of all cervical parameters: cSVA (6.0 vs 3.6 cm, p < 0.001), cervical lordosis (8.2° vs −5.3°, p < 0.001), cervical scoliosis (6.5° vs 2.2°, p < 0.001), and T1-slope (40.2° vs 34.5°, p < 0.001). There were also reciprocal changes to the distal spine: thoracic kyphosis (54.4° vs 46.4°, p < 0.001), lumbar lordosis (49.9° vs 45.8°, p = 0.003), and thoracolumbar scoliosis (13.9° vs 11.1°, p = 0.009). Overall, 4 patients (3.7%) suffered aspiration-related complications, 3 patients (2.8%) experienced dysphagia requiring a feeding tube, and 4 patients (3.7%) had compromised airways, with 1 resulting in death. The mean ICU and hospital LOS were 2.8 days and 7.9 days, respectively. Multivariate analysis identified three factors independently associated with longer ICU LOS: female sex (3.0 vs 2.4 days, p = 0.004), ≥ 12 segments fused (3.5 vs 1.9 days, p = 0.002), and postoperative complication (4.0 vs 1.9 days, p = 0.017). These same factors were independently associated with longer hospital LOS as well: female sex (8.3 vs 7.3 days, p = 0.013), ≥ 12 segments fused (9.4 vs 6.2 days, p = 0.001), and complication (9.7 vs 6.7 days, p = 0.026).CONCLUSIONSPosterior-based osteotomies are very effective for the correction of ACD, but postoperative hospital stays are relatively longer than those following surgery for degenerative disease. Risk factors for prolonged ICU and hospital LOS consist of both nonmodifiable (female sex) and modifiable (≥ 12 segments fused and presence of complication) risk factors. Additional multicenter prospective studies will be needed to validate these findings.

scholarly journals Tuberculosis in the Intensive Care Unit: A Retrospective Descriptive Cohort Study with Determination of a Predictive Fatality Score

2012 ◽  
Vol 23 (4) ◽  
pp. 173-178 ◽  
Author(s):  
Sandrine Valade ◽  
Laurent Raskine ◽  
Mounir Aout ◽  
Isabelle Malissin ◽  
Pierre Brun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Pulmonary Tuberculosis ◽  
Tuberculosis Patients ◽  
Independent Variables ◽  
Related Mortality

BACKGROUND: Despite effective treatments, tuberculosis-related mortality remains high among patients requiring admission to the intensive care unit (ICU).OBJECTIVE: To determine prognostic factors of death in tuberculosis patients admitted to the ICU, and to develop a simple predictive scoring system.METHODS: A 10-year, retrospective study of 53 patients admitted consecutively to the Hôpitaux de Paris, Hôpital Lariboisière (Paris, France) ICU with confirmed tuberculosis, was conducted. A multivariate analysis was performed to identify risk factors for death. A predictive fatality score was determined.RESULTS: Diagnoses included pulmonary tuberculosis (96%) and tuberculous encephalomeningitis (26%). Patients required mechanical ventilation (45%) and vasopressor infusion (28%) on admission. Twenty patients (38%) died, related to direct tuberculosis-induced organ failure (n=5), pulmonary bacterial coinfections (n=14) and pulmonary embolism (n=1). Using a multivariate analysis, three independent factors on ICU admission were predictive of fatality: miliary pulmonary tuberculosis (OR 9.04 [95% CI 1.25 to 65.30]), mechanical ventilation (OR 11.36 [95% CI 1.55 to 83.48]) and vasopressor requirement (OR 8.45 [95% CI 1.29 to 55.18]). A score generated by summing these three independent variables was effective at predicting fatality with an area under the ROC curve of 0.92 (95% CI 0.85 to 0.98).CONCLUSIONS: Fatalities remain high in patients admitted to the ICU with tuberculosis. Miliary pulmonary tuberculosis, mechanical ventilation and vasopressor requirement on admission were predictive of death.

