scholarly journals An Analysis of 1255 ICU Patients at a Tertiary Military Hospital

2013 ◽  
Vol 1 (1) ◽  
pp. 40-44
Author(s):  
MHM Delwar Hossain ◽  
Abdullah Al Maruf
Keyword(s):  
Intensive Care Unit ◽  
Nursing Care ◽  
Ventilatory Support ◽  
Military Hospital ◽  
Organ Support ◽  
Organizational Capability ◽  
Icu Mortality ◽  
Icu Patients ◽  
Medical Discipline ◽  
Special Part

An intensive care unit (ICU) is a special part of hospital where expertise medical and nursing care has been provided along with monitoring and organ support. An analysis of 1255 patients was carried out to investigate retrospective review of data from ICU of combined military hospital (CMH) Dhaka. During this study period, the frequency of admission into ICU was more from medical discipline (59.92%) than other disciplines like surgical (37.52%), gynaecological, obstetric and other disciplines (2.55%). The incidence of survival was 53.86% from medical, 69% from surgical and 84.38% from gynaecological, obstetric and other disciplines and mortality was 46.14%, 31% and 15.62% respectively. Occurrence of total ventilatory support provided in all disciplines was 45.34%. In other studies it was found that the ICU mortality varies between 15% to 44% depending on various factors like age, severity of diseases, length of stay and organizational capability of the ICU. The most prevalence of diseases admitted into this ICU was cardiovascular diseases, which were 42.47% and second prevalent diseases were head injury (11.34%). The incidence of immediate mortality within 12 hours was 7.97%.DOI: http://dx.doi.org/10.3329/bccj.v1i1.14368 Bangladesh Crit Care J March 2013; 1: 40-44

scholarly journals An Analysis of First 300 ICU Patients at Rajshahi Medical College Hospital

2018 ◽  
Vol 25 ◽  
pp. 8-12
Author(s):  
AHM Kamal ◽  
W Khatun
Keyword(s):  
Nursing Care ◽  
Ventilatory Support ◽  
Medical College Hospital ◽  
Organ Support ◽  
Organizational Capability ◽  
Icu Mortality ◽  
College Hospital ◽  
Medical College ◽  
Medical Discipline ◽  
Special Part

An intensive care unit (ICU) is a special part of hospital where expertise medical and nursing care has been provided along with monitoring and organ support. An analysis of first 300 patients was carried out to investigate retrospective review of data from ICU of Rajshahi Medical College Hospital (RMCH) Rajshahi. During this study period, the frequency of admission into ICU was more from medical discipline (49%%) than other disciplines like surgical (42.33%), gynaecological, obstetric and other disciplines (8.66%%). The incidence of survival was 56.69% from surgical, 44.21% from medical and 38.46% from gynaecological and other disciplines and mortality was 35.94%, 53.59% and 10.45% respectively. Occurrence of total ventilatory support provided in all disciplines was 68%. In other studies it was found that the ICU mortality varies between 15% to 44% depending on various factors like age, severity of diseases, length of stay and organizational capability of the ICU. The most prevalence of diseases admitted into this ICU was medical diseases, which were 25% and second prevalent diseases were head injury 20.66%. The incidence of immediate mortality within 24 hours was 42 %TAJ 2012; 25: 8-12

scholarly journals Profile of Intensive Care Unit admission and Outcomes of Medical and Surgical patients at A Tertiary Government Hospital: A 5 Year Trend Analysis

2018 ◽  
Vol 29 (2) ◽  
pp. 59-62
Author(s):  
Shakera Ahmed ◽  
Omar Faruque Yusuf ◽  
AKM Shamsul Alam ◽  
Anisul Awal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Ventilatory Support ◽  
Surgical Patients ◽  
College Hospital ◽  
Medical College ◽  
Advanced Airway ◽  
Medical Discipline ◽  
Record Review

