scholarly journals Adverse events during the intrahospital transfer of critically ill perioperative patients in a South African tertiary hospital

2020 ◽  
pp. 131-138
Author(s):  
LY Seilbea ◽  
K de Vasconcellos
Keyword(s):  
Intensive Care Unit ◽  
Adverse Event ◽  
Intensive Care ◽  
Adverse Events ◽  
South African ◽  
Critically Ill ◽  
Multivariable Analysis ◽  
Inotropic Support ◽  
Physiological Changes ◽  
Increased Risk

Background: Critically ill patients frequently require intrahospital transfer for diagnostic or therapeutic procedures, or transfer to the intensive care unit. Intrahospital transfer exposes patients to an increased risk of adverse events. The reported rate of adverse events ranges from 4.2% to 79% based on data from high income countries. There is limited data available on intrahospital transfers in the South African context. This study aimed to determine the incidence of adverse events during intrahospital transfer, the physiological effects of intrahospital transfer, identify potential risk factors for adverse events and determine if adverse events were associated with poor clinical outcomes. Methods: The study was a single-centre, prospective, observational study of adult patients undergoing transport between the operating theatre and the intensive care unit (or vice versa) of a tertiary academic hospital in South Africa. Demographic data, transfer data (including adverse events, and the physiological parameters of the patients before and after transfer), and intensive care unit outcome data was collected between September 2018 and May 2019. Results: Data on 94 transfers was collected. Adverse events occurred in 23.4% (95% CI 14.7–32.1%) of transfers. Clinical adverse events, namely hypotension requiring management, made up 55% of the adverse events, while the remaining were technical adverse events (32% monitor failure, 9% ventilator failure and 4% infusion pump failure). The median transfer time was 10 minutes. Patients who developed adverse events during transfer were significantly older (median age 48 years versus 37 years, p = 0.037) and were significantly more likely to be receiving inotropic support (81.8% versus 51.4%, OR 4.26; 95% CI 1.31–13.82, p = 0.011) than those who did not have adverse events. Only the association with inotropic support remained on multivariable analysis. Patients who suffered an adverse event during transfer had a significantly higher mortality than those who did not have an adverse event (63.6% versus 30.6%, OR 3.98; 95% CI 1.46–10.84, p = 0.005) on univariate analysis, however this association was no longer significant on multivariable analysis. Increasing age, inotropic support and transfer by a medical officer as opposed to a registrar remained significant predictors on multivariable analysis. Significant physiological changes were noted in 80.9% of patients, with 64.9% of patients showing deterioration in at least one physiological parameter. Conclusion: Adverse events are common during the transfer of critically ill patients between the operating theatre and the intensive care unit. Even in the absence of adverse events, physiological changes occur in the majority of patients undergoing transfer. Patients receiving inotropic support are at increased risk of adverse events during transfer and enhanced attention to pre-transfer preparation and intratransfer management is warranted in these patients. The potential associations between adverse events during transfer and transferring personnel and ICU mortality needs to be explored in further studies.

scholarly journals SAT-150 ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS IN A SOUTH AFRICAN TERTIARY INTENSIVE CARE UNIT

2019 ◽  
Vol 4 (7) ◽  
pp. S68
Author(s):  
R. AYLWARD ◽  
M. van Niekerk ◽  
D. Baker ◽  
J. Ensor ◽  
S. Pazi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
South African ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury

scholarly journals Low 25-Hydroxyvitamin D Levels on Admission to the Intensive Care Unit May Predispose COVID-19 Pneumonia Patients to a Higher 28-Day Mortality Risk: A Pilot Study on a Greek ICU Cohort

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3773
Author(s):  
Alice G. Vassiliou ◽  
Edison Jahaj ◽  
Maria Pratikaki ◽  
Stylianos E. Orfanos ◽  
Ioanna Dimopoulou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Vitamin D ◽  
Intensive Care ◽  
Critically Ill ◽  
Mortality Risk ◽  
Rank Test ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D

We aimed to examine whether low intensive care unit (ICU) admission 25-hydroxyvitamin D (25(OH)D) levels are associated with worse outcomes of COVID-19 pneumonia. This was a prospective observational study of SARS-CoV2 positive critically ill patients treated in a multidisciplinary ICU. Thirty (30) Greek patients were included, in whom 25(OH)D was measured on ICU admission. Eighty (80%) percent of patients had vitamin D deficiency, and the remaining insufficiency. Based on 25(OH)D levels, patients were stratified in two groups: higher and lower than the median value of the cohort (15.2 ng/mL). The two groups did not differ in their demographic or clinical characteristics. All patients who died within 28 days belonged to the low vitamin D group. Survival analysis showed that the low vitamin D group had a higher 28-day survival absence probability (log-rank test, p = 0.01). Critically ill COVID-19 patients who died in the ICU within 28 days appeared to have lower ICU admission 25(OH)D levels compared to survivors. When the cohort was divided at the median 25(OH)D value, the low vitamin D group had an increased risk of 28-day mortality. It seems plausible, therefore, that low 25(OH)D levels may predispose COVID-19 patients to an increased 28-day mortality risk.

