scholarly journals The Impact of Routine Cardiology Consultation on Critically Ill Patients with Elevated Troponin Levels

2020 ◽  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Elevated Troponin ◽  
Specific Context ◽  
Coronary Syndrome ◽  
The Impact ◽  
Critical Care Patients

Cardiac troponin (cTn) is used to diagnose acute coronary syndrome (ACS). However, cTn can also be elevated in critically ill patients secondary to demand ischaemia or myocardial injury. In a meta-analysis of 20 different studies involving critically ill patients, cTn was found to be elevated in 43% of patients.1 Prior studies have evaluated the significance of cTn as a prognostic factor and mortality predictor in different clinical entities in intensive care units (ICU).2,3 However, the data on the impact of cardiology consultation on the outcomes in this specific context of critical care patients are limited. While prior studies have addressed such an impact on the outcomes among different groups of surgical patients,4,5 to the authors’ knowledge, no prior studies have examined that impact on critically ill patients with elevated cTn. This study aimed to investigate the impact of cardiology consultation on critically ill patients in the medical ICU with elevated cTn and no signs of ACS.

scholarly journals Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit

2021 ◽  
Author(s):  
Sunil K. Nadar ◽  
Muhammad M. Shaikh ◽  
Muhammad A. Khatri ◽  
Wael A. Abdelmottaleb ◽  
Sheeraz Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Myocardial Injury ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Coronary Syndrome

Objectives: Critically ill patients have been shown to have raised troponins.  The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients. Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.

THE IMPACT OF ROUTINE CARDIOLOGY CONSULTATION ON CRITICALLY ILL PATIENTS WITH ELEVATED TROPONIN LEVELS

2020 ◽  
Vol 75 (11) ◽  
pp. 196
Author(s):  
Omar Kousa ◽  
Amr Essa ◽  
Muhammad Ahsan ◽  
Venkata Siva Kumar Pajjuru ◽  
Abedelrahman Anani ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Elevated Troponin ◽  
The Impact

Arginine Immunonutrition in Critically Ill Patients: A Clinical Dilemma

2004 ◽  
Vol 13 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Joyce K. Stechmiller ◽  
Beverly Childress ◽  
Tricia Porter
Keyword(s):  
Immune System ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Nutritional Deficiencies ◽  
Review Of The Literature ◽  
Clinical Dilemma ◽  
Enteral Formula ◽  
Meta Analyses

Commercial enteral nutritional formulas for enhancement of the immune system are widely used in critical care. Immunonutrition with arginine can enhance inflammatory and immunologic responses in animal models and in humans. Although clinical improvements in surgical patients have been reported, benefits in critically ill patients with systemic inflammatory response syndrome, sepsis, or organ failure are less clear. Recent meta-analyses on the use of immunonutrition with arginine in critically ill and surgical patients revealed methodological weaknesses in most published studies. Specifically, a meta-analysis indicated that critically ill patients with preexisting severe sepsis may have an increased mortality rate when fed an immunonutritional enteral formula that contains arginine. These findings brought about confusion and controversy over the use of immunonutritional formulas in subsets of critically ill patients. A review of the literature on the function of arginine, its effect on the immune system, its roles in immunonutrition and in the clinical outcomes of critically ill patients, and the implications for nursing practice indicated that the benefits of immunonutrition with arginine in critically ill patients are unproven and warrant further study. Until more information is available, nutritional support should focus primarily on preventing nutritional deficiencies rather than on immunomodulation.

RENAL OUTCOMES FOLLOWING HYDROXYETHYL STARCH RESUSCITATION: A META-ANALYSIS OF RANDOMISED TRIALS

2008 ◽  
Vol 31 (4) ◽  
pp. 26 ◽  
Author(s):  
Ryan Zarychanski ◽  
Alexis F Turgeon ◽  
Dean A Fergusson ◽  
Deborah J Cook ◽  
Paul Hébert ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Volume Resuscitation ◽  
Renal Outcomes ◽  
Risk Of Death ◽  
The Impact

Objectives: To evaluate the impact of HES solutions on adverse renal outcomes and mortality in critically ill patients requiring acute volume resuscitation. Design: Systematic review and meta-analysis of randomized controlled trials. Data Sources: We searched electronic databases from 1950 to 2007 (MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials, and the SCOPUS database). Conference proceedings and grey literature sources were also searched from 2002-2007. Review Methods: We included all randomised controlled trials of patients requiring acute volume resuscitation who received HES compared to an alternative resuscitation fluid. No restrictions were considered regarding language or publication type. Data were independently extracted in duplicate. Results:Of 2381 citations reviewed, we included 22 trials (n=1866) in the analysis. Patients receiving HES were more likely to receive renal replacement therapy [odds ratio [OR] 1.91 (95% confidence interval [CI] 1.22-2.99, I^210.5%)]. This was also true for patients with severe sepsis or septic shock [OR 1.82 (95% CI 1.27-2.62, I^20%)]. In high quality trials, multicentre trials, and in reports indicating adequate allocation concealment, there was a trend toward increased risk of death associated with HES. Other adverse events were not systematically evaluated and were poorly reported. Limitations: Considerable clinical and methodologic heterogeneity exists among these trials. Conclusions: The use of HES for volume resuscitation in critically ill patients is associated with increased use of renal replacement therapy and may result in increased mortality. We caution against the routine use of HES for volume resuscitation in critically ill patients.

scholarly journals Use of music to enhance sleep and psychological outcomes in critically ill patients: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e037561
Author(s):  
Lixia Chen ◽  
Fang Wang ◽  
Jianhua Li ◽  
Li Cui ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Psychological Outcomes ◽  
Risk Of Bias ◽  
Pharmacological Intervention ◽  
Controlled Trials ◽  
Music Listening ◽  
Cochrane Central Register ◽  
The Impact

IntroductionMusic listening is used as a non-pharmacological intervention in various populations with positive results; however, evidence for its effect on sleep and psychological outcomes in critically ill patients remains unclear. It is essential to understand the impact of music listening for critically ill patients to optimise care and minimise the risk for harm. We will assess whether music listening improves sleep and psychological outcomes in critically ill patients.Methods and analysisWe will systematically search scientific databases for relevant studies, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest, the Cochrane Central Register of Controlled Trials, China Biological Medicine Database, China National Knowledge Infrastructure Library, Wan fang databases, VIP Database for Chinese Technical Periodicals and the Chinese Clinical Trial Registry. Databases will be searched for articles published from inception to 10 June 2020. Music therapy journals and reference lists in some articles will be hand-searched. Grey literature will also be searched. We will include randomised and quasi-randomised controlled trials that used music listening to improve sleep and psychological outcomes in critically ill patients. The primary outcomes will be sleep-related outcomes, and secondary outcomes will be anxiety and depression scores and physiological outcomes. Two reviewers will independently verify study eligibility and methodological quality; disagreements will be resolved by a third reviewer or through discussion. The risk of bias will be independently determined using the Cochrane Risk of Bias Tool. The Consolidated Standards of Reporting Trials checklist will be used to examine the quality of included papers. Data will be extracted from eligible studies by two researchers. RevMan V.5.3 will be used for meta-analysis.Ethics and disseminationThis work will review existing trial data and will not introduce new patient data or interventions; therefore, ethics committee approval is not required. We will disseminate this protocol in a related peer-reviewed journal.PROSPERO registration numberCRD42019147202.

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