Predictors of Mortality in Ventilated Neonates in Intensive Care Unit

Background: A large number of neonates in intensive care unit require mechanicalventilation due to various conditions and have a high mortality. To reduce the highmortality in this group of neonates, identification of risk factors is important.Objective: This study was undertaken to find out the predictors of mortality in ventilatedneonates in the Intensive Care Unit.Methods: This study was carried out in the Intensive Care Unit of Dhaka ShishuHospital from March 2006 to November 2006. Neonates consecutively put onmechanical ventilation during the study period were enrolled. The enrolled neonateswere divided into two groups; neonates who died after putting to the ventilator were ingroup-I and neonates who survived after receiving mechanical ventilation were ingroup-II. Clinical, biochemical and ventilator parameters were analyzed to find out thepredictors of mortality of ventilated neonates.Results: During the study period total 51 out born very critically sick neonates wereventilated due to different causes. Out of these 51 neonates, 58.8% were male with amale to female ratio 1.42:1. Mean age, weight and gestational age were 5.3±6.5 days,2171±796.2 gm and 34.8±4.1 weeks respectively. Out of 51 mechanically ventilatedneonates enrolled for this study, 70.6% died. Factors significantly different in nonsurvivorswere mean weight, mean gestational age, initial arterial pH and duration ofhospital stay (p<0.05). Weight <2500gm, gestation <34weeks, initial pH <7.1, PaCO2>60 mmHg, serum sodium <130 mmol/l, serum potassium <3.5 mmol/l and FiO2>60% were significantly associated with mortality in neonates requiring mechanicalventilation (p <0.05). Significant relation with mortality was found in those neonateswho developed complications during ventilation (p=0.01).Conclusion: Among the analyzed factors weight <2500gm, gestation <34weeks,initial arterial pH <7.1, O2 saturation<80%, PaCO2 >60mmHg, FiO2 >60%,hyponatremia, hypokalemia and complications during ventilation were the significantpredictors of mortality in ventilated neonates in the intensive care unit.Key words: Neonates; mechanical ventilation; predictors of mortality.DOI: 10.3329/bjch.v33i3.5687Bangladesh Journal of Child Health 2009; Vol.33(3): 77-82

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Predictors of Ventilator Associated Pneumonia of Neonate in a Neonatal and Paediatric Intensive Care Unit

Bangladesh Journal of Child Health ◽

10.3329/bjch.v43i2.42552 ◽

2019 ◽

Vol 43 (2) ◽

pp. 90-96

Author(s):

Uzzal Kumar Ghosh ◽

Mohammad Monir Hossain ◽

Mahfuza Shirin ◽

Md Shafiul Hoque ◽

Sheikh Farjana Sonia ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Nosocomial Infection ◽

Gestational Age ◽

Pediatric Patients ◽

Prolonged Mechanical Ventilation ◽

Ventilator Associated Pneumonia ◽

Age Group ◽

Female Ratio

Background: Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia develops 48 hours or more after initiation of mechanical ventilation. Hospital acquired infection (HAI) is the second most common infection for the pediatric population. VAP about 20% of all HAI among patients in NICU & PICU. Higher mortality and morbidity rate for mechanically ventilated pediatric patients with VAP compared to those without VAP. Few data & very few researches exist regarding VAP in pediatric patients to identify risk factors of VAP and that might be helpful for preventing VAP. This study was done to find out the predictors of VAP of neonate in Neonatal and Pediatric Intensive Care Unit. Methodology: A prospective cohort study was carried out in NICU & PICU of Dhaka Shishu (Children) Hospital, Dhaka. Neonates those not had pneumonia; requiring mechanical ventilation at least 48 hours in the NICU or PICU were taken for this study. Then VAP patients were selected by radiographic changes after 48 hours of intubation. Portable chest x-ray was done after 48 hours and as required after initiation of ventilation. Then details history were taken and some relevant investigation were done. Result: Majority (51.4%) of the neonates belonged to age group 0-10 days. Male female ratio was 2.8:1. More than half (51.4%) were of gestational age 34 to < 37 weeks. Sixty nine point four percent of the neonates had Weight < 2.5 kg. Transferred from other NICU or PICU was found in 34.7% , prolonged mechanical ventilation was found in 40.3%, reintubation were 36.1%, prior antibiotics use were 73.6%, nosocomial infection were 76.4%, oropharyngeal aspiration were 11.1% and those having VAP were 79.2%. Age group 11-20 days (RR=1.41; 95% CI 1.18 to 1.67), gestational age <37 weeks (RR=1.48; 95% CI 1.12 to 1.96), weight <2.5 kg (RR=2.24; 95% CI 1.20 to 4.18%), nosocomial infection (RR= 3.21; 95% CI 1.53 to 6.73%), transferred from other NICU & PICU (RR=1.47; 95% CI 1.21 to 1.79), Prolonged Mechanical Ventilation (RR=1.50; 95% CI 1.01 to 2.23%) and Reintubation (RR=1.48; 95% CI 1.21 to 1.81%) were found independent predictors for developing VAP. P value was found statistically significant (p<0.05). Conclusion: Age group 11-20 days, gestational age <37 weeks, weight <2.5 kg, transferred from other NICU & PICU, prolonged mechanical ventilation, reintubation and nosocomial infection were regarded as predictors for VAP and those predictors were significantly associated with VAP. Bangladesh J Child Health 2019; VOL 43 (2) :90-96

