scholarly journals An audit of airway management in critically ill patients in a sub-Saharan tertiary hospital

2016 ◽  
Vol 13 (1) ◽  
pp. 6
Author(s):  
OyebolaOlubodun Adekola ◽  
OlusolaTemitayo Kushimo ◽  
EsoheIvie Ohuoba ◽  
GabrielKolawole Asiyanbi ◽  
OlugbengaOluseyi Olusoji ◽  
...  
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Hospital ◽  
Sub Saharan

Characteristics and Outcomes of Critically Ill Patients with COVID-19 Disease in Jordan

2020 ◽  
pp. 1-3
Author(s):  
Hasan Ibrahim Al-Balas ◽  
Keyword(s):  
Health Care ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Hospital ◽  
Published Data ◽  
First Case ◽  
Global Health Care ◽  
Novel Coronavirus ◽  
Overall Mortality

Introduction: Coronavirus disease 2019 (COVID-19) is an emerging global health care threat that is caused by a novel coronavirus named 2019-nCoV (SARS-CoV-2). The first case of diagnosed COVID-19 patient was declared in Jordan in early March 2020. As of June 8, Jordan had confirmed 831 cases, with 9 deaths, with an overall mortality rate of 1.08%. As there is no published data about critically ill patients in Jordan, we aimed to describe the characteristics and outcomes of critically ill COVID-19 patients in a tertiary hospital in Jordan.

scholarly journals Identifying the effects of an upgraded ‘fever clinic’ on COVID-19 control and the workload of emergency department: retrospective study in a tertiary hospital in China

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039177
Author(s):  
Jiangshan Wang ◽  
Liang Zong ◽  
Jinghong Zhang ◽  
Han Sun ◽  
Joseph Harold Walline ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Disease Transmission ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
College Hospital ◽  
Upper Respiratory Infection ◽  
Number Of Patients ◽  
Screening And Prevention

ObjectiveCOVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH).DesignA retrospective cohort study.ParticipantsA total of 6365 patients were screened in the FC.MethodsThe FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed.Results6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected.ConclusionThe workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.

Airway Management in Critically Ill Patients

CHEST Journal ◽  
2007 ◽  
Vol 132 (5) ◽  
pp. 1714
Author(s):  
Ali Al-Khafaji ◽  
Su Min Cho
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Airway management in critically sick in intensive care

2020 ◽  
Author(s):  
S. K. Malhotra ◽  
Komal Gandhi
Keyword(s):  
Intensive Care ◽  
Airway Management ◽  
Difficult Airway ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Operation Theatre ◽  
Physiological Reserve ◽  
Airway Equipment ◽  
One Airway ◽  
Airway Devices

In critically ill patients in Intensive Care Unit (ICU), patency of airway and managementof difficult airway are of utmost importance. The incidence of difficult intubation maybe 10% to 22% depending on the various factors in patient as well as availability ofequipment facilities. As compared to the regular surgery in operation theatre, themanagement of airway in critically ill patients is considerably different and morechallenging. The physiological reserve and co-morbidities are more common in criticallyill patients. In ICU, recent techniques of airway management must be considered andpracticed, such as videolaryngoscope (VLS), fiberoptic bronchoscope and supraglotticdevices. The success for airway management would be greater if airway expert, therequired devices and an adequate protocol are available. The outcome of managingairway would be enhanced if best use of available airway devices in a particular hospitalsetup since every instrument may not be available. The standard guidelines for difficultairway and the protocol of individual hospital may reduce the complications; hencemust be followed. The availability of difficult airway cart and capnograph is a must. Theindications and timing of surgical airway must be clear to the airway team. The Trainingcourses for the staff in ICU should be held regularly to apprise them of advancementin airway management. The best use of available airway equipment should be made incritically ill patients. At least, one airway expert must be accessible in ICU at any giventime. Received: 12 Sep 2018Reviewed: 5 Oct 2018Accepted: 10 Oct 2018 Citation: Malhotra SK, Gandhi K. Airway management in critically sick in intensive care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S21-S28

scholarly journals The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

2020 ◽  
pp. 139-148
Author(s):  
L Geldenhuys ◽  
R Wise ◽  
R Rodseth
Keyword(s):  
Adverse Events ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Hospital ◽  
Composite Outcome ◽  
Post Intervention ◽  
Hospital System ◽  
Metropolitan Hospital ◽  
Event Rates ◽  
The Impact

