scholarly journals Relationship of serum procalcitonin levels and c-reactive protein levels in newborns with sepsis in different types of respiratory support in intensive care unit

2021 ◽  
Vol 13 (1) ◽  
pp. 39-47
Author(s):  
Aspazija Sofijanova ◽  
Sonja Bojadzieva ◽  
Silvana Naunova- Timovska ◽  
Hristina Mandzukovska ◽  
Elizabeta Shuperliska ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Clinical Signs ◽  
Severe Infection ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Protein Levels ◽  
Time Period ◽  
High Level

Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive  Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) ​​were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia  and proven sepsis,  p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.  

Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

2019 ◽  
Vol 70 (8) ◽  
pp. 3008-3013
Author(s):  
Silvia Maria Stoicescu ◽  
Ramona Mohora ◽  
Monica Luminos ◽  
Madalina Maria Merisescu ◽  
Gheorghita Jugulete ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Receiver Operating Curve ◽  
Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

2006 ◽  
Vol 72 (1) ◽  
pp. 7-10
Author(s):  
George C. Velmahos ◽  
Carlos V. Brown ◽  
Demetrios Demetriades
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Clinical Suspicion ◽  
Severely Injured ◽  
Duplex Scan ◽  
Severely Injured Patients ◽  
High Level ◽  
Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

Quantifying Occupational Stress in Intensive Care Unit Nurses: An Applied Naturalistic Study of Correlations Among Stress, Heart Rate, Electrodermal Activity, and Skin Temperature

2021 ◽  
pp. 001872082110408
Author(s):  
Nima Ahmadi ◽  
Farzan Sasangohar ◽  
Tariq Nisar ◽  
Valerie Danesh ◽  
Ethan Larsen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Skin Temperature ◽  
Electrodermal Activity ◽  
Laboratory Research ◽  
Prior Literature ◽  
High Level ◽  
Intensive Care Unit Nurses ◽  
Skin Temperatures

Objective To identify physiological correlates to stress in intensive care unit nurses. Background Most research on stress correlates are done in laboratory environments; naturalistic investigation of stress remains a general gap. Method Electrodermal activity, heart rate, and skin temperatures were recorded continuously for 12-hr nursing shifts (23 participants) using a wrist-worn wearable technology (Empatica E4). Results Positive correlations included stress and heart rate (ρ = .35, p < .001), stress and skin temperature (ρ = .49, p < .05), and heart rate and skin temperatures (ρ = .54, p = .0008). Discussion The presence and direction of some correlations found in this study differ from those anticipated from prior literature, illustrating the importance of complementing laboratory research with naturalistic studies. Further work is warranted to recognize nursing activities associated with a high level of stress and the underlying reasons associated with changes in physiological responses. Application Heart rate and skin temperature may be used for real-time detection of stress, but more work is needed to validate such surrogate measures.

scholarly journals Statistical Analysis Plan for the Selective Decontamination of the Digestive Tract in Intensive Care Unit (SuDDICU) study

2020 ◽  
Author(s):  
Laurent Billot ◽  
John Myburgh ◽  
Fiona Goodman ◽  
Simon Finfer ◽  
Ian Seppelt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Digestive Tract ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Statistical Analysis Plan ◽  
Selective Decontamination ◽  
Cluster Randomised ◽  
Randomised Controlled

SuDDICU is an international, multicentre, cross-over, cluster randomised controlled trial comparing the effect of selective decontamination of the digestive tract to usual care on hospital mortality in patients receiving mechanical ventilation in the intensive care unit. This manuscript presents the pre-specified statistical analysis plan (SAP) for the SuDDICU trial. The SAP was written without knowledge of the effect of the intervention.

scholarly journals Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

2021 ◽  
Vol 10 (11) ◽  
pp. 4283
Author(s):  
Rehana Rashid ◽  
Saniyah Khan Galzie ◽  
Javid Ahmed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Health Care Facilities ◽  
Near Miss ◽  
Care Hospital ◽  
Kashmir Valley ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Obstetric Haemorrhage

Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity.

PREVALENCE OF HIGH LEVEL AMINOGLYCOSIDE RESISTANCE AND VANCOMYCIN RESISTANT ENTEROCOCCI IN ENTEROCOCCAL ISOLATES IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 3-5
Author(s):  
Sunita Agarwal ◽  
Nazneen Pathan ◽  
Shivra Batra ◽  
Rajni Sharma
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Automated System ◽  
Care Hospital ◽  
Enterococcus Species ◽  
Aminoglycoside Resistance ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
High Level