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Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0653 ◽

2021 ◽

Vol 74 (6) ◽

Author(s):

Caroline Gonçalves Pustiglione Campos ◽

Aline Pacheco ◽

Maria Dagmar da Rocha Gaspar ◽

Guilherme Arcaro ◽

Péricles Martim Reche ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Diagnostic Criteria ◽

Statistical Tests ◽

Significant Risk ◽

Diagnostic Methods ◽

Ventilator Associated Pneumonia

ABSTRACT Objectives: to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. Methods: retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. Results: the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. Conclusions: patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.

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Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

European Respiratory Review ◽

10.1183/16000617.0061-2018 ◽

2018 ◽

Vol 27 (150) ◽

pp. 180061 ◽

Cited By ~ 5

Author(s):

Julio A. Huapaya ◽

Erin M. Wilfong ◽

Christopher T. Harden ◽

Roy G. Brower ◽

Sonye K. Danoff

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Interstitial Lung Disease ◽

Mortality Rate ◽

Lung Disease ◽

Mortality Rates ◽

Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

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Incidence and Characteristics of Infants with Retinopathy of Prematurity in Croatia

Integrative Pediatrics and Child Care ◽

10.18314/ipcc.v1i1.1258 ◽

2018 ◽

Vol 1 (1) ◽

pp. 35-45

Author(s):

Mirjana Vucinovic ◽

Ljubo Znaor ◽

Ana Vucinovic ◽

Vesna Capkun ◽

Julijana Bandic

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Small For Gestational Age ◽

Neonatal Intensive Care ◽

Type 1 Rop

PURPOSE: To study the incidence of retinopathy of prematurity (ROP) in a neonatal intensive care unit in Croatia and obtain information on risk factors associated with ROP. There have been limited studies on ROP in Croatia where the screening for ROP and its treatment is still insufficient and not introduced in many intensive care units. MATERIAL AND METHODS: This retrospective study included 247 premature infants admitted to the neonatal intensive care unit of University Hospital Split, over a 5-year period between January 2012, and December 2016. In this paper the relationship between clinical risk factors and the development of ROP was analyzed. RESULTS: The overall incidence for ROP was 23,9 % (59 infants), for Type 1 ROP was 9,3% (23 infants); for Type 2 ROP was 14,6% (36 infants). Median gestational age (GA) and birthweight (BW) were significantly lower among infants with ROP versus those without ROP (29: 23-34 vs. 31: 23-34,p<0,001 and 1,180:630-2,000 vs. 1485:590-2000, p<0,001 respectively). Multivariate analysis showed that only BW (p=0,029) and small for gestational age (SGA) (p=0,045) predicted the development of ROP. CONCLUSION: Birth weight and small for gestational age were the most significant risk factors for developing ROP. In comparison with studies from highly developed countries, infants with a much wider range of gestational age and birth weights are developing Type 1 ROP.

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Evaluation of Clinical Characteristics and Outcomes of Obstetric Patients Admitted to Intensive Care Unit

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i1.167 ◽

2018 ◽

Vol 6 (1) ◽

pp. 11-16

Author(s):

Deepak Shrestha ◽

Shreyashi Aryal ◽

Sebina Baniya

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Blood Loss ◽

Gestational Age ◽

Near Miss ◽

Hypertensive Disorder ◽

Obstetric Hemorrhage ◽

Surgical Interventions ◽

Emergency Cesarean

Introduction: The need for critical care support and admission to intensive care unit (ICU) in obstetric population is infrequent. The proportion ranges from 0.1 to 8.5%. Yet, obstetric admissions to ICU and mortality continue to have a significant impact on overall maternal health care. The study of epidemiology and predictors of obstetric admissions to ICU will prove a useful proxy for better understanding maternal near miss events and mortality. Methods: This was a case control study reviewing all the obstetric cases admitted to ICU over a study period of five years. The individual files were recovered from the record section and data pertaining to referral status, demographics, clinical profile and ICU information were retrieved. The ICU data comprised of the length of ICU stay, indications for admission, interventions required, and outcomes. The data were then compared to historical controls. Results: A total of 80 patients were admitted to ICU accounting for 0.84% of total deliveries and 4.6% of total ICU admissions. Mean age was 24.84 years, mean gestational age was 32.33 weeks, and mean blood loss was 707.27 ml. Hypertensive disorder of pregnancy followed by obstetric hemorrhage were the most common indications. Lower gestational age, increased blood loss, emergency cesarean sections, and surgical interventions were noteworthy risk factors for ICU admissions. There was a mortality rate of 5%. Conclusion: Hypertensive disorders account for the most number of admissions to ICU followed by obstetric hemorrhage. Lower gestational age, increased blood loss and emergency cesarean section are notable risk factors for ICU admission.

