scholarly journals The Intensive care outcome of patients with a solid tumor in a tertiary care hospital in Saudi Arabia: Results of a prospective ICU Registry

2021 ◽  
Vol 8 (10) ◽  
pp. 608-618
Author(s):  
Asiah Salem Rugaan ◽  
Naved Hasan ◽  
Masood Iqbal ◽  
Elaf Damanhouri ◽  
Rwan Emad Radi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Solid Tumors ◽  
Metastatic Disease ◽  
Solid Tumor ◽  
Sofa Score ◽  
Tertiary Care ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Icu Mortality

Objective: There is a paucity of research on the factors predicting mortality and a length of stay in the Intensive Care Unit (ICU) with solid tumor patients. This study will assess the characteristics and predictors of outcomes of patients with solid tumors in medical ICU. Material and Methods: This research has been designed as a retrospective observational study using an ICU database. Patients who have a solid tumor were included in the study (May 2015 to July 2018). Post-surgical and those with a length of stay of more than one day are excluded from the study. We identified the predictors     for ICU mortality and ICU long stay (≥21 days). Results: Out of 2883 patients, 364 patients with solid tumors were enrolled. The commonest sites for solid tumors were breast (15.9%), colorectal (11.5%), and lung (9.9%). 158 (43.4%) had metastatic disease, and 264 (72.5%) with progressive disease. The major reasons for ICU admission were a respiratory failure (52.7%) and severe sepsis (52.2%). The ICU and hospital mortality rates were 32.4% and 47%, respectively. Fifty patients (13.7%) had long stayed (≥ 21 days) in ICU. The independent predictors for mortality were Sequential Organ Failure Assessment (SOFA) score (OR, 1.2; 95% CI, 1.1–1.3; P=.000), invasive ventilation (OR, 3.5; 95% CI, 1.5–8.3; P=.004) and vasopressor (OR, 2.6; 95% CI, 1.1–5.9; P=.018), while the independent predictors of long-stay were ICU infections (odds ratio [OR], 18.9; 95% CI, 5.3 – 66.7; P=.0001), SOFA score (OR, 1.5; 95% CI, 1.2–1.8; P=.0001), invasive ventilation (OR, 8.2; 95% CI, 1.6–40.4; P=.009), bilirubin (OR, .5; 95% CI .2–.9; P=.049). Conclusion: Irrespective of the cancer stage, patients had a reasonable survival, and most do not require a long stay in the ICU. Flexibility in admission should be considered as disease progression and metastatic disease were not independent predictors of ICU mortality or long stay in this study.

Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

2021 ◽  
pp. 1-7
Author(s):  
Jonathan M. Hyak ◽  
Mayar Al Mohajer ◽  
Daniel M. Musher ◽  
Benjamin L. Musher
Keyword(s):  
Solid Tumors ◽  
Solid Tumor ◽  
Cardiopulmonary Arrest ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Tumor Patients ◽  
Binomial Regression ◽  
Sirs Criteria

Abstract Objective: To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. Design, setting, and participants: We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Methods: Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. Results: Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). Conclusions: SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

scholarly journals Non-Invasive Ventilation in a Paediatric Intensive Care Unit (PICU) with Respiratory Failure: Experience at a Tertiary Care Hospital in Dhaka

2019 ◽  
Vol 30 (Number 1) ◽  
pp. 20-25
Author(s):  
S Hoque ◽  
ASM N U Ahmed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Co2 Concentration ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Cross Sectional ◽  
The Mean

Noninvasive ventilation (NIV) has now become an integral tool within the treatment of both acute and chronic respiratory failure, and at an equivalent time reducing the necessity for invasive ventilation. A cross sectional, retrospective study based on a retrospective review of hospital medical records of patients who underwent NIV in the period between January 2017 and December 2019, to determinate the efficacy of NIV in pediatrics whom admitted to Pediatric intensive care unit (PICU) with respiratory failure (short term evaluation), demographic and clinical data were collected before and after applying the NIV. The data included heart rate (HR), respiratory rate (RR), oxygen concentration (P02) and CO2 concentration (PCO2). NIV was used for a total of 61 pediatric patients admitted to PICU during the period of the study. Pneumonia was the commonest indication for the NIV (n=25, 41.0%), and continuous positive airway pressure (CPAP) was used in 52(85.2%) patients. The mean duration of NIV was 817.2 days, there was a significant clinical improvement after one hour from application of NIV The mean improvement in RR was from 48.412.2 to 35.01I.5 (P=0.000), SPO2 was improved from 88.111.8 to 96.510.7 (P= 0.000), and the PCO2 was improved from 61.4±6.1 to 48.713 7 (P=0.002). Five patients were failing to respond to the NIV and shifted to mechanical ventilation. The NIV is a useful tool for treatment of respiratory failure in pediatrics, especially under the age of one year. Pneumonia was the commonest indication for the use of the NB!. More investigation is needed to fully evaluate the ramifications of increased use of this technology in the PICU.