Background: Intrahospital transfer (IHT) of critically ill patients is associated with a high incidence of adverse events (AEs). This study aimed to determine whether the introduction of an intervention bundle could decrease AEs during, and immediately after IHT to the intensive care unit (ICU), as compared to event rates prior to the bundle’s introduction. Methods: This was a prospective, pre- and post-intervention trial, conducted in both a regional and tertiary hospital in Pietermaritzburg, South Africa. The intervention bundle consisted of an IHT protocol, a transport backpack, emergency drug container and simulation training. Primary outcomes were: 1) composite outcome of serious AEs, and 2) composite outcome of AEs contributing directly to morbidity or mortality. Secondary outcomes were miscellaneous complications, equipment-related AEs, total number of AEs, total number of IHTs complicated by AEs and the subjective measure of IHTs needing intervention within the first 30 minutes after arrival in ICU. Results: There were 381 pre-intervention IHTs and 264 post-intervention IHTs with one documented serious AE. Adverse events directly contributing to morbidity or mortality showed a reduction from 58.3% (CI 0.53–0.63) pre-intervention, to 56.1% (CI 0.50–0.62) post-intervention (p = 0.6). Miscellaneous complications yielded a reduction of 12.9% (CI 10.3–14.7%) pre-intervention to 9.5% (CI 8.3–11.1%) post-intervention (p = 0.2). Equipment-related AE reduced from 5.2% (CI 3.4–8%) to 1.9% (CI 0.8–4.5%) (p = 0.03). The total number of AEs reduced from 5% (CI 3.6–7.4%) to 4.1% (CI 2.4–6.8%) (p = 0.03), while the total number of transfers complicated by AEs reduced from 63.3% (CI 61.9–65.1%) to 60.6% (CI 58.8–63.1%) (p = 0.5). There was a reduction in IHTs requiring intervention within the first 30 minutes of arrival in ICU (34.6% to 22.7%; p = 0.001). Conclusion: These results support the use of an intervention bundle to decrease the incidence of AEs during IHT.

scholarly journals Hypophosphatemia and risk of refeeding syndrome in critically ill patients before and after nutritional therapy

2020 ◽  
Vol 66 (9) ◽  
pp. 1241-1246
Author(s):  
Amanda Coelho Ribeiro ◽  
Diana Borges Dock-Nascimento ◽  
João Manoel Silva Jr. ◽  
Cervantes Caporossi ◽  
José Eduardo de Aguilar-Nascimento
Keyword(s):  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Tertiary Hospital ◽  
Serum Phosphorus ◽  
Refeeding Syndrome ◽  
Before And After ◽  
Phosphorus Levels

Summary OBJECTIVE: To investigate the prevalence of hypophosphatemia as a marker of refeeding syndrome (RFS) before and after the start of nutritional therapy (NT) in critically ill patients. METHODS: Retrospective cohort study including 917 adult patients admitted at the intensive care unit (ICU) of a tertiary hospital in Cuiabá-MT/Brasil. We assessed the frequency of hypophosphatemia (phosphorus <2.5mg/dl) as a risk marker for RFS. Serum phosphorus levels were measured and compared at admission (P1) and after the start of NT (P2). RESULTS: We observed a significant increase (36.3%) of hypophosphatemia and, consequently, a greater risk of RFS from P1 to P2 (25.6 vs 34.9%; p<0.001). After the start of NT, malnourished patients had a greater fall of serum phosphorus. Patients receiving NT had an approximately 1.5 times greater risk of developing RFS (OR= 1.44 95%CI 1.10-1,89; p= 0.01) when compared to those who received an oral diet. Parenteral nutrition was more associated with hypophosphatemia than either enteral nutrition (p=0,001) or parenteral nutrition supplemented with enteral nutrition (p=0,002). CONCLUSION: The frequency of critically ill patients with hypophosphatemia and at risk for RFS on admission is high and this risk increases after the start of NT, especially in malnourished patients and those receiving parenteral nutrition.

Nutritional risk assessment using the NUTRIC score in critically ill patients undergoing nutrition therapy in a Brazilian tertiary hospital

2017 ◽  
Vol 42 ◽  
pp. 409
Author(s):  
Fabiana Ruotolo ◽  
Paulo César Ribeiro ◽  
Sandra Regina Alves Belo ◽  
Ivens Augusto Oliveira de Souza ◽  
Paulo César Ribeiro ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Therapy ◽  
Tertiary Hospital ◽  
Nutritional Risk

Airway Management

2019 ◽  
Author(s):  
James M. Dargin ◽  
Lillian L. Emlet
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Critically Ill Patients ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Bag Mask Ventilation ◽  
Upper Gastrointestinal

Endotracheal intubation is a commonly performed procedure in the intensive care unit (ICU). Active upper gastrointestinal bleeding, emesis in the airway, and the presence of a cervical collar are just a few examples of conditions encountered in critically ill patients that can make endotracheal intubation difficult. Furthermore, critically ill patients usually require intubation because they have exhausted their physiologic reserve and can deteriorate rapidly due to vasodilation from induction medications, reduction in preload from positive pressure ventilation, hypercapnia and acidosis during periods of apnea, hypoxia from failed attempts at intubation, and an increase in intracranial pressure during laryngoscopy attempts. Up to one third of patients undergoing emergency airway management will develop serious complications, including hypoxemia, hypotension, aspiration, or cardiac arrest. Careful planning, provision of the appropriate equipment and personnel, and an understanding of an individual patient’s physiologic derangements can help to prevent complications during intubation.  This review 13 figures, 4 tables, and 27 references.  Keywords: airway, intubation, endotracheal, rapid sequence, pre-oxygenation, bag-mask ventilation, laryngoscopy, cricothyrotomy, supraglottic airway 

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