scholarly journals Intensive Care Unit Scoring Systems

2021 ◽  
Vol 41 (4) ◽  
pp. 54-64
Author(s):  
Tiffany Purcell Pellathy ◽  
Michael R. Pinsky ◽  
Marilyn Hravnak
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Scoring Systems ◽  
Multiple Organ Dysfunction Score ◽  
Severity Scoring ◽  
Logistic Organ Dysfunction

Background Illness severity scoring systems are commonly used in critical care. When applied to the populations for whom they were developed and validated, these tools can facilitate mortality prediction and risk stratification, optimize resource use, and improve patient outcomes. Objective To describe the characteristics and applications of the scoring systems most frequently applied to critically ill patients. Methods A literature search was performed using MEDLINE to identify original articles on intensive care unit scoring systems published in the English language from 1980 to 2020. Search terms associated with critical care scoring systems were used alone or in combination to find relevant publications. Results Two types of scoring systems are most frequently applied to critically ill patients: those that predict risk of in-hospital mortality at the time of intensive care unit admission (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score, and Mortality Probability Models) and those that assess and characterize current degree of organ dysfunction (Multiple Organ Dysfunction Score, Sequential Organ Failure Assessment, and Logistic Organ Dysfunction System). This article details these systems’ differing features and timing of use, score calculation, patient populations, and comparative performance data. Conclusion Critical care nurses must be aware of the strengths, limitations, and specific characteristics of severity scoring systems commonly used in intensive care unit patients to effectively employ these tools in clinical practice and critically appraise research findings based on their use.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

2021 ◽  
Vol 1 (3) ◽  
pp. 44-48
Author(s):  
Cendy Legowo
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Postoperative Delirium ◽  
Mechanistic Explanation ◽  
Clinical Results ◽  
Care Plan ◽  
Prevention And Treatment

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

scholarly journals Insulin therapy for hyperglycemia in critically ill patients

2016 ◽  
Vol 53 (5) ◽  
pp. 250
Author(s):  
Julianti Julianti ◽  
Silvia Triratna ◽  
Aditiawati Aditiawati ◽  
Irfanuddin Irfanuddin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Mortality Rate ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Therapy Group ◽  
Control Group

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores ≤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

2021 ◽  
Vol 1 (3) ◽  
pp. 44-48
Author(s):  
Cendy Legowo
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Postoperative Delirium ◽  
Mechanistic Explanation ◽  
Clinical Results ◽  
Care Plan ◽  
Prevention And Treatment

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

Survival, Outcomes, and Use of Acuity Scoring Systems Following Tracheotomy in Veteran Patients

2020 ◽  
Vol 37 (11) ◽  
pp. 890-896
Author(s):  
Carol M. Bier-Laning ◽  
Jeffrey Hotaling ◽  
W. Jeffrey Canar ◽  
Aziz A. Ansari
Keyword(s):  
General Population ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Scoring Systems ◽  
Survival Outcomes ◽  
Logistic Organ Dysfunction ◽  
Failure Assessment

Objectives: To determine whether established prognosis tools used in the general population of critically ill patients will accurately predict tracheotomy-related outcomes and survival outcomes in critically ill patients undergoing tracheotomy. Methods: Retrospective chart review of 94 consecutive critically ill patients undergoing isolated tracheotomy. Results: Logistic Organ Dysfunction System (LODS) and sepsis-related organ failure assessment (SOFA) scores, 2 validated measures of acuity in critically ill patients, were calculated for all patients. The only tracheotomy-related outcome of significance was the finding that patients with an LODS score ≤6 were more likely to become ventilator independent ( P < .015). Higher LODS or SOFA scores were associated with in-house death (LODS, P = .001, SOFA, P = .008) and death within 90 days (LODS, P = .009, SOFA, P = .031), while death within 180 days was associated only with a higher LODS score (LODS, P = .018). When controlling for age, there was an association between both LODS ( P = .015) and SOFA ( P = .019) scores and death within 90 days of tracheotomy. Conclusions: The survival outcome for critically ill patients undergoing tracheotomy seems accurately predicted based on scoring systems designed for use in the general population of critically ill patients. Logistic Organ Dysfunction System may also be useful to predict the likelihood of the tracheotomy-related outcome of ventilator independence. This suggests that LODS scores may be helpful to palliative care clinicians as part of a shared decision-making aid in critically ill, ventilated patients for whom tracheotomy is being considered.

