Daytime-to-Nighttime Sleep Ratios and Cognitive Impairment in Older Intensive Care Unit Survivors

Background Sleep duration and proportion of daytime versus nighttime sleep may affect cognitive function in older patients in the transition out of the intensive care unit. Objective To explore the relationship between the daytime-to-nighttime sleep ratio and cognitive impairment in older intensive care unit survivors. Methods The study enrolled 30 older adults within 24 to 48 hours after intensive care unit discharge. All participants were functionally independent before admission and underwent mechanical ventilation in the intensive care unit. Actigraphy was used to estimate daytime (6 AM to 9:59 PM) and nighttime (10 PM to 5:59 AM) total sleep duration. Daytime-to-nighttime sleep ratios were calculated by dividing the proportion of daytime sleep by the proportion of nighttime sleep. The National Institutes of Health Toolbox Cognition Battery Dimensional Change Card Sort Test (DCCST) was used to assess cognition. Associations between sleep and cognition were explored using multivariate regression after adjusting for covariates. Results The mean (SD) daytime sleep duration was 7.55 (4.30) hours (range, 0.16-14.21 hours), and the mean (SD) nighttime sleep duration was 4.99 (1.95) hours (range, 0.36-7.21 hours). The mean (SD) daytime-to-nighttime sleep ratio was 0.71 (0.30) (range, 0.03-1.10). Greater daytime sleep duration (β = −0.351, P = .008) and higher daytime-to-nighttime sleep ratios (β = −0.373, P = .008) were negatively associated with DCCST scores. Conclusions The daytime-to-nighttime sleep ratio was abnormally high in the study population, revealing an altered sleep/wake cycle. Higher daytime-to-nighttime sleep ratios were associated with worse cognition, suggesting that proportionally greater daytime sleep may predict cognitive impairment.

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Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001759 ◽

2020 ◽

Vol 134 (8) ◽

pp. 688-695 ◽

Cited By ~ 1

Author(s):

N Glibbery ◽

K Karamali ◽

C Walker ◽

I Fitzgerald O'Connor ◽

B Fish ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Standard Deviation ◽

Intensive Care Unit Discharge ◽

Organ Support ◽

Unit Discharge ◽

Surgical Tracheostomy ◽

Ventilatory Assistance ◽

The Mean ◽

Mean Time

AbstractObjectivesTo report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.MethodsTwenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.ResultsThe mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8–26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).ConclusionPerforming a tracheostomy in coronavirus disease 2019 positive patients at 8–14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.

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1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1594 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S713-S713

Author(s):

Carlo Fopiano Palacios ◽

Eric Lemmon ◽

James Campbell

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Linear Regression ◽

Length Of Stay ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

P Value ◽

Fisher Exact Test ◽

The Mean ◽

Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

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Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study

Scientific Reports ◽

10.1038/s41598-020-76314-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Piotr F. Czempik ◽

Agnieszka Jarosińska ◽

Krystyna Machlowska ◽

Michał P. Pluta

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sleep Quality ◽

Sleep Duration ◽

Smartphone Application ◽

Sound Level ◽

Related Factors ◽

Cross Sectional ◽

Sound Levels ◽

The Impact

Abstract Sleep disruption is common in patients in the intensive care unit (ICU). The aim of the study was to measure sound levels during sleep-protected time in the ICU, determine sources of sound, assess the impact of sound levels and patient-related factors on duration and quality of patients' sleep. The study was performed between 2018 and 2019. A commercially available smartphone application was used to measure ambient sound levels. Sleep duration was measured using the Patient's Sleep Behaviour Observational Tool. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The study population comprised 18 (58%) men and 13 (42%) women. There were numerous sources of sound. The median duration of sleep was 5 (IQR 3.5–5.7) hours. The median score on the RCSQ was 49 (IQR 28–71) out of 100 points. Sound levels were negatively correlated with sleep duration. The cut-off peak sound level, above which sleep duration was shorter than mean sleep duration in the cohort, was 57.9 dB. Simple smartphone applications can be useful to estimate sound levels in the ICU. There are numerous sources of sound in the ICU. Individual units should identify and eliminate their own sources of sound. Sources of sound producing peak sound levels above 57.9 dB may lead to shorter sleep and should be eliminated from the ICU environment. The sound levels had no effect on sleep quality.