Risk Factors Associated with Hospital-Acquired Venous Thromboembolism in the Pediatric Intensive Care Unit

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2313-2313
Author(s):  
Minh Q Tran ◽  
Steven L Shein ◽  
Hong Li ◽  
Sanjay P Ahuja
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Odds Ratio ◽  
Pediatric Intensive Care ◽  
Primary Diagnosis ◽  
Factors Associated ◽  
Hospital Acquired

Abstract Introduction: Venous thromboembolism (VTE) in Pediatric Intensive Care Unit (PICU) patients is associated with central venous catheter (CVC) use. However, risk factors for VTE development in PICU patients with CVCs are not well established. The impact of Hospital-Acquired VTE in the PICU on clinical outcomes needs to be studied in large multicenter databases to identify subjects that may benefit from screening and/or prophylaxis. Method: With IRB approval, the Virtual Pediatric Systems, LLC database was interrogated for children < 18yo admitted between 01/2009-09/2014 who had PICU length of stay (LOS) <1 yr and a CVC present at some point during PICU care. The exact timing of VTE diagnosis was unavailable in the database, so VTE-PICU was defined as an "active" VTE that was not "present at admission". VTE-prior was defined as a VTE that was "resolved," "ongoing" or "present on admission." Variables extracted from the database included demographics, primary diagnosis category, and Pediatric Index of Mortality (PIM2) score. PICU LOS was divided into quintiles. Chi squared and Wilcoxon rank-sum were used to identify variables associated with outcomes, which were then included in multivariate models. Our primary outcome was diagnosis of VTE-PICU and our secondary outcome was PICU mortality. Children with VTE-prior were included in the mortality analyses, but not the VTE-PICU analyses. Data shown as median (IQR) and OR (95% CI). Results: Among 143,524 subjects, the median age was 2.8 (0.47-10.31) years and 55% were male. Almost half (44%) of the subjects were post-operative. The median PIM2 score was -4.11. VTE-prior was observed in 2498 patients (1.78%) and VTE-PICU in 1741 (1.2%). The incidence of VTE-PICU were 852 (1.7%) in patients ≤ 1 year old, 560 (0.9%) in patients 1-12 years old, and 303 (1.1%) in patients ≥ 13 years old (p < 0.0001). In univariate analysis, variables associated with a diagnosis of VTE-PICU were post-operative state, four LOS quintiles (3-7, 7-14, and 14-21 and >21 days) and several primary diagnosis categories: cardiovascular, gastrointestinal, infectious, neurologic, oncologic, genetic, and orthopedic. Multivariate analysis showed increased risk of VTE with cardiovascular diagnosis, infectious disease diagnosis, and LOS > 3 d (Table 1). The odds increased with increasing LOS: 7 d < LOS ≤ 14 d (5.18 [4.27-6.29]), 14 d < LOS ≤ 21 d (7.96 [6.43-9.82]), and LOS > 21 d (20.73 [17.29-24.87]). Mortality rates were 7.1% (VTE-none), 7.2% (VTE-prior), and 10.1% (VTE-PICU) (p < 0.0001). In the multivariate model, VTE-PICU (1.25 [1.05-1.49]) and VTE-prior (1.18 [1.002-1.39]) were associated with death vs. VTE-none. PIM2 score, trauma, and several primary diagnosis categories were also independently associated with death (Table 2). Conclusion: This large, multicenter database study identified several variables that are independently associated with diagnosis of VTE during PICU care of critically ill children with a CVC. Children with primary cardiovascular or infectious diseases, and those with PICU LOS >3 days may represent specific populations that may benefit from VTE screening and/or prophylaxis. Hospital-Acquired VTE in PICU was independently associated with death in our database. Additional analysis of this database, including adding specific diagnoses and secondary diagnoses, may further refine risk factors for Hospital-Acquired VTE among PICU patients with a CVC. Table 1. Multivariate analysis of Factors Associated with VTE-PICU. Factors Odds Ratio 95% Confidence Interval 3d < LOS ≤ 7d vs LOS ≤ 3d 2.19 1.78-2.69 7d < LOS ≤ 14d vs LOS ≤ 3d 5.18 4.27-6.29 14d < LOS ≤ 21d vs LOS ≤ 3d 7.95 6.44-9.82 LOS > 21d vs LOS ≤ 3d 20.73 17.29-24.87 Age 1.00 0.99-1.01 Post-operative 0.89 0.80-0.99 PIM2 Score 1.47 1.01-1.07 Primary Diagnosis: Cardiovascular 1.50 1.31-1.64 Primary Diagnosis: Infectious 1.50 1.27-1.77 Primary Diagnosis: Genetics 0.32 0.13-0.78 Table 2. Multivariate Analysis of Factors Associated with PICU Mortality. Factors Odds Ratio 95% ConfidenceInterval VTE-prior 1.18 1.00-1.39 VTE-PICU 1.25 1.05-1.49 PIM2 Score 2.08 2.05-2.11 Trauma 1.92 1.77-2.07 Post-operative 0.45 0.42-0.47 Primary Diagnosis: Genetic 2.07 1.63-2.63 Primary Diagnosis: Immunologic 2.45 1.51-3.95 Primary Diagnosis: Hematologic 1.63 1.30-2.06 Primary Diagnosis: Metabolic 0.71 0.58-0.87 Primary Diagnosis: Infectious 1.47 1.36-1.59 Primary Diagnosis: Neurologic 1.37 1.27-1.47 Disclosures No relevant conflicts of interest to declare.

