scholarly journals Enteral Nutrition Feeding Adequacy among Mechanically Ventilated Critically Ill Patients with High Nutrition Risk in a selected Public Hospital in Malaysia : A preliminary study

2016 ◽  
Vol 4 (1) ◽  
pp. 9-13
Author(s):  
Zheng Yii Lee ◽  
Mohd Yusof Barakatun Nisak ◽  
Ibrahim Noor Airini
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Therapy ◽  
Critically Ill Patient ◽  
Protein Requirement ◽  
Nutrition Risk ◽  
Mechanically Ventilated ◽  
Icu Admission ◽  
Risk Patients ◽  
Nutrition Intake

Background : Critically Ill patients with high nutrition risk require optimal amount of nutrition therapy for a better clinical outcome.Objective : The objective of this study was to study EN feeding adequacy among mechanically ventilated critically ill patient with high nutrition risk.Method : A prospective observational study was carried out at General Intensive Care Unit (ICU), Hospital Serdang. Adult patients (? 18 years old) who were intubated and mechanically ventilated within 48 hours of ICU admission, stayed in ICU for ? 72 hours and exclusively fed with EN were included. Eligible patients were followed in ICU for a maximum of 12 days or until death or discharge from ICU. High nutrition risk is determined by a validated nutrition risk screening tool -- the Modified Nutrition Risk in the Critically Ill (NUTRIC) score of ? 6.Results : A total of 25 patients were sampled. Mean age was 53 ± 17 years and mean BMI was 26.3 ± 5.3 kg/m2. Median time of EN initiation since ICU admission was 8 (Interquartile range [IQR] 3.5-17.5) hours. Among 17 (68%) patients with high nutrition risk, 15 (88.2%) did not receive the recommended optimal nutrition requirement (? 80% of calculated energy and protein requirement), despite the fact that the overall energy and protein adequacy was 71.8 ± 14.8% and 62.4 ± 15.1%, performing better than the international average of 61.2 ± 29.4% and 57.6% ± 29.6%, respectively.Conclusion : EN feeding adequacy was suboptimal among critically ill patients with high nutrition risk, as evidenced by 88.2% of high nutrition risk patients not receiving the recommended energy and protein requirement. Identification of patients with high nutrition risk is important to optimize nutrition intake in patients most likely to benefit from optimal amounts of nutrition therapy.Bangladesh Crit Care J March 2016; 4 (1): 9-13

scholarly journals Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Al Juhani ◽  
Ghazwa B. Korayem ◽  
Khalid Eljaaly ◽  
Alaa Alhubaishi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Outcomes ◽  
Multicenter Cohort Study ◽  
Mechanically Ventilated ◽  
Icu Admission ◽  
Early Use ◽  
Late Group

Abstract Rationale: It is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. Objectives: To evaluate the appropriate timing of systemic dexamethasone initiation in critically ill patients with COVID-19. Methods: A multicenter, non-interventional cohort study including adults with COVID-19 patients admitted to intensive care units (ICUs) received systemic dexamethasone between March 2020 and January 2021. Patients were divided into two groups based on the timing for dexamethasone use (early vs. late). Early use is defined as the new initiation of dexamethasone within 24 hours of ICU admission. Propensity score matching was used based on the patient’s SOFA score, MV within 24 hours of ICU admission, proning status, and tocilizumab use during ICU stay. Results: A total of 480 patients were included in the study; dexamethasone was initiated early within 24 hours of ICU admission in 367 patients. Among 202 patients matched using propensity score, 101 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). The 30-day mortality (OR [95%CI]: 1.82[1.04, 3.19], P=0.04) and in-hospital mortality (OR [95%CI]: 1.80[1.03, 3.15], P=0.04) were higher in the late group. Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 3.8 [1.41, 10.3], P=0.008). Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 was associated with mortality benefits. Moreover, dexamethasone's early use might be considered a proactive measure in non-mechanically ventilated critically ill patients with COVID-19, to prevent further complications.

scholarly journals Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Al Juhani ◽  
Ghazwa B. Korayem ◽  
Khalid Eljaaly ◽  
Alaa Alhubaishi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Outcomes ◽  
Multicenter Cohort Study ◽  
Mechanically Ventilated ◽  
Icu Admission ◽  
Early Use ◽  
Late Group

