FACTORS AFFECTING INTENSIVE CARE AND MORTALITY IN SARS-CoV 2019 HOSPITAL PATIENTS

2021 ◽  
pp. 7-11
Author(s):  
Gulfidan Uzan ◽  
Bedriye Kar ◽  
Evren Canel Karakas ◽  
Macit Koldas ◽  
Mehmet Mesut Sonmez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Laboratory ◽  
Treatment Options ◽  
Shortness Of Breath ◽  
Factors Affecting ◽  
Laboratory Parameters ◽  
Radiological Data ◽  
Hospital Patients

Backround: Information on prognosis and treatment in COVID-19 is limited and variable. We wanted to report the demographic, clinical, laboratory, radiological data and treatment and follow-up results of our patients diagnosed with COVID-19 in the study and to determine the factors affecting prognosis and mortality. Materials-methods: The study included 1161 inpatients with PCR positive and/or radiologically diagnosed COVID-19 pneumonia. Of these, 151 patients were taken to the intensive care unit and 37 patients were intubated. The data obtained through the system were evaluated retrospectively and observationally. Results: The mean age of 1161 inpatients was 54.5 years and 616 (53.1%) were male. 104 (8.9%) of 1161 inpatients died. 151 (13%) were taken to the intensive care unit. Of these, 37 (24.5%) were intubated. The analysis revealed age(p<0.001), gender(p<0.001), presence of comorbid disease (p<0.001), cough(p<0.001), shortness of breath (p<0.001), fatigue and malaise symptoms (p<0.001) and in the laboratory and signicant correlation was found with some laboratory parameters and some treatment options (p<0.001).When the living and deceased patients were compared; age (p<0.001), gender(p=0.001), presence of additional disease (p<0.001), cough(p<0.001), shortness of breath (p<0.001), malaise and fatigue symptoms (p<0.001), in the laboratory; signicant correlation was found with some laboratory parameters and some treatment options (p<0.001).Conclusion: We believe that these data obtained in our study will be important in predicting prognosis and mortality and in effective patient management. We wanted to emphasize that hydroxychloroquine, favipravir, methylprednisolone and enoxoparin are effective in reducing mortality in the treatment.

Aminoglycoside Dosing Considerations in Intensive Care Unit Patients

1993 ◽  
Vol 27 (3) ◽  
pp. 351-357 ◽  
Author(s):  
Sharon M. Watling ◽  
Joseph F. Dasta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Concentrations ◽  
Once Daily ◽  
Factors Affecting ◽  
Study Selection ◽  
Aminoglycoside Toxicity ◽  
Dosing Regimens

OBJECTIVE: Factors affecting aminoglycoside dosing requirements in critically ill adult patients were reviewed. DATA SOURCES: A literature search was performed from 1979 to 1992 and articles pertaining to aminoglycoside dosing were obtained. STUDY SELECTION: Only studies appearing in peer-reviewed journals were selected. Topics selected included: Bactericidal kill kinetics, once-daily dosing regimens, critical illness, toxicity, aminoglycosides, intensive care unit, and lung penetration. CONCLUSIONS: Studies suggest that larger initial aminoglycoside doses are necessary in critically ill patients (tobramycin/gentamicin 3 mg/kg or amikacin 9 mg/kg) to achieve adequate peak serum concentrations. Current studies have not shown an increase in the incidence of aminoglycoside toxicity when using these larger initial doses. Follow-up monitoring is dependent upon the patient's physiology and risk factors for aminoglycoside-induced toxicity.

scholarly journals Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Abraham Markin ◽  
Diego F. Cabrera-Fernandez ◽  
Rebecca M. Bajoka ◽  
Samantha M. Noll ◽  
Sean M. Drake ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Treatment Options ◽  
Educational Interventions ◽  
Family Conference ◽  
Internal Medicine Residents ◽  
Simulation Based ◽  
Eol Care

Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU.Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis.Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean;pvalue), including discussing bad news (3.3; 4.2;p<0.01), conducting a family conference (3.1; 4.1;p<0.01), discussing treatment options (3.2; 3.9;p<0.01), discussing discontinuing ICU treatments (2.9; 3.5;p<0.01), and expressing empathy (3.9; 4.5;p<0.01). Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly.Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents’ confidence to discuss EOL care with family members of patients in the ICU.

scholarly journals Evaluation of COVID-19 Patients Admitted to Pediatric Emergency Department

2021 ◽  
pp. 111-116
Author(s):  
Murat Doğan ◽  
Binnaz Çelik
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Laboratory ◽  
Pediatric Emergency ◽  
World Health ◽  
Older Children ◽  
Laboratory Findings ◽  
Asymptomatic Patients ◽  
Radiological Data ◽  
Health Organization