Effect of Nosocomial Infections Due to Antibiotic-Resistant Organisms on Length of Stay and Mortality in the Pediatric Intensive Care Unit

2007 ◽  
Vol 28 (3) ◽  
pp. 299-306 ◽  
Author(s):  
Elizabeth E. Foglia ◽  
Victoria J. Fraser ◽  
Alexis M. Elward
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infections ◽  
Univariate Analysis ◽  
Pediatric Intensive Care ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Risk Of Mortality ◽  
The Mean

Objective.To determine the prevalence, risk factors, and outcomes of nosocomial infection due to antimicrobial resistant bacteria in patients treated in the pediatric intensive care unit (PICU).Design.Nested case-cohort study. Patient data were collected prospectively, and antimicrobial susceptibility data were abstracted retrospectively.Setting.A large pediatric teaching hospital.Patients.All PICU patients admitted from September 1, 1999, to September 1, 2001, unless they died within 24 hours after PICU admission, were 18 years old or older, or were neonatal intensive care unit patients receiving extracorporeal membrane oxygenation.Results.A total of 135 patients with more than 1 nosocomial bacterial infection were analyzed; 52% were male, 75% were white, the mean Pediatric Risk of Mortality score was 10.5, and the mean age was 3.5 years. Of these patients, 37 (27%) had nosocomial infections due to antibiotic-resistant organisms. In univariate analysis, transplantation (odds ratio [OR], 2.83 [95% confidence interval (CI), 1.05-7.66]) and preexisting lung disease (OR, 2.63 [95% CI, 1.18-5.88]) were associated with nosocomial infections due to antibiotic-resistant organisms. Age, Pediatric Risk of Mortality score at admission, length of hospital stay before infection, and other underlying conditions were not associated with infections due to antibiotic-resistant organisms. Patients infected with antibiotic-resistant organisms had greater mean PICU lengths of stay after infection, compared with patients infected with antibiotic-susceptible organisms (22.9 vs 12.8 days;P= .004), and higher crude mortality rates (OR, 2.40 [95% CI, 1.03-5.61]).Conclusions.Identifiable risk factors exist for nosocomial infections due to antibiotic-resistant organisms. In univariate analysis, infections due to antibiotic-resistant bacteria are associated with increased length of stay in the PICU after onset of infection and increased mortality.

scholarly journals Risk Factors for the Development of Delayed TSH Elevation in Neonatal Intensive Care Unit Newborns

2017 ◽  
Vol 102 (8) ◽  
pp. 3050-3055 ◽  
Author(s):  
Amnon Zung ◽  
Rachel Bier Palmon ◽  
Agneta Golan ◽  
Mara Troitzky ◽  
Smadar Eventov-Friedman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Univariate Analysis ◽  
Packed Red Blood Cells

