scholarly journals Assessment of incidence and risk factors for intensive care acquired delirium in mechanically ventilated patients in surgical intensive care unit – National Hospital of Sri Lanka

2018 ◽  
Vol 26 (2) ◽  
pp. 131
Author(s):  
P. A. Nimali Lochanie ◽  
Nuwan M.D. Ranawaka
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sri Lanka ◽  
Surgical Intensive Care Unit ◽  
National Hospital ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Prediction of fluid responsiveness in mechanically ventilated patients in surgical intensive care unit by pleth variability index and inferior vena cava diameter

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Diaaeldin Badr Metwally Kotb Aboelnile ◽  
Mohamed Ismail Abdelfattah Elseidy ◽  
Yasir Ahmed Elbasiony Mohamed Kenawey ◽  
Ibrahim Mohammed Alsayed Ahmed Elsherif
Keyword(s):  
Intensive Care Unit ◽  
Fluid Responsiveness ◽  
Threshold Value ◽  
Surgical Intensive Care Unit ◽  
Pleth Variability Index ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Variability Index ◽  
Ventilated Patients

Abstract Background Patients may have signs of hypovolemia, but fluid administration is not always beneficial. We are in need of bedside devices and techniques, which can predict fluid responsiveness effectively and safely. This study is aiming to compare the effectiveness and reliability of the pleth variability index (PVI) and IVC distensibility index (dIVC) as predictors of fluid responsiveness by simultaneous recordings in all sedated mechanically ventilated patients in the surgical intensive care unit (ICU). We used the passive leg raising test (PLR) as a harmless reversible technique for fluid challenge, and patients were considered responders if the cardiac index (CI) measured by transthoracic echocardiography (TTE) increased ≥ 15% after passive leg raising test (PLR). Results This observational cross-sectional study was performed randomly on 88 intubated ventilated sedated patients. Compared with CI measured by transthoracic echocardiography, the dIVC provided 79.17% sensitivity and 80% specificity at a threshold value of > 19.42% for fluid responsiveness prediction and was statistically significant (P < .0001), with an area under the curve (AUC) of 0.886 (0.801–0.944), while PVI at a threshold value of > 14% provided 93.75% sensitivity and 87.5% specificity and was statistically significant (P < .0001), with an AUC of 0.969 (0.889–0.988). Conclusion PVI and dIVC are effective non-invasive bedside methods for the assessment of fluid responsiveness in ICU for intubated ventilated sedated patients with sinus rhythm, but PVI has the advantage of being continuous, operator-independent, and more reliable than dIVC.

Correlation of Pneumonia Score with Electronic Nose Signature: A Prospective Study

2005 ◽  
Vol 114 (7) ◽  
pp. 504-508 ◽  
Author(s):  
Neil G. Hockstein ◽  
Erica R. Thaler ◽  
Yuanqing Lin ◽  
D. Daniel Lee ◽  
C. William Hanson
Keyword(s):  
Intensive Care ◽  
Prospective Study ◽  
Electronic Nose ◽  
Arterial Oxygen ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
A Prospective Study ◽  
Ventilated Patients

Objectives: Ventilator-associated pneumonia (VAP) is a frequent complication in patients in surgical intensive care units. Pneumonia scores, chest radiography, and bronchoscopy are all employed, but there is no gold standard test for the diagnosis of VAP. The electronic nose, a sensor of volatile molecules, is well suited to testing the breath of mechanically ventilated patients. Our objective was to determine the potential use of an electronic nose as a diagnostic adjunct in the detection of VAP. Methods: We performed a prospective study of mechanically ventilated patients in a surgical intensive care unit. Clinical data, including temperature, white blood cell count, character and quantity of tracheal secretions, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, and chest radiographs, were collected, and a pneumonia score between 0 and 10 was calculated. Exhaled gas was sampled from the expiratory limb of the ventilator circuit. The gases were assayed with a commercially available electronic nose. Multidimensional data reduction analysis was used to analyze the results. Results: Forty-four patients were studied. Fifteen patients had pneumonia scores of 7 or greater, and 29 patients had scores of 6 or less. With Fisher discriminant analysis and K—nearest neighbor analysis, the electronic nose was able to discriminate between the two groups. Conclusions: The electronic nose is a new technology that is inexpensive, noninvasive, and portable. We demonstrate its ability to predict pneumonia, based on a well-recognized scoring system. This technology promises to serve as a diagnostic adjunct in the management of VAP.

