Manejo do delirium em pacientes com internação prolongada em UTI / Delirium management in patients with prolonged ICU stay

Abstract Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

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Sarcopenia—The Impact on Physical Capacity of Liver Transplant Patients

Life ◽

10.3390/life11080740 ◽

2021 ◽

Vol 11 (8) ◽

pp. 740

Author(s):

Maciej Miarka ◽

Krzysztof Gibiński ◽

Maciej K. Janik ◽

Renata Główczyńska ◽

Krzysztof Zając ◽

...

Keyword(s):

Liver Transplant ◽

Common Factor ◽

Lumbar Vertebra ◽

Peak Oxygen Uptake ◽

Cardiac Biomarkers ◽

Skeletal Muscle Index ◽

Icu Stay ◽

Prolonged Icu Stay ◽

Related Liver Disease ◽

The Impact

Optimizing patients’ condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = −0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.

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Prediction of Prolonged ICU Stay in Cardiac Surgery Patients as a Useful Method to Identify Nutrition Risk in Cardiac Surgery Patients: A Post Hoc Analysis of a Prospective Observational Study

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1486 ◽

2018 ◽

Vol 43 (6) ◽

pp. 768-779 ◽

Cited By ~ 9

Author(s):

Christian Stoppe ◽

Julia Ney ◽

Vladimir V. Lomivorotov ◽

Sergey M. Efremov ◽

Carina Benstoem ◽

...

Keyword(s):

Cardiac Surgery ◽

Observational Study ◽

Prospective Observational Study ◽

Nutrition Risk ◽

Post Hoc Analysis ◽

Icu Stay ◽

Prolonged Icu Stay ◽

Post Hoc

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Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

10.21203/rs.2.18217/v3 ◽

2020 ◽

Author(s):

laura Allum ◽

Chloe Apps ◽

Nicholas Hart ◽

Natalie Pattison ◽

Bronwen Connolly ◽

...

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Care Delivery ◽

Cochrane Library ◽

Future Research ◽

Care Plans ◽

Icu Stay ◽

Structured Care ◽

High Dependency ◽

Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety, however these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational, and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

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Abstract 17348: Clinical Outcomes in Acute Coronary Syndrome Patients Following Coronary Artery Bypass Grafting in Relation to Timing of Ticagrelor Discontinuation: Insights From the CAPITAL Registry

Circulation ◽

10.1161/circ.132.suppl_3.17348 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Juan J Russo ◽

Tyler E James ◽

Nikita Malhotra ◽

Daniel Goubran ◽

Fraser D Rubens ◽

...

Keyword(s):

Clinical Outcomes ◽

Artery Bypass ◽

Postoperative Bleeding ◽

Significant Proportion ◽

Timing Of Surgery ◽

Blood Transfusions ◽

Bypass Grafting ◽

Coronary Syndrome ◽

Icu Stay ◽

Prolonged Icu Stay

Background: We sought to assess in-hospital clinical outcomes in ACS patients undergoing CABG in relation to the duration of ticagrelor discontinuation prior to surgery. Methods: We identified consecutive ACS patients who underwent CABG after having received ticagrelor. Patients were divided into 3 groups based on the timing of surgery after discontinuation of ticagrelor (<48 hours, 48 hours to <5 days, 5 days or more). We then compared clinical outcomes following CABG in relation to the duration of ticagrelor discontinuation prior to surgery. Clinical variables evaluated included postoperative bleeding, need for surgical reopening or blood transfusions, and length of stay in the intensive care unit (ICU). Results: Of 664 ACS patients undergoing CABG between January 2012 and March 2015, 53 received ticagrelor prior to CABG. Ticagrelor had been discontinued <48 hours prior to CABG in 22 patients (41%); 48 hours to <5 days in 19 (36%); and 5 days or more in 12 (23%). Patients who underwent CABG <48 hours after ticagrelor discontinuation were more likely to require blood transfusions and a prolonged ICU stay (defined as >3 days). In addition, they had numerically higher, but non-statistically significant, rates of postoperative bleeding. Patients who underwent CABG 48 hours to <5 days after ticagrelor discontinuation had similar rates of postoperative bleeding and duration of ICU stay compared to patients who waited at least 5 days. Conclusions: A significant proportion of ACS patients (77%) who require CABG undergo surgery before the guideline recommended ticagrelor discontinuation period of 5 days. Patients who undergo CABG <48 hours after ticagrelor discontinuation are more likely to require postoperative blood transfusions and a prolonged ICU stay. Notably, patients who undergo CABG 48 hours to <5 days after ticagrelor discontinuation have similar postoperative outcomes compared to patients who undergo CABG after 5 days of ticagrelor discontinuation.