Abstract Context Delayed thyrotropin (TSH) elevation (dTSH) is defined as elevated TSH at the second neonatal screening (after normal TSH levels at the initial screening) in premature, low-birth-weight, and ill newborns, mostly in the neonatal intensive care unit (NICU) setting. The pathogenesis of dTSH is elusive. Objective To identify the risk factors for dTSH development among newborns in the NICU. Design, Setting, and Patients A retrospective medical record review of neonates with dTSH was conducted in eight university-affiliated NICUs. Two controls were selected for each patient, matched for sex and birth weight. The risk factors for dTSH were identified by univariate analysis, followed by multivariate analysis. Main Outcome Measures Maternal variables, types of NICU treatments and procedures, syndromes, and various medical conditions were compared between dTSH patients and their matched controls. Results We enrolled 100 dTSH patients and 200 matched controls and 46 variables were compared between the two groups. Twelve risk factors for dTSH were identified on univariate analysis: cesarean section, mechanical ventilation, patent ductus arteriosus (PDA), pneumothorax, and administration of cefotaxime, vancomycin, fluconazole, dopamine, ibuprofen, furosemide, insulin, and packed red blood cells. On multivariate analysis, four risk factors were identified: PDA and vancomycin, insulin, and furosemide administration. In 26 twin pairs, in which one twin had dTSH, all variables presented similarly in both twins. Conclusions Although some variables had direct effects on pituitary–thyroid axis dysfunction, these variables, altogether, reflect the severity of the clinical conditions in the NICU, which is the common basis for dTSH.

scholarly journals Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092636 ◽  
Author(s):  
Mafumi Shinohara ◽  
Masayuki Iwashita ◽  
Takeru Abe ◽  
Ichiro Takeuchi
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Airway Obstruction ◽  
Odds Ratio ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Laryngeal Edema ◽  
Female Sex

Objective Post-extubation stridor and hoarseness are important clinical manifestations that indicate laryngeal edema due to intubation. In previous studies the incidence of post-extubation stridor and hoarseness ranged from 1.5% to 26.3% in postoperative patients and patients in the intensive care unit. Female sex and prolonged intubation are reportedly risk factors for post-extubation stridor. However, the risk factors for post-extubation stridor and the appropriate endotracheal tube size in emergency settings remain unknown. This study was performed to identify the risk factors for post-extubation laryngeal edema after emergency intubation. Methods A prospective observational study was conducted in a tertiary emergency medical center/trauma center. The primary outcome was post-extubation stridor and hoarseness. Results During the study period, 482 emergency intubations and 227 extubations were performed in adult patients. In total, 29% of the patients presented symptoms of stridor and/or hoarseness. Female sex (odds ratio, 2.65; 95% confidence interval, 1.21–5.81) and the duration of intubation (odds ratio, 1.18; 95% confidence interval, 1.05–1.32) were associated with stridor and/or hoarseness. Conclusions Patients who undergo emergency intubation have a higher risk of post-extubation upper airway obstruction symptoms than postoperative patients and patients in the intensive care unit, and female sex is associated with these symptoms.

scholarly journals Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis

2015 ◽  
Vol 45 (5) ◽  
pp. 1353-1363 ◽  
Author(s):  
Antoni Torres ◽  
Catia Cillóniz ◽  
Miquel Ferrer ◽  
Albert Gabarrús ◽  
Eva Polverino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Arterial Oxygen ◽  
C Reactive Protein ◽  
Antibiotic Resistant ◽  
Reactive Protein

