scholarly journals Progression of Fibrinogen Decrease during High Dose Tigecycline Therapy in Critically Ill Patients: A Retrospective Analysis

2021 ◽  
Vol 10 (20) ◽  
pp. 4702
Author(s):  
Benedikt Treml ◽  
Sasa Rajsic ◽  
Tobias Hell ◽  
Dietmar Fries ◽  
Mirjam Bachler
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Course ◽  
Surgical Intensive Care Unit ◽  
High Dose ◽  
Coagulation Disorder ◽  
Surgical Intensive Care ◽  
Intensive Care Patients

Tigecycline is a novel glycylcycline broad-spectrum antibiotic offering good coverage for critically ill patients experiencing complicated infections. A known side effect is a coagulation disorder with distinct hypofibrinogenemia. To date, the information on possible risk factors and outcomes is sparse. Therefore, the aim of this study is to examine the time course of fibrinogen level changes during tigecycline therapy in critically ill patients. Moreover, we sought to identify risk factors for coagulopathy and to report on clinically important outcomes. We retrospectively reviewed all intensive care patients admitted to our General and Surgical Intensive Care Unit receiving tigecycline between 2010 and 2018. A total of 130 patients were stratified into two groups based on the extent of fibrinogen decrease. Patients with a greater fibrinogen decrease received a higher dose, a longer treatment and more dose changes of tigecycline, respectively. In regard to the underlying pathology, these patients showed higher inflammation markers as well as a slightly reduced liver synthesis capacity. We, therefore, conclude that such a fibrinogen decrease may be based upon further impairment of liver synthesis during severe inflammatory states. To decrease the risk of bleeding, cautious monitoring of coagulation in critically ill patients treated with high-dose tigecycline is warranted.

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

scholarly journals AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

2020 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Sebastian Hafner ◽  
Florian Balling ◽  
Eberhard Barth
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Acetylcholinesterase Activity ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Baseline Values

Abstract Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020

Bedside Videolaryngoscopic Assessment of Intubation Trauma

1989 ◽  
Vol 98 (8) ◽  
pp. 586-590 ◽  
Author(s):  
David M. Alessi ◽  
David G. Hanson ◽  
George Berci
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vocal Fold ◽  
Video Recording ◽  
Surgical Intensive Care Unit ◽  
Voice Rehabilitation ◽  
Surgical Intensive Care ◽  
Vocal Fold Paresis

Telescopic laryngoscopic examination was performed at the bedside after extubation in 29 consecutive surgical intensive care unit patients who required endotracheal intubation for more than 16 hours. The examinations were documented with a portable video recording system. The majority of patients exhibited evidence of acute endolaryngeal trauma. Vocal fold ulceration and vocal fold motion abnormalities were the most common lesions. Patients with abnormal larynges were followed up after discharge from the intensive care unit. Most of the identified injuries resolved without intervention. However, silent aspiration was identified frequently in patients with vocal fold paresis and was thought to be a significant factor in postoperative pulmonary complications. Early identification of significant laryngeal trauma and/or vocal fold paresis in critically ill patients is important for both postoperative pulmonary care and voice rehabilitation. This pilot study demonstrated that documentation of the laryngeal examination is feasible in critically ill patients in an intensive care unit setting.

scholarly journals Efficacy of an 8-week Bedside Ultrasound Training Program for Surgical Residents in the Intensive Care Unit

2021 ◽  
Author(s):  
Kyoung Moo Im ◽  
Eun Young Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Training Program ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bedside Ultrasound ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Post Graduate ◽  
Surgical Residents

Abstract BackgroundBedside ultrasound has become one of the most important non-invasive and readily available diagnostic tools especially for critically ill patients. However, the current ultrasound training program is not standardized and is mostly unavailable to all surgical residents equally. The aim of this study was to assess and evaluate the effectiveness of our new training program in bedside ultrasound for surgical residents.MethodsPostgraduate residents (years 1 to 4) from the department of general surgery in a tertiary hospital attended the newly designed, 8-week training course in bedside ultrasound for critically ill patients at the surgical intensive care unit. Didactic and experimental lectures in basic ultrasound physics and machine usage were delivered, followed by daily hands-on ultrasound training to patients. Each participant prospectively documented their ultrasound findings and completed self-assessment of ultrasound skills using a Likert scale.Results44 residents were enrolled in the current study and only 36.4% of them were previously exposed to bedside ultrasound experience. Following the course completion, the proficiency levels and the objective structured assessment of ultrasound skill (OSAUS) scores showed significant improvement in all elements (P < 0.001). The mean differences in pre- and post-course score between post-graduate years were recorded, except for proficiency in peritoneal cavity (P = 0.163). Post-hoc analysis revealed that post-graduate year 2 residents showed a higher improvement in most elements. The training program showed improvement in post-course scores, whether or not residents had previous experience.ConclusionsOur results revealed that the knowledge and confidence of surgical residents in bedside ultrasound could be improved via short-term and impact training curriculum. The authors believe that such education should be encouraged for all surgical residents to enhance competency in performing bedside ultrasound evaluation of critically ill patients.

scholarly journals Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Christoph Sponholz ◽  
Ole Bayer ◽  
Björn Kabisch ◽  
Karin Wurm ◽  
Katharina Ebert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Span ◽  
Unfractionated Heparin ◽  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Filter Life

Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001). Femoral vascular access was associated with reduced filter life span (P=0.012), especially under heparin anticoagulation (P=0.015). Patients on RAC had higher rates of metabolic alkalosis (P=0.001), required more transfusions (P=0.045), and showed higher illness severity measured by SOFA scores (P=0.001). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

Predicting the risk of pressure ulcers in critically ill patients

1999 ◽  
Vol 8 (4) ◽  
pp. 262-269 ◽  
Author(s):  
EV Carlson ◽  
MG Kemp ◽  
S Shott
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Sensory Perception ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Braden Scale ◽  
The Mean

BACKGROUND: Critically ill patients are at high risk for pressure ulcers. OBJECTIVES: To determine the contributions of the Braden subscales in predicting pressure ulcers in critically ill patients and to investigate how often the Braden scale should be completed to assess the risk for pressure ulcers in critically ill patients. METHOD: The Braden scale was used to assess repeatedly 136 adult patients without pressure ulcers in a medical intensive care unit, a surgical intensive care unit, and a noninvasive respiratory care unit, and the patients' skin was inspected routinely for pressure ulcers. RESULTS: A total of 36 pressure ulcers, most commonly on the sacrum or coccyx and the heels (15 stage 1, 20 stage 2, 1 stage 3), developed in 17 patients (12%). In 14 (82%) of the 17, the ulcers developed within 72 hours of admission to the intensive care unit. The risk for pressure ulcers increased as the mean sensory perception (P = .01) and the mean total Braden (P = .046) scores decreased. The mean sensory perception scores obtained at 12 and 36 hours after admission also had a significant relationship to the risk for pressure ulcers (P = .03). CONCLUSIONS: Patients in intensive care units have an increased risk for pressure ulcers. Although waiting until 12 hours after a patient's admission to the intensive care unit to obtain the initial Braden rating may be reasonable (with the second rating obtained 36 hours after admission), additional research is needed before this practice can be recommended.

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