scholarly journals A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

2019 ◽  
Vol 35 (11) ◽  
pp. 1162-1172 ◽  
Author(s):  
Klaus Stahl ◽  
Markus Busch ◽  
Sabine K. Maschke ◽  
Andrea Schneider ◽  
Michael P. Manns ◽  
...  
Keyword(s):  
Intensive Care ◽  
Organ Failure ◽  
Sofa Score ◽  
Mesenteric Ischemia ◽  
Tertiary Care ◽  
Intervention Group ◽  
Clinical Signs ◽  
Care Hospital ◽  
Nonocclusive Mesenteric Ischemia ◽  
Intensive Care Patients

Background: To analyze demography, clinical signs, and survival of intensive care patients diagnosed with nonocclusive mesenteric ischemia (NOMI) and to evaluate the effect of a local intra-arterial prostaglandin therapy. Methods: Retrospective observational study screening 455 intensive care patients with acute arterial mesenteric perfusion disorder in a tertiary care hospital within the past 8 years. Lastly, 32 patients with NOMI were enrolled, of which 11 received local intra-arterial prostaglandin therapy. The diagnosis of NOMI was based on the clinical presentation and established biphasic computed tomography criteria. Clinical and biochemical data were obtained 24 hours before, at the time, and 24 hours after diagnosis. Results: Patients were 60.5 (49.3-73) years old and had multiple comorbidities. Most of them were diagnosed with septic shock requiring high doses of norepinephrine (NE: 0.382 [0.249-0.627] μg/kg/min). The Sequential Organ Failure Assessment (SOFA) score was 18 (16-20). A decrease in oxygenation (Pao 2/Fio 2), pH, and bicarbonate and an increase in international normalized ratio, lactate, bilirubin, leucocyte count, and NE dose were early indicators of NOMI. Median SOFA score significantly increased in the last 24 hours before diagnosis of NOMI (16 vs 18, P < .0001). Overall, 28-day mortality was 75% (81% nonintervention vs 64% intervention cohort; P = .579). Median SOFA scores 24 hours after intervention increased by +5% in the nonintervention group and decreased by 5.5% in the intervention group ( P = .0059). Conclusions: Our data suggest that NOMI is a detrimental disease associated with progressive organ failure and a high mortality. Local intra-arterial prostaglandin application might hold promise as a rescue treatment strategy. These data encourage future randomized controlled trials are desirable.

Prognostic value of SOFA score and SIRS criteria for ICU mortality in adult sepsis patients admitted to the ICU of a tertiary care Hospital of Bangladesh

2021 ◽  
Vol 11 (2) ◽  
pp. 84-89
Author(s):  
Debasish Kumar Saha ◽  
Madhurima Saha ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Sofa Score ◽  
Prognostic Value ◽  
Tertiary Care ◽  
Scoring Systems ◽  
Admission Diagnosis ◽  
P Value ◽  
Care Hospital ◽  
Icu Mortality ◽  
Male Predominance ◽  
Sirs Criteria

Background: Sepsis is one of the most common admission-diagnosis in intensive care unit (ICU). It is associated with rapid organ dysfunction with increased mortality. Different scoring systems {e.g. Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, systemic inflammatory response syndrome (SIRS) criteria} are commonly used to identify and predict prognosis of sepsis in ICU at present. The objective was to determine the prognostic value of SOFA score and SIRS criteria among sepsis patients. Methods: This was a prospective observational study, conducted in the department of Critical Care Medicine, BIRDEM General Hospital during the period of January, 2018 to July, 2019. Consecutive sampling was conducted in patients fulfilling the selection criteria. After admission of patients with sepsis from indoor or emergency department; SOFA score and SIRS criteria were calculated using physiological and laboratory parameters recorded within 24 hours of ICU admission. Standard criteria were applied, an increase of point of e” 2 in SOFA score, and/ or SIRS criteria was regarded as sepsis. Patients who were admitted in ICU other than sepsis., known cases of acute myocardial infarction (MI), trauma victims, acute stroke, pregnancy, end stage renal disease (ESRD), decompensated chronic liver disease (CLD), who developed sepsis after admission in ICU, readmitted cases were excluded. All patients were followed up daily. Outcome was measured in terms of ICU mortality. Results: A total 203 patients were analyzed. About one-third (29.6%) patients belonged to age group 61-70 years (mean age: 58.25 ± 15.03 years); with slightly male predominance (52.2%). Pneumonia (56%) was the most common on admission diagnosis followed by uro-sepsis (19.7%). SOFA score showed greater discrimination (AUROC, 0.900 [95% CI, 0.860-0.941]) (p value <0.001) than SIRS criteria (AUROC,0.406 [95% CI, 0.327-0.486]). Conclusion: SOFA score had higher prognostic value than SIRS criteria regarding ICU mortality in sepsis. Birdem Med J 2021; 11(2): 84-89

scholarly journals The Intensive Care Outcome of Patients with a Solid Malignancy in a Tertiary Hospital in Saudi Arabia: A prospective Intensive Care Unit Registry Study