Sedation, Pain Management, and Pharmacology

2019 ◽  
pp. 87-99
Author(s):  
Sophie Samuel ◽  
Jennifer Cortes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Infectious Diseases ◽  
Operating Room ◽  
Critically Ill ◽  
Residency Training ◽  
Critically Ill Patients ◽  
Clinical Vignettes

The study of pharmacology enables the principle method of intervention for critically ill patients. Because many variables exists that affect the efficacy and indications for drug intervention, a thorough knowledge of pharmacology is needed in the intensive care unit, just as it is needed in the operating room. Because pharmacology effects every system it may potentially be included in every type of question. In order to achieve a pharmacologic focus, much of this chapter emphasizes and infrequently seen but non-isoteric contact. Overall, chapter is designed to evaluate pharmacologic knowledge with highly clinical vignettes for the reader. Additionally, the reader will find an emphasis on practice pharmacologic elements of managing infectious diseases and complexities of sedation, which anesthesiologists will find reminiscent of the residency training with a critical care “twist”.

Transfusion Requirements in Critical Care (TRICC)

2018 ◽  
pp. 114-118
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Ischemia ◽  
Red Cell ◽  
Transfusion Threshold ◽  
Chronic Anemia ◽  
Transfusion Requirements

This case focuses on red cell transfusions in critically ill patients by asking the question: When should patients in the intensive care unit (ICU) with anemia receive red cell transfusions? For most critically ill patients, waiting to transfuse red cells until the hemoglobin (Hgb) drops below 7 g/dL is at least as effective as, and likely preferable to, transfusing at an Hgb less than 10 g/dL. These findings may not apply to patients with chronic anemia, who were excluded from the trial. The results also may not apply to patients with active cardiac ischemia, who were poorly represented in the trial and had nonsignificantly worse outcomes with a transfusion threshold of 7.

Mid-regional pro-adrenomedullin predicts poor outcome in non-selected patients admitted to an intensive care unit

2019 ◽  
Vol 57 (4) ◽  
pp. 549-555 ◽  
Author(s):  
Chiara Bellia ◽  
Luisa Agnello ◽  
Bruna Lo Sasso ◽  
Giulia Bivona ◽  
Maurizio Santi Raineri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Icu Admission ◽  
Open Issue ◽  
The One

Abstract Background Mortality risk and outcome in critically ill patients can be predicted by scoring systems, such as APACHE and SAPS. The identification of prognostic biomarkers, simple to measure upon admission to an intensive care unit (ICU) is an open issue. The aim of this observational study was to assess the prognostic value of plasma mid-regional pro-adrenomedullin (MR-proADM) at ICU admission in non-selected patients in comparison to Acute Physiology and Chronic Health Evaluation II (APACHEII) and Simplified Acute Physiology Score II (SAPSII) scores. Methods APACHEII and SAPSII scores were calculated after 24 h from ICU admission. Plasma MR-proADM levels were measured by TRACE-Kryptor on admission (T0) and after 24 h (T24). The primary endpoint was intra-hospital mortality; secondary endpoint was length of stay (LOS). Results One hundred and twenty-six consecutive non-selected patients admitted to an ICU were enrolled. Plasma MR-proADM levels were correlated with LOS (r=0.28; p=0.0014 at T0; r=0.26; p=0.005 at T24). Multivariate analysis showed that T0 MR-proADM was a significant predictor of mortality (odds ratio [OR]: 1.27; 95% confidence interval [95%CI]: 1.03–1.55; p=0.022). Receiver operating characteristic curves analysis revealed that MR-proADM on ICU admission identified non-survivors with high accuracy, not inferior to the one of APACHEII and SAPSII scores (area under the curve [AUC]: 0.71; 95%CI: 0.62–0.78; p=0.0002 for MR-proADM; AUC: 0.71; 95%CI: 0.62–0.79; p<0.0001 for APACHEII; AUC: 0.8; 95%CI: 0.71–0.87; p<0.0001 for SAPSII). Conclusions Our findings point out a role of MR-proADM as a prognostic tool in non-selected patients in ICUs being a reliable predictor of mortality and LOS and support its use on admission to an ICU to help the management of critically ill patients.

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