scholarly journals Impact of ToxigenicClostridium difficileColonization on the Risk of SubsequentC. difficileInfection in Intensive Care Unit Patients

2015 ◽  
Vol 36 (11) ◽  
pp. 1324-1329 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Karen C. Carroll ◽  
Pranita D. Tamma ◽  
Madeleine L. Sudekum ◽  
Reno Frei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Relative Risk ◽  
Independent Risk Factor ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Johns Hopkins Hospital ◽  
Increased Risk ◽  
Colonization Rates

BACKGROUNDClostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal highC. difficilecolonization rates on admission.OBJECTIVETo determine the rate of colonization with toxigenicC. difficileamong intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.METHODSProspective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenicC. difficile. The primary outcome was risk of developing CDI.RESULTSAmong 542 patients, 17 (3.1%) were colonized with toxigenicC. difficileon admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenicC. difficileon admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40],P=.003; and 15.66 [4.01–61.08],P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25],P=.017; and 10.93 [1.49–80.20],P=.019, respectively), while adjusting for potential confounders.CONCLUSIONSIn intensive care unit patients, colonization with toxigenicC. difficileis an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenicC. difficilecolonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.Infect. Control Hosp. Epidemiol.2015;36(11):1324–1329

scholarly journals Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study

2017 ◽  
Author(s):  
Charles Chin Han Lew ◽  
Gabriel Jun Yung Wong ◽  
Ka Po Cheung ◽  
Ai Ping Chua ◽  
Mary Foong Fong Chong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Unit Length ◽  
Increased Risk

There is limited evidence for the association between malnutrition and hospital mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with &ge;24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients&rsquo; nutritional status within 48 hours of ICU admission. Multivariate analyses were conducted in two ways: 1) presence versus absence of malnutrition, and 2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and 29.6% died before hospital discharge. Malnutrition was associated with an increased risk of hospital mortality [adjusted-RR 1.39 (95%CI: 1.10&ndash;1.76)], and this risk increased with a greater degree of malnutrition [adjusted-RR 1.09 (95%CI: 1.01&ndash;1.18) for each 1-point decrease in the 7-point SGA]. No significant association was found between malnutrition and ICU-LOS. Conclusion: There was a clear association between malnutrition and higher hospital mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

scholarly journals Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

2016 ◽  
Vol 32 (10) ◽  
Author(s):  
Keroulay Estebanez Roque ◽  
Teresa Tonini ◽  
Enirtes Caetano Prates Melo
Keyword(s):  
Intensive Care Unit ◽  
Adverse Event ◽  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Events ◽  
Prospective Study ◽  
Factors Associated ◽  
Healthcare Improvement ◽  
A Prospective Study ◽  
Event Occurrence

Abstract: This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.

Off-label drug use and the risk of medication errors in critically ill neonates: A conceptual pilot study

2021 ◽  
pp. 1-15
Author(s):  
Kannan Sridharan ◽  
Muna Al Jufairi ◽  
Eman Al Ansari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Drug Use ◽  
Critically Ill ◽  
Medication Errors ◽  
Off Label ◽  
Increased Risk ◽  
Critically Ill Neonates ◽  
Medication Risk

BACKGROUND: Off-label drug (OLD) use is common in neonates. There is a dearth of information associating the OLD use and the risk of medication errors in critically ill neonates. Hence, the present study was carried out. METHODS: Drug prescriptions in neonates admitted to the intensive care unit of a tertiary care hospital between September 2018 and June 2019 were evaluated. Details on their demographics, reason for admission in intensive care unit, drug-related information and serum creatinine were extracted. United States Food and Drug Administration approved drug labels were compared. World Health Organization (WHO) anatomy, therapeutic and chemical (ATC) classification was used for drug categorization. We assessed the risk of medication errors using a validated tool, medication risk score (MERIS). RESULTS: One hundred and seventy-one neonates with 2394 prescriptions were included in this study. Seventy one percent of the neonates in the present study received at least one OLD/unlicensed prescription item. A trend in increased numbers of OLD/unlicensed drug use in more premature and lower birth weight neonates were observed. Medication risk score was significantly higher in neonates receiving OLD/unlicensed drugs compared to those with only labelled drugs. Very and extreme pre-term (along with very low and extremely low birth weight) neonates were at higher risk of medication errors compared to others. Presence of OLD/unlicensed prescribed items is associated with an increased risk of medication errors by an odds ratio of 20.4 compared to labelled drugs. CONCLUSION: Significant proportions of critically ill neonates received at least one OLD/unlicensed drug and such use was associated with potentially increased risk of medication errors.

scholarly journals Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Myung Jin Song ◽  
Seok Kim ◽  
Dachung Boo ◽  
Changhyun Park ◽  
Sooyoung Yoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Proton Pump ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Prophylaxis

AbstractProton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.