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Prognostic Value of GDF-15 in Predicting Prolonged Intensive Care Stay following Cardiac Surgery: A Retrospective Case-Control Study

10.21203/rs.3.rs-194462/v1 ◽

2021 ◽

Author(s):

Henry Barton ◽

Elisabeth Zechendorf ◽

Dirk Ostareck ◽

Antje Ostareck-Lederer ◽

Christian Stoppe ◽

...

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Confidence Interval ◽

Prediction Models ◽

Unit Length ◽

Icu Stay ◽

Intensive Care Stay ◽

Cardio Pulmonary Bypass ◽

Prolonged Icu Stay ◽

Pulmonary Bypass

Abstract Background: Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Methods: We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardio-pulmonary bypass time and indicators of organ dysfunction.Results: Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis we could show that preoperatively raised levels of GDF-15 was positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardio-pulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% Confidence Interval 1 – 1.02, p= 0.029). On ROC curves, GDF-15 was found to predict prolonged ICU stay (AUC= 0.86, 95% Confidence Interval 0.71 – 0.99, p= 0.003).Conclusion: GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.

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Hypotonic fluids after liver transplantation may be associated with prolonged ICU stay

Critical Care ◽

10.1186/cc13347 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P157

Author(s):

A Nadeem ◽

N Salahuddin ◽

A ElHazmi ◽

M Joseph ◽

B Bohlega ◽

...

Keyword(s):

Liver Transplantation ◽

Icu Stay ◽

Hypotonic Fluids ◽

Prolonged Icu Stay

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The Impact of an ICU Liaison Nurse on Discharge Delay in Patients after Prolonged ICU Stay

Anaesthesia and Intensive Care ◽

10.1177/0310057x0603400101 ◽

2006 ◽

Vol 34 (1) ◽

pp. 55-60 ◽

Cited By ~ 34

Author(s):

W. Chaboyer ◽

L. Thalib ◽

M. Foster ◽

D. Elliott ◽

R. Endacott ◽

...

Keyword(s):

Icu Stay ◽

Prolonged Icu Stay ◽

The Impact ◽

Liaison Nurse

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Plasma MicroRNA-21 Predicts Postoperative Pulmonary Complications in Patients Undergoing Pneumoresection

Mediators of Inflammation ◽

10.1155/2016/3591934 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Yaling Liu ◽

Peiying Li ◽

Xinyu Cheng ◽

Weifeng Yu ◽

Liqun Yang ◽

...

Keyword(s):

Thoracic Surgery ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complication ◽

Icu Stay ◽

Increased Risk ◽

Diagnostic Role ◽

Prolonged Icu Stay ◽

Plasma Microrna ◽

Plasma Mirna

Postoperative pulmonary complication (PPC) remains the most common postoperative complication in patients undergoing noncardiac thoracic surgery. We conducted the clinical study to determine the diagnostic role of miRNA-21 in noncardiac thoracic surgery. 368 patients undergoing noncardiac thoracic surgery were recruited. Blood samples were collected before anesthesia and 2 hours after incision during surgery for RT-PCR measurement of miRNA-21. PPC occurrence, extrapulmonary complications, duration of ICU stay, and death within 1 year were evaluated. The overall rate of PPCs following surgery was 10.32%. A high relative miRNA-21 level was an independent risk factor for PPCs within 7 days (OR, 2.69; 95% CI, 1.25–5.66; andP<0.001). High miRNA-21 was also associated with an increased risk of extrapulmonary complications (OR, 3.62; 95% CI, 2.26–5.81; andP<0.001), prolonged ICU stay (OR, 6.54; 95% CI, 2.26–18.19; andP<0.001), increased death within 30 days (OR, 6.17; 95% CI, 2.11–18.08; andP<0.001), and death within 1 year (OR, 7.30; 95% CI, 2.76–19.28; andP<0.001). In summary, plasma miRNA-21 may serve as a novel biomarker of PPCs for patients undergoing noncardiac thoracic surgery.

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