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The use of score for neonatal acute physiology perinatal extention II (SNAPPE II) in predicting neonatal outcome in neonatal intensive care unit

Paediatrica Indonesiana ◽

10.14238/pi45.6.2005.241-5 ◽

2016 ◽

Vol 45 (6) ◽

pp. 241

Author(s):

Mia R A ◽

Risa Etika ◽

Agus Harianto ◽

Fatimah Indarso ◽

Sylviati M Damanik

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Characteristic Curve ◽

Newborn Care ◽

Scoring Systems ◽

Laboratory Observation ◽

The Mean ◽

Overall Mortality

Background Scoring systems which quantify initial risks have animportant role in aiding execution of optimum health services by pre-dicting morbidity and mortality. One of these is the score for neonatalacute physiology perinatal extention (SNAPPE), developed byRichardson in 1993 and simplified in 2001. It is derived of 6 variablesfrom the physical and laboratory observation within the first 12 hoursof admission, and 3 variables of perinatal risks of mortality.Objectives To assess the validity of SNAPPE II in predicting mor-tality at neonatal intensive care unit (NICU), Soetomo Hospital,Surabaya. The study was also undertaken to evolve the best cut-offscore for predicting mortality.Methods Eighty newborns were admitted during a four-month periodand were evaluated with the investigations as required for the specifi-cations of SNAPPE II. Neonates admitted >48 hours of age or afterhaving been discharged, who were moved to lower newborn care <24hours and those who were discharged on request were excluded. Re-ceiver operating characteristic curve (ROC) were constructed to derivethe best cut-off score with Kappa and McNemar Test.Results Twenty eight (35%) neonates died during the study, 22(82%) of them died within the first six days. The mean SNAPPE IIscore was 26.3+19.84 (range 0-81). SNAPPE II score of thenonsurvivors was significantly higher than the survivors(42.75+18.59 vs 17.4+14.05; P=0.0001). SNAPPE II had a goodperformance in predicting overall mortality and the first-6-daysmortality, with area under the ROC 0.863 and 0.889. The best cut-off score for predicting mortality was 30 with sensitivity 81.8%,specificity 76.9%, positive predictive value 60.0% and negativepredictive value 90.0%.Conclusions SNAPPE II is a measurement of illness severity whichcorrelates well with neonatal mortality at NICU, Soetomo Hospital.The score of more than 30 is associated with higher mortality

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Coronary Care in a General Hospital

Scottish Medical Journal ◽

10.1177/003693307101600302 ◽

1971 ◽

Vol 16 (3) ◽

pp. 173-182 ◽

Cited By ~ 4

Author(s):

Gavin Shaw ◽

Bernard Groden ◽

Evelyn Hastings

Keyword(s):

Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

General Hospital ◽

First Year ◽

Duration Of Stay ◽

Before And After ◽

The Mean ◽

Coronary Care ◽

Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

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Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

SAGE Open Medicine ◽

10.1177/20503121211001144 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110011

Author(s):

Thabit Alotaibi ◽

Abdulrhman Abuhaimed ◽

Mohammed Alshahrani ◽

Ahmed Albdelhady ◽

Yousef Almubarak ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Acinetobacter Baumannii ◽

Care Setting ◽

Multidrug Resistant ◽

University Hospital ◽

Published Data ◽

Tertiary Teaching ◽

The Mean

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

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Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽

10.1161/circ.142.suppl_3.15293 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Barry Burstein ◽

Vidhu Anand ◽

Bradley Ternus ◽

Meir Tabi ◽

Nandan S Anavekar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Power Output ◽

Critically Ill Patients ◽

Cardiac Intensive Care Unit ◽

Cardiac Power ◽

The Mean ◽

Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

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Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study

Birat Journal of Health Sciences ◽

10.3126/bjhs.v1i1.17090 ◽

2017 ◽

Vol 1 (1) ◽

pp. 8-12

Author(s):

L.K. Rajbanshi ◽

M. Dali ◽

S.B. Karki ◽

K. Khanal ◽

B. Aryal ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Observational Study ◽

Ventilatory Support ◽

Control Mode ◽

Adaptive Support Ventilation ◽

Support Ventilation ◽

Adaptive Support ◽

The Mean

Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12

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