scholarly journals Modifiable risk factors of ventilator-associated pneumonia in non-intensive care unit versus intensive care unit

2021 ◽  
Vol 15 (10) ◽  
pp. 1471-1480
Author(s):  
Patpong Udompat ◽  
Daravan Rongmuang ◽  
Ronald Craig Hershow
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Proton Pump ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Neurosurgical Patients

Introduction: Ventilator-associated pneumonia patients are treated in non-intensive care units because of a shortage of intensive care unit beds in Thailand. Our objective was to assess whether the type of unit and medications prescribed to the patient were associated with ventilator‑associated pneumonia and multidrug resistant ventilator‑associated pneumonia. Methodology: A matched case-control study nested in a prospective cohort of mechanical ventilation adult patients in a medical-surgical intensive care unit and five non-intensive care units from March 1 through October 31, 2013. The controls were randomly selected 1:1 with cases and matched based on duration and start date of mechanical ventilation. Results: 248 ventilator-associated pneumonia and control patients were analyzed. The most common bacteria were multidrug resistant Acinetobacter baumannii (82.4%). Compared with patients in the intensive care unit, those in the neurosurgical/surgical non-intensive care units were at higher risk (p = 0.278). Proton pump inhibitor was a risk factor (p = 0.011), but antibiotic was a protective factor (p = 0.054). Broad spectrum antibiotic was a risk factor (p < 0.001) for multidrug resistant ventilator-associated pneumonia. Conclusions: Post-surgical and neurosurgical patients treated in non-intensive care unit settings were at the highest risk of ventilator-associated pneumonia. Our findings suggest that alternative using proton pump inhibitors should be considered based on the risk-benefit of using this medication. In addition, careful stewardship of antibiotic use should be warranted to prevent multidrug resistant ventilator-associated pneumonia.

scholarly journals Candidemia in an intensive care unit

Medicina ◽  
2008 ◽  
Vol 45 (5) ◽  
pp. 351
Author(s):  
Dalia Adukauskienė ◽  
Aida Kinderytė ◽  
Asta Dambrauskienė ◽  
Astra Vitkauskienė
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Urinary Bladder ◽  
Intensive Care Units ◽  
Severe Disease ◽  
Candida Spp ◽  
Lethal Outcome ◽  
Bladder Catheter

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. Objective. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. Material and methods. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. Results. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). Conclusions. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.

scholarly journals TRAQUEOSTOMÍA TEMPRANA VS TARDÍA EN PACIENTES NEUROQUIRÚRGICOS INTERNADOS EN UNA UNIDAD DE CUIDADOS INTENSIVOS.

2020 ◽  
Vol 5 (4) ◽  
pp. 12
Author(s):  
Freiser Eceomo Cruz Mosquera ◽  
Nathaly Erazo Builes ◽  
Juan Camilo Angulo Cano ◽  
María Paula Solarte-Roa ◽  
Daniel Mauricio Muñoz Piamba ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Intensive Care Units ◽  
Total Sample ◽  
Early Tracheostomy ◽  
Neurosurgical Patients ◽  
Clinical Benefits ◽  
The City

Introducción: Los pacientes neurocríticos por lo general requieren periodos largos de ventilación mecánica, en ese contexto la traqueostomía es un procedimiento frecuente que se realiza para facilitar el destete de la ventilación y se asocia a múltiples beneficios; sin embargo, el momento de su realización sigue siendo objeto de debate. Objetivo: determinar los beneficios clínicos   de la traqueostomía temprana vs la tardía en los pacientes neurocríticos que ingresan a una unidad de cuidados intensivos (UCI) polivalente de una institución de salud de la ciudad de Cali. Metodología: investigación observacional, descriptiva, de serie de casos que incluyó pacientes neuroquirúrgicos, mayores de edad que ingresaron a una UCI durante el periodo 2016 -2018; a partir de la muestra total se estipularon dos grupos: traqueostomía temprana (≤ 9 días) y traqueostomía tardía (≥10 días).  El análisis estadístico se realizó en el programa SPSS versión 24. Resultados: Se incluyeron 20 sujetos con edad de 51.9±17 años, 10 fueron asignados al grupo de traqueostomía temprana y 10 al grupo den traqueostomía tardía. Se evidenció que los pacientes con traqueostomía temprana tienen menos días de sedación (10±2.1 vs 16±9; p=0.02) y los 3 casos que fallecieron habían sido traqueostomizados tardíamente. Conclusiones: La traqueostomía temprana puede traer beneficios clínicos a los pacientes neuroquirúrgicos que ingresan a unidades de cuidados intensivos.                                                                                                                   Palabras claves: Traqueostomía, unidades de cuidados intensivos, paciente, ventilación mecánica. ABSTRACT Introduction: Neurocritical patients generally require long periods of mechanical ventilation. In this context, tracheostomy is a frequent procedure performed to facilitate weaning from ventilation and is associated with multiple benefits; however, the timing of its implementation remains under debate. Objective: to determine the clinical benefits of early vs late tracheostomy in neurocritical patients admitted to a polyvalent intensive care unit (ICU) of a health institution in the city of Cali. Methodology: observational, descriptive investigation of a series of cases that included neurosurgical patients, of legal age who were admitted to an ICU during the period 2016 -2018; From the total sample, two groups were stipulated: early tracheostomy (≤ 9 days) and late tracheostomy (≥10 days). Statistical analysis was performed using SPSS version 24. Results: 20 subjects with an age of 51.9 ± 17 years were included, 10 were assigned to the early tracheostomy group and 10 to the late tracheostomy group. It was evidenced that patients with early tracheostomy had fewer days of sedation (10±2.1 vs 16± 9; p= 0.02) and the 3 cases that died had been tracheostomized late. Conclusions: Early tracheostomy can bring clinical benefits to neurosurgical patients admitted to intensive care units. Keywords: Tracheostomy, intensive care units, patient, mechanic ventilation.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Mortality ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being pre-operative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.Keywords: Intensive care unit; mortality; neurosurgery; outcome.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Advice ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being preoperative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.

Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study

2021 ◽  
Vol 74 (6) ◽  
Author(s):  
Caroline Gonçalves Pustiglione Campos ◽  
Aline Pacheco ◽  
Maria Dagmar da Rocha Gaspar ◽  
Guilherme Arcaro ◽  
Péricles Martim Reche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Diagnostic Criteria ◽  
Statistical Tests ◽  
Significant Risk ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia

ABSTRACT Objectives: to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. Methods: retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. Results: the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. Conclusions: patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.

scholarly journals Global Muscle Strength But Not Grip Strength Predicts Mortality and Length of Stay in a General Population in a Surgical Intensive Care Unit

2012 ◽  
Vol 92 (12) ◽  
pp. 1546-1555 ◽  
Author(s):  
Jeanette J. Lee ◽  
Karen Waak ◽  
Martina Grosse-Sundrup ◽  
Feifei Xue ◽  
Jarone Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Manual Muscle Testing ◽  
Surgical Intensive Care Unit ◽  
Muscle Testing

Background Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design This investigation was a prospective, observational study. Methods One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles=3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.

Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit in Saudi Arabia: A 30-Month Prospective Surveillance

2004 ◽  
Vol 25 (9) ◽  
pp. 753-758 ◽  
Author(s):  
Maha Almuneef ◽  
Ziad A. Memish ◽  
Hanan H. Balkhy ◽  
Hala Alalem ◽  
Abdulrahman Abutaleb
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Pediatric Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Prospective Surveillance ◽  
The Mean ◽  
Prior Antibiotic Therapy

AbstractObjective:To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients.Methods:This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions.Results:Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP.Conclusions:The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

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