Abstract Rationale: It is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. Objectives: To evaluate the appropriate timing of systemic dexamethasone initiation in critically ill patients with COVID-19. Methods: A multicenter, non-interventional cohort study including adults with COVID-19 patients admitted to intensive care units (ICUs) received systemic dexamethasone between March 2020 and January 2021. Patients were divided into two groups based on the timing for dexamethasone use (early vs. late). Early use is defined as the new initiation of dexamethasone within 24 hours of ICU admission. Propensity score matching was used based on the patient’s SOFA score, MV within 24 hours of ICU admission, proning status, and tocilizumab use during ICU stay. Results: A total of 480 patients were included in the study; dexamethasone was initiated early within 24 hours of ICU admission in 367 patients. Among 202 patients matched using propensity score, 101 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). The 30-day mortality (OR [95%CI]: 1.82[1.04, 3.19], P=0.04) and in-hospital mortality (OR [95%CI]: 1.80[1.03, 3.15], P=0.04) were higher in the late group. Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 3.8 [1.41, 10.3], P=0.008). Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 was associated with mortality benefits. Moreover, dexamethasone's early use might be considered a proactive measure in non-mechanically ventilated critically ill patients with COVID-19, to prevent further complications.

scholarly journals Early Dexamethasone Use as A Protective Measure In Non-Mechanically Ventilated Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ghazwa B. Korayem ◽  
Khalid Eljaaly ◽  
Ali F. Altebainawi ◽  
Omar Al Harbi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Protective Measure ◽  
Multicenter Cohort Study ◽  
Mechanically Ventilated ◽  
Icu Admission ◽  
Multicenter Cohort ◽  
Early Use ◽  
Ventilated Patients

Abstract Background: Dexamethasone showed mortality benefits in COVID-19 patients. However, the optimal timing for dexamethasone initiation to prevent COVID-19 consequences such as respiratory failure requiring MV is debatable. As a result, the purpose of this study is to assess the impact of early dexamethasone initiation in non-MV critically ill patients with COVID19.Methods: A multicenter cohort study including adult patients with COVID-19 admitted to intensive care units (ICUs) and received systemic dexamethasone between March 2020 and March 2021. Patients were categorized into two groups based on the timing for dexamethasone initiation (early vs. late). The primary endpoint is developing respiratory failure that required MV; other outcomes were considered secondary. Propensity score matching was used based on the patient’s SOFA score, mechanical ventilation (MV) status, prone status, and early use of tocilizumab within 24 hours of ICU admission.Results: Among 208 patients matched using propensity score, 104 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 2.75 [1.12, 6.76], P=0.02). Additionally, late use was associated with longer hospital LOS (Est. [95%CI]: 0.55 [0.22, 0.88], P=0.001).The 30-day and in-hospital mortality were higher in the late group; however, were not statistically significant.Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 might be considered a proactive protective measure in non-mechanically ventilated patients.

scholarly journals Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Al Juhani ◽  
Ghazwa B. Korayem ◽  
Khalid Eljaaly ◽  
Alaa Alhubaishi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Outcomes ◽  
Multicenter Cohort Study ◽  
Mechanically Ventilated ◽  
Icu Admission ◽  
Multicenter Cohort ◽  
Early Use

Abstract Rationale: It is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. Objectives: To evaluate the appropriate timing of systemic dexamethasone initiation in critically ill patients with COVID-19. Methods: A multicenter, non-interventional cohort study including adults with COVID-19 patients admitted to intensive care units (ICUs) received systemic dexamethasone between March 2020 and January 2021. Patients were divided into two groups based on the timing for dexamethasone use (early vs. late). Early use is defined as the new initiation of dexamethasone within 24 hours of ICU admission. Propensity score matching was used based on the patient’s SOFA score, MV within 24 hours of ICU admission, proning status, and tocilizumab use during ICU stay. Results: A total of 480 patients were included in the study; dexamethasone was initiated early within 24 hours of ICU admission in 367 patients. Among 202 patients matched using propensity score, 101 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). The 30-day mortality (OR [95%CI]: 1.82[1.04, 3.19], P=0.04) and in-hospital mortality (OR [95%CI]: 1.80[1.03, 3.15], P=0.04). Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 3.8 [1.41, 10.3], P=0.008) Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 was associated with mortality benefits. Moreover, dexamethasone's early use might be considered a proactive measure in non-mechanically ventilated critically ill patients with COVID-19, to prevent further complications.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Rene A. Posma ◽  
Trine Frøslev ◽  
Bente Jespersen ◽  
Iwan C. C. van der Horst ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Mortality ◽  
Prognostic Impact ◽  
Icu Admission ◽  
Lactate Levels ◽  
Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

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