2020 ◽  
Author(s):  
Asia Rugaan ◽  
Masood Iqbal ◽  
Asma Almadani ◽  
Elham Bugis ◽  
Ahlam Rawah ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Solid Tumor ◽  
Sofa Score ◽  
Tertiary Hospital ◽  
Icu Mortality ◽  
Prolonged Stay ◽  
Solid Malignancy

Abstract Aim: There is a paucity of research on the factors predicting mortality and prolonged stay in the Intensive Care Unit (ICU) in critically ill patients with a solid malignancy. We aimed to assess the characteristics and outcomes of these patients who admitted to a medical ICU in a tertiary hospital in Saudi Arabia, and determine the predictors of ICU mortality and ICU prolonged stay. Method: Clinical data from patients with solid tumors extracted from a comprehensive prospective ICU registry. We used logistic regression analysis to identify the predictors influencing ICU mortality and ICU prolonged stay. Results: Of 2883 patients admitted to the ICU, 364 patients identified with solid tumor were enrolled in this study. The most common solid tumor types were: breast (15.9%), colorectal (11.5%) and lung (9.9%) cancers. The ICU mortality rate was (32.4%), and there were 50 (13.7%) patients had a prolonged stay of ≥ 21 days. In the multivariate analysis, three factors were the independent predictors for the ICU mortality: Sequential Organ Failure Assessment (SOFA) score (P <.001), mechanical ventilation (P=.004) and inotropic/vasopressor agents (P=.018), and four variables were independent predictors for the prolonged stay in ICU: ICU acquired infection (P<.001), SOFA score (P <.001), mechanical ventilation (P<.001) and bilirubin (P=.049).Conclusion: In patients with solid tumour the ICU mortality is 32.4%, and 13.7% had a prolonged ICU stay. The reported outcome in this study indicate benefit from ICU care in this category of cases The identified predictors of ICU mortality and prolonged stay of patients would help in assessing the potential benefit of ICU admission, and prognostication.

scholarly journals Detection of SARS-CoV-2 and Other Infectious Agents in Lower Respiratory Tract Samples Belonging to Patients Admitted to Intensive Care Units of a Tertiary-Care Hospital, Located in an Epidemic Area, during the Italian Lockdown

2021 ◽  
Vol 9 (1) ◽  
pp. 185
Author(s):  
Adriana Calderaro ◽  
Mirko Buttrini ◽  
Sara Montecchini ◽  
Giovanna Piccolo ◽  
Monica Martinelli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Intensive Care Units ◽  
Lower Respiratory Tract ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Agents ◽  
Epidemic Area ◽  
Significant Difference

The aim of this study was the detection of infectious agents from lower respiratory tract (LRT) samples in order to describe their distribution in patients with severe acute respiratory failure and hospitalized in intensive care units (ICU) in an Italian tertiary-care hospital. LRT samples from 154 patients admitted to ICU from 27 February to 10 May 2020 were prospectively examined for respiratory viruses, including SARS-CoV-2, bacteria and/or fungi. SARS-CoV-2 was revealed in 90 patients (58.4%, 72 males, mean age 65 years). No significant difference was observed between SARS-CoV-2 positives and SARS-CoV-2 negatives with regard to sex, age and bacterial and/or fungal infections. Nonetheless, fungi were more frequently detected among SARS-CoV-2 positives (44/54, 81.4%, p = 0.0053). Candida albicans was the overall most frequently isolated agent, followed by Enterococcus faecalis among SARS-CoV-2 positives and Staphylococcus aureus among SARS-CoV-2 negatives. Overall mortality rate was 40.4%, accounting for 53 deaths: 37 among SARS-CoV-2 positives (mean age 69 years) and 16 among SARS-CoV-2 negatives (mean age 63 years). This study highlights the different patterns of infectious agents between the two patient categories: fungi were prevalently involved among SARS-CoV-2-positive patients and bacteria among the SARS-CoV-2-negative patients. The different therapies and the length of the ICU stay could have influenced these different patterns of infectious agents.

Etiology and outcomes for patients infected with HIV in intensive care units in a tertiary care hospital in China

2014 ◽  
Vol 87 (3) ◽  
pp. 366-374 ◽  
Author(s):  
Jiang Xiao ◽  
Wen Zhang ◽  
Yingxiu Huang ◽  
Yunfei Tian ◽  
Wenjing Su ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital
Sign in / Sign up

Export Citation Format

Share Document