Introduction: The emergence of High Level Aminoglycoside Resistance (Resistant to Gentamycin and Streptomycin) and Vancomycin Resistant Enterococci among Indoor and Intensive Care Unit admitted patient presents a serious challenge for clinicians. Objective: To determine Enterococcal burden in blood and urine specimens and to detect the prevalence of High Level Aminoglycoside Resistance and Vancomycin Resistant Enterococci. Material & Methods: One hundred ten Enterococci were isolated from blood and urine samples and processed according to standard laboratory protocol. Species identication and sensitivity was done using the VITEK 2 automated system (Biomerieux France) with the cards GPID and AST 67 respectively. Results: Out of 110 Enterococci isolates, 36 were from blood and 74 from urine were detected. Different Species isolated were Enterococcal faecium (59%), Enterococcal faecalis (34%), Enterococcal rafnosus (2.7%), Enterococcal gallinarum (1.8%), Enterococcal casseliavus (0.9%) and Enterococcal duran (0.9%).Out of 36 blood isolates, 14 (38%) were found to be both High Level Gentamycin Resistant (HLGR) & High Level Streptomycin Resistant (HLSR), 10 (27%) were only HLGR and 8 (22%) were only HLSR. 20 strain (55%) of Enterococcus species isolated in blood were VRE. All VRE strains were found to be resistant to both aminoglycosides ( HLAR).Among the 74 urinary isolates, 24 (34%) were found to be both HLGR & HLSR, only HLGR was observed in 20 (27%) and HLSR was observed in 11 (14%) isolates. 24 strains (34%) of Enterococcus species were found to be vancomycin resistant in urine. 23 strains out of 24 were resistant to high level of aminoglycosides. Conclusion: The prevalence of HLAR and VRE is very high among Enterococcus specimens from indoor/ intensive care unit patients. Early species identication and antibiotic sensitivity result can help in better clinical outcome.

scholarly journals The Agents Intervening against Delirium in the Intensive Care Unit Trial (AID‐ICU trial): A detailed statistical analysis plan

2020 ◽  
Vol 64 (9) ◽  
pp. 1357-1364
Author(s):  
Nina Andersen‐Ranberg ◽  
Lone M. Poulsen ◽  
Anders Perner ◽  
Jørn Wetterslev ◽  
Ole Mathiesen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Statistical Analysis Plan ◽  
Detailed Statistical Analysis

Drug Use in a Surgical Intensive Care Unit

1986 ◽  
Vol 20 (10) ◽  
pp. 752-756 ◽  
Author(s):  
Joseph F. Dasta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Use ◽  
Patient Characteristics ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Surgical Intensive Care ◽  
Drug Usage ◽  
Time Period ◽  
Short Time

A retrospective review of drug usage in 180 patients admitted to a surgical intensive care unit was conducted. The average stay was three days and the total and daily number of drugs averaged 7.6 and 5.6, respectively. The most common drug class used was antibiotics, with cefazolin being the most commonly used antibiotic. Other commonly used drugs include analgesics, diuretics, H2-antagonists, vasoactive drugs and inotropes, antacids, and antiarrhythmics. This study indicates that patients admitted to a surgical intensive care unit are exposed to a variety of potent drugs, often given in combination over a short time period. Although further studies are needed to delineate specific aspects of drug use and patient characteristics, this study suggests that there is a need for close monitoring of drug therapy in these patients with special attention to reduction of drug costs.

scholarly journals Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study

2019 ◽  
Vol 29 ◽  
Author(s):  
A. Vuagnat ◽  
F. Jollant ◽  
M. Abbar ◽  
K. Hawton ◽  
C. Quantin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Overdose ◽  
Psychiatric Inpatient ◽  
National Level ◽  
Significant Risk ◽  
Medical Decision ◽  
Short Term ◽  
Predictive Values ◽  
Self Harm

Abstract Aims A large number of people present each day at hospitals for non-fatal deliberate self-harm (DSH). Examination of the short-term risk of non-fatal recurrence and mortality at the national level is of major importance for both individual medical decision-making and global organisation of care. Methods Following the almost exhaustive linkage (96%) of two national registries in France covering 45 million inhabitants (i.e. 70% of the whole population), information about hospitalisation for DSH in 2008–2009 and vital status at 1 year was obtained. Individuals who died during the index hospital stay were excluded from analyses. Results Over 2 years, 136,451 individuals were hospitalised in medicine or surgery for DSH. The sample comprised 62.8% women, median age 38 in both genders, with two peaks at 16 and 44 years in women, and one peak at 37 years in men. The method used for DSH was drug overdose in 82.1% of cases. Admission to an intensive care unit occurred in 12.9%. Following index hospitalisation, 71.3% returned home and 23.7% were transferred to a psychiatric inpatient care unit. DSH recurrence during the following year occurred in 12.4% of the sample, within the first 6 months in 75.2%, and only once in 74.6%. At 1 year, 2.6% of the sample had died. The overall standardised mortality ratio was 7.5 but reached more than 20 in young adults. The causes were natural causes (35.7%), suicide (34.4%), unspecified cause (17.5%) and accident (12.4%). Most (62.9%) deaths by suicide occurred within the first 6 months following index DSH. Violent means (i.e. not drug overdose) were used in 70% of suicide cases. Concordance between means used for index DSH and for suicide was low (30% overall), except for drug overdose. Main suicide risk factors were older age, being male, use of a violent means at index DSH, index admission to an intensive care unit, a transfer to another medical department or to a psychiatric inpatient unit, and recurrence of DSH. However, these factors had low positive predictive values individually (below 2%). Conclusions Non-fatal DSH represent frequent events with a significant risk of short-term recurrence and death from various causes. The first 6 months following hospital discharge appear to be a critical period. Specific short-term aftercare programs targeting all people with a DSH episode have to be developed, along other suicide prevention strategies.

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