Prevalence of Advance Directives Among Older Adults Admitted to Intensive Care Units and Requiring Mechanical Ventilation

Human to human transmitted disease is the game of coronavirus disease (COVID-19) transmission and it had been declared an emergency global pandemic that caused major disastrous in the respiratory system to more than five million people and killing more than half a billion deaths across the globe. Besides lower acute respiratory syndrome, there is damage to the alveolar with severe inflammatory exudation. COVID-19 patients often have lower immunosuppressive CD4+ T and CD8+ T cells and most patients in intensive care units (ICU) need mechanical ventilation, hence longer stay in hospitals. These patients have been discovered to develop fungal co-infections. COVID-19 patients develop what is known as mucormycosis a black fungal infection that is deadly leading to loss of sight and hearing and eventually death. This chapter will focus on mucormycosis, a black fungus caused during post covid complications.

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Candidemia in an intensive care unit

Medicina ◽

10.3390/medicina45050044 ◽

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.

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Prognosis of Severe Nosocomial Sepsis in 33 Older Adults Not Eligible for Intensive Care Units

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2011.03748.x ◽

2012 ◽

Vol 60 (1) ◽

pp. 179-180

Author(s):

Jérôme Bédoucha ◽

Véronique Mangin d'Ouince ◽

Farouk Mahious ◽

Anne-Marie Hallet-Lezy ◽

Dragoslav Miric

Keyword(s):

Older Adults ◽

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Sepsis

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Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units

Critical Care Medicine ◽

10.1097/ccm.0b013e3181a037ac ◽

2009 ◽

Vol 37 (8) ◽

pp. 2360-2369 ◽

Cited By ~ 136

Author(s):

Despoina Koulenti ◽

Thiago Lisboa ◽

Christian Brun-Buisson ◽

Wolfgang Krueger ◽

Antonio Macor ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Pneumonia

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Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.301 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Caroline Ong ◽

Albert Lui ◽

John A Dodson ◽

Jordan B Strom ◽

Carlos Alviar

Keyword(s):

Older Adults ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Medical Center ◽

Older Age ◽

Icu Mortality ◽

Differential Outcomes ◽

Medical Intensive Care ◽

Cardiac Intensive Care

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

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Inverse reinforcement learning for intelligent mechanical ventilation and sedative dosing in intensive care units

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-019-0763-6 ◽

2019 ◽

Vol 19 (S2) ◽

Cited By ~ 4

Author(s):

Chao Yu ◽

Jiming Liu ◽

Hongyi Zhao

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Reinforcement Learning ◽

Intensive Care Units ◽

Inverse Reinforcement Learning

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Pain Scales in Neonates Receiving Mechanical Ventilation in Neonatal Intensive Care Units – Systematic Review

Journal of Pain Research ◽

10.2147/jpr.s248042 ◽

2020 ◽

Vol Volume 13 ◽

pp. 1883-1897 ◽

Cited By ~ 1

Author(s):

Hanna Popowicz ◽

Katarzyna Kwiecień-Jaguś ◽

Jolanta Olszewska ◽

Wioletta A Mędrzycla-Dąbrowska

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Pain Scales

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Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2017051403416 ◽

2019 ◽

Vol 53 ◽

Author(s):

Renata Eloah de Lucena Ferretti-Rebustini ◽

Nilmar da Silva Bispo ◽

Winnie da Silva Alves ◽

Thiago Negreiro Dias ◽

Cristiane Moretto Santoro ◽

...

Keyword(s):

Older Adults ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Group Method ◽

Predictive Capacity ◽

Organic Dysfunction ◽

Intensity Of Care ◽

Correlation Tests ◽

The City

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults.

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