Five-Year Outcomes After Implementing a Pain, Agitation, and Delirium Protocol in a Mixed Intensive Care Unit

2021 ◽  
pp. 088506662110634
Author(s):  
Jeffrey T. Fish ◽  
Jared T. Baxa ◽  
Ryan R. Draheim ◽  
Matthew J. Willenborg ◽  
Jared C. Mills ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Academic Medical Center ◽  
Admission Diagnosis ◽  
Surgical Intensive Care Unit ◽  
Standardized Mortality Ratio ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mortality Ratio ◽  
Apache Iv

Objective: Assess for continued improvements in patient outcomes after updating our institutional sedation and analgesia protocol to include recommendations from the 2013 Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium (PAD) guidelines. Methods: Retrospective before-and-after study in a mixed medical/surgical intensive care unit (ICU) at an academic medical center. Mechanically ventilated adults admitted from September 1, 2011 through August 31, 2012 (pre-implementation) and October 1, 2012 through September 30, 2017 (post-implementation) were included. Measurements included number of mechanically ventilated patients, APACHE IV scores, age, type of patient (medical or surgical), admission diagnosis, ICU length of stay (LOS), hospital LOS, ventilator days, number of self-extubations, ICU mortality, ICU standardized mortality ratio, hospital mortality, hospital standardized mortality ratio, medication data including as needed (PRN) analgesic and sedative use, and analgesic and sedative infusions, and institutional savings. Results: Ventilator days (Pre-PAD = 4.0 vs. Year 5 post = 3.2, P < .0001), ICU LOS (Pre-PAD = 4.8 days vs. Year 5 post = 4.1 days, P = .0004) and hospital LOS (Pre-PAD = 14 days vs. Year 5 post = 12 days, P < .0001) decreased after protocol implementation. Hospital standardized mortality ratio (Pre-PAD = 0.69 vs. Year 5 post = 0.66) remained constant; while, APACHE IV scores (Pre-PAD = 77 vs. Year 5 post = 89, P < .0001) and number of intubated patients (Pre-PAD = 1146 vs. Year 5 post = 1468) increased over the study period. Using the decreased ICU and hospital LOS estimates, it is projected the institution saved $4.3 million over the 5 years since implementation. Conclusions: Implementation of an updated PAD protocol in a mixed medical/surgical ICU was associated with a significant decrease in ventilator time, ICU LOS, and hospital LOS without a change in the standardized mortality ratio over a five-year period. These favorable outcomes are associated with a significant cost savings for the institution.

Risk factors for poor outcome in older patients admitted in a surgical intensive care unit

2021 ◽  
Author(s):  
Emilie Occhiali ◽  
Pierre Prolange ◽  
Florence Cassiau ◽  
Frédéric Roca ◽  
Benoit Veber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Older Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Poor Outcome

scholarly journals The ethical concerns of seeking consent from critically ill, mechanically ventilated patients for research – A matter of possessing capacity or surrogate insight

2018 ◽  
Vol 13 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Avelino C Verceles ◽  
Waqas Bhatti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Informed Consent ◽  
Critically Ill ◽  
Ethical Issues ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ethical Concerns ◽  
Multiple Factors ◽  
Ventilated Patients

Conducting clinical research on subjects admitted to intensive care units is challenging, as they frequently lack the capacity to provide informed consent due to multiple factors including intensive care unit acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from mechanically ventilated, critically ill patients, in addition to the concerns that may arise when a legally authorized representative is asked to provide informed consent on behalf of these patients.

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