The Coronavirus disease (COVID-19) rapidly spread all around the world and was declared a worldwide pandemic by World Health Organization in March 2020. We aimed to investigate the clinical, demographic and laboratory characteristics of COVID-19 in children admitted to the pediatric emergency triage. Epidemiological, clinical, laboratory, and radiological data of children were collected retrospectively and analyzed to compare by symptoms. A total of 213 pediatric cases with COVID-19 were included. Most of the patients were asymptomatic (63.8%). The main clinical features were mild symptoms including fever (7.5%), cough (6.5%), myalgia (6.3%) or no (63.8%). Of the patients who had CT scan, 25% had specific findings of COVID-19. Ground-like opacities were common radiological findings (25%). Symptomatic patients had higher lymphopenia rate (p=0.03), higher CRP and procalcitonin (PCT) values (p=0.04, p=0.04), lower age (p<0.001) and lower neutrophil count (p=0.01). The rate of neutropenia and leukopenia were higher in asymptomatic patients (p=0.15, p=0.05, respectively). The most common cause of transmission in children is family contact. Home isolation was recommended for 89.6% of the patients, 10.3% were hospitalized, 2.3% needed an intensive care unit (ICU). Only one death was reported. We found found that children with COVID-19 are generally mild severe or asymptomatic clinic. Young children were relatively more symptomatic than older children, and those with underlying diseases often needed intensive care unit. The most important laboratory findings difference between symptomatic and asymptomatic patients are lymphopenia, increased CRP and PCT values (p=0.04 for all three parameter).

scholarly journals Evaluation of Epidemiological, Paraclinical, and Imaging Findings of Patients With ‎Covid-19 Hospitalized in Intensive Care Unit of Rasht Hospitals in March 2020

2021 ◽  
Vol 30 (2) ◽  
pp. 84-97
Author(s):  
Mohammad Haghighi ◽  
◽  
Hossein Khoshrang ◽  
Samaneh Ghazanfar Tehran ◽  
Pegah Aghajanzadeh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Clinical Laboratory ◽  
Underlying Disease ◽  
Demographic Characteristics ◽  
Imaging Features ◽  
Shortness Of Breath ◽  
Imaging Findings ◽  
Laboratory Findings

Background: Considering the high prevalence of Coronavirus Disease 2019 (COVID-19) and the medical resource constraints, a better understanding of the characteristics of the disease and identifying the factors indicating the severity of the disease‎ can help decide on the allocation of important and limited resources. The current study aimed to investigate the demographic, clinical, laboratory characteristics, and imaging features of critically-ill patients with COVID-19 who were admitted to the Intensive Care Unit )ICU) of 3 hospitals in Rash City, Iran. Objective: This retrospective study was performed on 138 patients with COVID-19 who were admitted to the ICU. The study patients’ data, including demographic characteristics, underlying disease, laboratory, imaging findings, and disease outcome were extracted from their records. Methods: This retrospective study was performed on 138 patients with COVID-19 who were admitted to ICU. Patient data, including demographic characteristics, underlying disease, laboratory and imaging findings, and disease outcomes, were extracted from patient records. Results: In this study, the majority of patients were male and in the age range of 55-69 years. Diabetes mellitus, hypertension, and chronic heart disease were the most common underlying diseases; shortness of breath, fever, and cough were the most common symptoms. Ground glass opacities were the most common sign in lung Computer Tomography (CT) scan and an increase in the level of LDH, ESR, CRP, neutrophil percentage, and lymphopenia were the most common laboratory findings in the study subjects. The mortality rate was equal to 90.58%. Conclusion: This study revealed that most patients with severe manifestations of the disease were older, had a history of underlying disease, symptoms of shortness of breath, cough, and fever, and extensive lung involvement in imaging and changes in laboratory results. Mortality remained high despite medical therapy and mechanical ventilation.

scholarly journals Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

2020 ◽  
Vol 68 (1) ◽  
Author(s):  
Reem M. Soliman ◽  
Fatma Alzahraah Mostafa ◽  
Antoine Abdelmassih ◽  
Elham Sultan ◽  
Dalia Mosallam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

Family-Centered Care

PEDIATRICS ◽  
1994 ◽  
Vol 93 (6) ◽  
pp. 1023-1024
Author(s):  
Robert D. Cunningham
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
State Government ◽  
Neonatal Intensive Care ◽  
Developmental Outcomes ◽  
Third Parties ◽  
Adverse Impact ◽  
Centered Care ◽  
Family Centered

I read "The Principles for Family-Centered Neonatal Care" with great interest. As a physician who has worked in a state government-operated neonatal intensive care unit follow-up clinic, I agree wholeheartedly with the principle of open and honest communication between parents and professionals, especially regarding poor developmental outcomes. Unfortunately, physicians, despite their own feelings about this issue, may come under pressure from third parties to withhold certain information from families. In my own experiences, I have been drawn aside in private conversations and told that if I continue to tell parents that their child is mentally retarded or has cerebral palsy, it might have an adverse impact on my career.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

2021 ◽  
pp. 000992282110472
Author(s):  
Andrew Brown ◽  
Mary Quaile ◽  
Hannah Morris ◽  
Dmitry Tumin ◽  
Clayten L. Parker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Care Coordination ◽  
Chronic Conditions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Admission ◽  
Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

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