Background: The intensive care unit (ICU) is that part of the hospital where critically ill patients that require advanced airway, respiratory and haemodynamic supports are usually admitted. Intensive care unit admissions which aim at achieving an outcome better than if the patients were admitted into other parts of the hospital however come at a huge cost to the hospital, the personnel and patients’ relations.Objective: To audit the 5 year bed occupancy rate and outcome of medicine and surgical patients admitted into the ICU of the Chittagong Medical College Hospital, Chittagong, Bangladesh.Design: A 5 years retrospective study (Record review) from January 2012 to December 2016. Method: Data were extracted from the ICU records of the patient and analyzed.Results: During this study period, the frequency of admission into ICU was significantly more (p<0.001) from medical discipline (55.20%) than surgical disciplines (44.80%). The incidence of survival was significantly lower (p<0.001) from medical discipline (37.68%), than from surgical disciplines (49.05%). Occurrence of total ventilatory support provided in all disciplines was 60.32% and it was significantly higher for the surgical patients. Overall mortality rate was 57.23%.Conclusion: During prioritizing the patients for ICU admission surgical cases should get preference. It is primarily necessary to optimize patient to doctor ratio and patient to nurse ratio and providing the service by critical care physicians (“intensivists”) to reduce the mortality rate of ICU.Bangladesh J Medicine Jul 2018; 29(2) : 59-62

scholarly journals Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study

Metabolites ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 386
Author(s):  
Alice G. Vassiliou ◽  
Edison Jahaj ◽  
Ioannis Ilias ◽  
Vassiliki Markaki ◽  
Sotirios Malachias ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Lactate ◽  
Organ Dysfunction ◽  
Apache Ii ◽  
Icu Mortality ◽  
Icu Patients ◽  
Time Pattern ◽  
Cox Regression Analysis ◽  
Icu Admission

Coronavirus disease-19 (COVID-19) continues to be a health threat worldwide. Increased blood lactate is common in intensive care unit (ICU) patients; however, its association with outcomes in ICU COVID-19 patients remains currently unexplored. In this retrospective, observational study we assessed whether lactate is associated with outcomes in COVID-19 patients. Blood lactate was measured on ICU admission and thereafter daily up to day 14 in 45 patients with confirmed COVID-19 pneumonia. Acute physiology and chronic health evaluation (APACHE II) was calculated on ICU admission, and sequential organ failure assessment (SOFA) score was assessed on admission and every second day. The cohort was divided into survivors and non-survivors based on 28-day ICU mortality (24.4%). Cox regression analysis revealed that maximum lactate on admission was independently related to 28-day ICU mortality with time in the presence of APACHE II (RR = 2.45, p = 0.008). Lactate’s area under the curve for detecting 28-day ICU mortality was 0.77 (p = 0.008). Mixed model analysis showed that mean daily lactate levels were higher in non-survivors (p < 0.0001); the model applied on SOFA scores showed a similar time pattern. Thus, initial blood lactate was an independent outcome predictor in COVID-19 ICU patients. The time course of lactate mirrors organ dysfunction and is associated with poor clinical outcomes.

scholarly journals Evaluation of intermittent hemodialysis conducted off-site on patients with renal insufficiency admitted in the intensive care unit of a developing country

2019 ◽  
Vol 7 (2) ◽  
pp. 410
Author(s):  
Aïcha Simour ◽  
Tarek Dendane ◽  
Khalid Abidi ◽  
Jihane Belayachi ◽  
Naoufel Madani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Intermittent Hemodialysis ◽  
Icu Mortality ◽  
Icu Patients ◽  
Hemodialysis Unit ◽  
Median Serum ◽  
Improvement In Survival