The sensitivity of blood cultures in the diagnosis of bacteraemia for community-acquired pneumonia is low. Recommendations, by guidelines, to perform blood cultures are discordant. We aimed to determine the incidence, microbial aetiology, risk factors and outcomes of bacteraemic patients with community-acquired pneumonia, including cases with antibiotic-resistant pathogens (ARP).A prospective, observational study was undertaken on consecutive adult patients admitted to the Hospital Clinic of Barcelona (Barcelona, Spain) with community-acquired pneumonia and blood cultures were obtained.Of the 2892 patients included, bacteraemia was present in 297 (10%) patients; 30 (10%) of whom had ARP (multidrug-resistantStreptococcus pneumoniae, methicillin-resistantStaphylococcus aureus,Pseudomonas aeruginosa, and an extended spectrum of beta-lactamase producingEnterobacteriaceae). In multivariate analyses, pleuritic pain, C-reactive protein ≥21.6 mg·dL−1and intensive care unit admissions were independently associated with bacteraemia, while prior antibiotic treatment and pneumococcal vaccine were protective factors. The risk factors for ARP bacteraemia were previous antibiotics and C-reactive protein <22.2 mg·dL−1, while pleuritic pain was the only protective factor in the multivariate analysis. Bacteraemia (excluding ARP), appropriate empiric treatment, neurological disease, arterial oxygen tension/inspiratory oxygen fraction <250, pneumonia severity index risk classes IV and V, and intensive care unit admission were independently associated with a 30-day hospital mortality in the multivariate analysis. Inappropriate therapy was more frequent in ARP bacteraemia, compared with other bacteraemias (27%versus3%, respectively, p<0.001).Antibiotic therapy protected against bacteraemia, but increased specifically the risk of bacteraemia from ARP due to the inappropriate coverage of these pathogens. Identifying patients at risk of ARP bacteraemia would help in deciding appropriate empiric antimicrobial therapy. The results from this study provide evidence concerning community-acquired pneumonia patients in whom blood cultures should not be performed.

scholarly journals Characteristics and Outcomes of Long-Stay Patients in the Pediatric Intensive Care Unit

2017 ◽  
Vol 07 (01) ◽  
pp. 001-006 ◽  
Author(s):  
Qian Sng ◽  
Lu Zhang ◽  
Judith Ming Wong ◽  
Janil Puthucheary ◽  
Jan Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Independent Predictor ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Organ Support ◽  
Risk Of Mortality ◽  
Strong Independent Predictor

AbstractLong-stay patients in the PICU have a higher risk of mortality as compared with non–long-stay patients. We aim to describe mortality and characteristics of long-stay patients and to determine the risk factors for mortality in these children. Total 241 (4.8%) long-stay admissions were identified. Mortality of long-stayers was 48/241 (20%). Higher severity-of-illness score at admission, need for organ support therapies, number of nosocomial infections, and bloodstream nosocomial infection were associated with a higher mortality in long-stay patients in the PICU. Based on multivariate analysis, oncologic diagnosis as a preexisting comorbidity is a strong independent predictor of mortality for long-stay patients.

scholarly journals ADVERSE EVENTS RELATED TO MECHANICAL VENTILATION IN A PEDIATRIC INTENSIVE CARE UNIT

2021 ◽  
Vol 39 ◽  
Author(s):  
Lana dos Santos Martins ◽  
Alexandre Rodrigues Ferreira ◽  
Fabiana Maria Kakehasi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Adverse Events ◽  
Pediatric Intensive Care Unit ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Unplanned Extubation ◽  
Factors Associated

ABSTRACT Objective: To identify the prevalence and factors associated with adverse events (AE) related to invasive mechanical ventilation in patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary public hospital. Methods: This is a cross-sectional study from July 2016 to June 2018, with data collected throughout patients’ routine care in the unit by the care team. Demographic, clinical and ventilatory characteristics and adverse events were analysed. The logistic regression model was used for multivariate analysis regarding the factors associated with AE. Results: Three hundred and six patients were included, with a total ventilation time of 2,155 days. Adverse events occurred in 66 patients (21.6%), and in 11 of those (16.7%) two AE occurred, totalling 77 events (36 AE per 1000 days of ventilation). The most common AE was post-extubation stridor (25.9%), followed by unplanned extubation (16.9%). Episodes occurred predominantly in the afternoon shift (49.3%) and associated with mild damage (54.6%). Multivariate analysis showed a higher occurrence of AE associated with length of stay of 7 days or more (Odds Ratio [OR]=2.6; 95% confidence interval [95%CI] 1.49-4.66; p=0.001). Conclusions: The results of the present study show a significant number of preventable adverse events, especially stridor after extubation and accidental extubation. The higher frequency of these events is associated with longer hospitalization.

Sign in / Sign up

Export Citation Format

Share Document