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Incidence of Delirium in Critically Ill Cancer Patients

Pain Research and Management ◽

10.1155/2018/4193275 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Luis A. Sánchez-Hurtado ◽

Nancy Hernández-Sánchez ◽

Mario Del Moral-Armengol ◽

Humberto Guevara-García ◽

Francisco J. García-Guillén ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Cancer Patients ◽

Critically Ill ◽

Potential Risk ◽

Assessment Method ◽

Icu Stay ◽

Potential Risk Factors

Objective. The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods. This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient’s ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results. There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion. Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

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Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620967083 ◽

2020 ◽

Vol 26 ◽

pp. 107602962096708

Author(s):

Belayneh Kefale ◽

Gobezie T. Tegegne ◽

Amsalu Degu ◽

Melaku Tadege ◽

Desalegn Tesfa

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

English Language ◽

Meta Analysis ◽

Thrombotic Event ◽

Cochrane Library ◽

Pooled Prevalence ◽

D Dimer

Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

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Risk Factors for Falls among Hospitalized Trauma Patients

The American Surgeon ◽

10.1177/000313481307900520 ◽

2013 ◽

Vol 79 (5) ◽

pp. 465-469 ◽

Cited By ~ 3

Author(s):

Carlos V. R. Brown ◽

Sadia Ali ◽

Romeo Fairley ◽

Bryan K. Lai ◽

Justin Arthrell ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Fall Prevention ◽

Male Gender ◽

Trauma Patients ◽

Inpatient Falls ◽

Serious Injury

Inpatient falls lead to an injury in 30 per cent of cases and serious injury in 5 per cent. Increasing staffing and implementing fall prevention programs can be expensive and require a significant use of resources. We hypothesized that trauma patients have unique risk factors to sustain a fall while hospitalized. This is a retrospective cohort study from 2005 to 2010 of all trauma patients admitted to an urban Level I trauma center. Patients who fell while hospitalized were compared with patients who did not fall to identify risk factors for sustaining an inpatient fall. There were 16,540 trauma patients admitted during the study period and 128 (0.8%) fell while hospitalized. Independent risk factors for a trauma patient to fall while hospitalized included older age (odds ratio [OR], 1.02 [1.01 to 1.03], P < 0.001), male gender (OR, 1.6 [1.0 to 2.4], P = 0.03), blunt mechanism (OR, 5.1 [1.6 to 16.3], P = 0.006), Glasgow Coma Score at admission (OR, 0.59 [0.35 to 0.97], P = 0.04), intensive care unit admission (OR, 2.3 [1.4 to 3.7], P = 0.001), and need for mechanical ventilation (OR, 2.2 [1.2 to 3.9], P = 0.01). Trauma patients who fell while hospitalized sustained an injury in 17 per cent of cases and a serious injury in 5 per cent. Inpatient falls in hospitalized trauma patients are uncommon. Risk factors include older age, male gender, blunt mechanism, lower Glasgow Coma Score, and the need for intensive care unit admission or mechanical ventilation. Trauma patients with these risk factors may require higher staffing ratios and should be enrolled in a formal fall prevention program.

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Nosocomial Sepsis and its Risk Factors: A Cross-Sectional Study in a Neonatal Intensive Care Unit

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v2i1.24970 ◽

2019 ◽

Vol 2 (1) ◽

pp. 52-59

Author(s):

Sunil Kumar Yadav ◽

SP Yadav ◽

P Kanodia ◽

N K Bhatta ◽

R R Singh ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Nosocomial Sepsis

Introduction: Nosocomial sepsis is a common and serious infection of neonates who are admitted in intensive care unit. They lead to significant morbidity and mortality in both developed and resource limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating the infections and, hence, needs preventive intervention. The study was carried out to determine the risk factors for nosocomial sepsis in neonatal intensive care unit. Material and Methods: This was a cross-sectional study conducted in a seven bedded teaching and referral hospital NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Nosocomial sepsis was diagnosed according to the CDC criteria. Risk factors for nosocomial sepsis were analyzed with Chi-square test and Logistic regression model. P-value of <0.05 was considered significant. Results: Low birth weight (both preterm and IUGR) and mechanical ventilation were found to be related with nosocomial sepsis. Conclusions: Low birth weight and mechanical ventilation were the most important risk factors fornosocomial sepsis.

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

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2012/361292 ◽

2012 ◽

Vol 23 (4) ◽

pp. 173-178 ◽

Cited By ~ 14

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.

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