Background: In most developing countries, the renal replacement therapy (RRT) in ICU is not performed locally. We designed this study to assess the intermittent hemodialysis (IHD) offsite intakes on survival in critically ill patients admitted with renal failure.Methods: We prospectively analyzed all patients admitted to medical ICU with Acute Renal Failure (AKF) or Chronic Renal Failure (CKF) from February 2011 to September 2013. Patients were divided into two groups: those that received IHD in Hemodialysis Unit (IHD+) and those who did not (IHD-). Every patient IHD+ was matched to a patient IHD - using propensity score.Results: 202 patients were included: 151 with ARF and 51 with CRF. 116 patients were matched (age: 48±18 years; 46F/70M; median serum creatinine: 51mg/l; IQR: 32-90 mg/l). The total number of dialysis sessions was 112 for 58 patients (1.8±1.4 session/patient). The median delay to initiate IHD was 5.5h (IQR: 2-8h) and median duration of transportation was 10 min (IQR: 10-15min) with 23.6% transportation incidents. Significant hypotension with tachycardia were reported during IHD. ICU mortality rate was the same in the both groups (58.6%). In multivariate analysis, CRF (RR=2.69; p=0.006), serum creatinine >50mg/l (RR=3.54; p=0.007) and requirement for vasopressors infusion (RR=1.8; p=0.041) were independent predictive factors for receiving IHD.Conclusions: Our study doesn’t show an improvement in survival in ICU patients who receive IHD offsite. The probability to require IHD offsite increases with CRF and the use of vasopressors.

scholarly journals Management and outcomes in critically ill nonagenarian versus octogenarian patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Raphael Romano Bruno ◽  
Bernhard Wernly ◽  
Malte Kelm ◽  
Ariane Boumendil ◽  
Alessandro Morandi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Financial Burden ◽  
Secondary Outcome ◽  
Organ Support ◽  
Icu Mortality ◽  
Clinical Frailty Scale ◽  
Icu Patients ◽  
Link Type ◽  
Increased Risk ◽  
Icu Management

Abstract Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration NCT03134807 and NCT03370692.

scholarly journals Underweight but not overweight is associated with excess mortality in septic ICU patients

2021 ◽  
Author(s):  
Thomas Danninger ◽  
Richard Rezar ◽  
Behrooz Mamandipoor ◽  
Daniel Dankl ◽  
Andreas Koköfer ◽  
...  
Keyword(s):  
Management Strategies ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Organ Support ◽  
Research Database ◽  
Obese Patients ◽  
Icu Mortality ◽  
Icu Patients ◽  
Underweight Patients ◽  
The Impact

Summary Background Higher survival has been shown for overweight septic patients compared with normal or underweight patients in the past. This study aimed at investigating the management and outcome of septic ICU patients in different body mass index (BMI) categories in a large multicenter database. Methods In total, 16,612 patients of the eICU collaborative research database were included. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analysis was performed to fit three sequential regression models for the binary primary outcome (ICU mortality) to evaluate the impact of the BMI categories: underweight (<18.5 kg/m2), normal weight (18.5 to < 25 kg/m2), overweight (25 to < 30 kg/m2) and obesity (≥ 30 kg/m2). Data were adjusted for patient level characteristics (model 2) as well as management strategies (model 3). Results Management strategies were similar across BMI categories. Underweight patients evidenced higher rates of ICU mortality. This finding persisted after adjusting in model 2 (aOR 1.54, 95% CI 1.15–2.06; p = 0.004) and model 3 (aOR 1.57, 95%CI 1.16–2.12; p = 0.003). No differences were found regarding ICU mortality between normal and overweight patients (aOR 0.93, 95%CI 0.81–1.06; p = 0.29). Obese patients evidenced a lower risk of ICU mortality compared to normal weight, a finding which persisted across all models (model 2: aOR 0.83, 95%CI 0.69–0.99; p = 0.04; model 3: aOR 0.82, 95%CI 0.68–0.98; p = 0.03). The protective effect of obesity and the negative effect of underweight were significant in individuals > 65 years only. Conclusion In this cohort, underweight was associated with a worse outcome, whereas obese patients evidenced lower mortality. Our analysis thus supports the thesis of the obesity paradox.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

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