Faecal diversion system usage in an adult intensive care unit

2020 ◽  
Vol 22 (2) ◽  
pp. 152-157
Author(s):  
Nicholas Wilson ◽  
◽  
Rinaldo Bellomo ◽  
Tyler Hay ◽  
Timothy Fazio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rectal Tube ◽  
Adult Intensive Care Unit ◽  
Packed Red Blood Cells ◽  
Risk Of Death ◽  
Faecal Diversion

OBJECTIVE: To determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients. DESIGN: A single centre observational study over 15 months. SETTING: Intensive care unit (ICU). PARTICIPANTS: Patients admitted during this period. MAIN OUTCOME MEASURES: Frequency of rectal tubes utilisation in ICU, as well as associated adverse events, with major events defined as lower gastrointestinal bleeding associated with defined blood transfusion of two or more units of red cells or endoscopy or surgical intervention. RESULTS: Of 3418 admission episodes, there were 111 episodes of rectal tubes inserted in 99 patients. Rectal tubes remained indwelling for a median of 5 days (range, 1–23) for a total of 641 patient-days. The most frequent indication for insertion was excessive bowel motions. A major adverse event was observed in three patients (3%; 0.5 events per 100 device days). Two patients underwent laparotomy and one patient sigmoidoscopy. These patients received between two and 23 units of packed red blood cells. Patients who had a rectal tube inserted had a substantially greater duration of ICU admission (mean, 14 days [SD, 14] v 2.8 days [SD, 3.7]) and hospital mortality (15% v 7.7%; risk ratio, 2.0; 95% CI, 1.2–3.4) as well as an overall higher Australian and New Zealand Risk of Death (ANZROD) score (mean, 27 [SD, 22] v 12.6 [SD, 20]). CONCLUSION: Rectal tubes appear to be frequently inserted and can lead to major adverse events in critically ill patients.

scholarly journals Effect of family reorientation messages on delirium prevention among critically ill patients

2019 ◽  
Vol 9 (10) ◽  
pp. 50
Author(s):  
Nermine M. Elcokany ◽  
Fatma Refaat Ahmed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cost Of Care ◽  
Pharmacological Intervention ◽  
Effective Strategy ◽  
Intervention Period ◽  
The Family

Background: About 50%-80% of critically ill patients develop delirium during their intensive care unit (ICU) stay. Adverse events associated with delirium can range from functional disability, cognitive and psychological impairment, dementia and even death. Removal of invasive lines, self-extubation, prolonged sedation and ventilation therapies which delay the ICU liberation, and increase the overall hospital length of stay are also negative squeals of delirium. Delirium has series of adverse events that are not limited to the associated morbidies and mortality, but also extended to include the burden placed on caregivers, families and healthcare services, in addition to increasing the cost of care. Using auditory stimulation as a non-pharmacological intervention can stimulate the affected neural networks, accelerate brain plasticity and avoid sensory deprivation that could induce pain, agitation, and delirium and slow down the patients' recovery. It is evident that familiar auditory stimuli by a familiar voice is eliciting more responses to auditory tones as it can grasp patients' attention without much effort and disrupts ongoing cognitive activities. Accordingly, multicomponent family reorientation strategy has recently been proposed to achieve better outcomes.Methods: A quasi experimental research design was used in this study in which one tool was used for data collection: “Confusion Assessment Method-intensive care unit (CAM-ICU)”. Results: During the five-day intervention period, the delirium free days was all the days in the family voice group, four days in the unfamiliar voice group and no free days in the control group which indicates a significant difference among groups on number of delirium free days (MCp < .001*).Conclusion: Reorienting critically ill patients through recorded messages is an effective strategy to reduce the incidence of delirium. Furthermore, using a familiar family sound is more effective in reducing delirium as proved by the number of delirium free days. During the five-day intervention period, the family voice group shows more delirium free days than the unfamiliar voice group. The intervention used in this study is easy, costless and effective strategy in prevention of delirium among critically ill patients.

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