Factors of cardiovascular risk in a cardiology intensive care unit

2009 ◽  
Vol 4 (1) ◽  
pp. 191 ◽  
Author(s):  
Etiane De Oliveira Freitas ◽  
Luiza De Oliveira Pitthan ◽  
Laura De Azevedo Guido ◽  
Graciele Fernanda da Costa Linch ◽  
Juliane Umann
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiovascular Risk ◽  
Coronary Angiography ◽  
Clinical Manifestations ◽  
Coronary Event ◽  
Study Data ◽  
Coronary Syndrome ◽  
Santa Maria

ABSTRACTObjectives: to identify the epidemiological profile, factors of cardiovascular risk, clinical manifestations, and coronary angiography findings in patients hospitalized in a Cardiology Intensive Care Unit, after a coronary event. Methods: this is a transversal study. Data were collected through a questionnaire. The criteria of inclusion were: diagnosis of the acute coronary syndrome, conduction of a coronary angiography, age >21 years old, both gender, conscious and able to interact, and with a minimum time hospitalized of 24 hours. In the analysis, the category variables were expressed with percentages or an absolute value, and the data on the average and standard deviation. The Ethics in Research of the Federal University of Santa Maria approved this study (0010.0.243.000-09). Results: the population was constituted by 30 patients, 63.33% male, the age average was 62.3 years. The most prevalent risk factors were SAH (83.3%) and obesity (63.3%). 40% of the patients were diagnosed with angina and coronary lesion of a vessel. They were submitted to PTCA 46.6% of the patients. Conclusions: knowing the characteristics of the patients in a Cardiology Intensive Care Unit enables the nursing team to plan and/or intensify the actions of education in health in order to change life habits of this population. Descriptors: risk factors; cardiovascular diseases; health education.  RESUMOObjetivos: identificar o perfil epidemiológico, fatores de risco cardiovascular, manifestações clínicas e achados cinecoronariográficos em pacientes internados em uma Unidade de Cardiologia Intensiva, após evento coronariano. Métodos: trata-se de estudo transversal cujos dados foram coletados por meio de questionário. Os critérios de inclusão foram: diagnóstico de síndrome coronariana aguda, realização de cineangiocoronariografia, idade >21 anos, ambos os sexos, com capacidade de interação e com tempo mínimo de 24 horas de internação. Para análise, as variáveis categóricas foram expressas com percentual ou valor absoluto, as contínuas como média e desvio padrão. O Comitê de Ética em Pesquisa da Universidade Federal de Santa Maria aprovou este estudo (0010.0.243.000-09). Resultados: a população constituiu-se de 30 pacientes, 63,3% do sexo masculino, média de idade de 62,3 anos. Os fatores de risco prevalentes foram a HAS (83,3%) e a obesidade (63,3%).40,0% dos pacientes tiveram diagnóstico de angina e lesão coronariana de um vaso. Foram submetidos à ACTP 46,6% dos pacientes. Conclusões: conhecer as características dos pacientes em uma Unidade de Cardiologia Intensiva, possibilita à equipe de enfermagem planejar e/ou intensificar ações de educação em saúde, voltada à mudança de hábitos de vida dessa população. Descritores: fatores de risco; doenças cardiovasculares; educação em saúde. RESUMENObjetivos: identificar el perfil epidemiológico, fatores de riesgo cardiovascular, manifestaciones clínicas y hallazgos cinecoronariográficos en pacientes internados en una Unidad de Cardiologia Intensiva, luego de evento coronariano.  Métodos: este es un estudio transversal. Los datos fueron recogidos a través de un cuestionario. Los critérios de inclusión fueron: diagnóstico de síndrome coronariana aguda, realización de cineangiocoronariografia, edad: mayores de 21 años, ambos sexos, que estuvieran concientes,  con capacidad de interacción y con un tiempo mínimo de 24 horas de internación. El análisis, las variables categóricas fueron expresadas con percentual o valor absoluto, las contínuas como media y desvio patrón. El Comité de Ética en Investigación de la Universidad Fedral de Santa Maria aprobó este estúdio (0010.0.243.000-09). Resultados: la población constituye por 30 pacientes, 63,33% sexo masculino. La media de edad fue de 62,3 años. Los fatores de riesgo que prevalecieron fueron las HAS(833%) y la obesidad (63,3%). 40% de los pacientes tuvo diagnóstico de angina y  lesión coronariana de un vaso. Fueron sometidos a ACTP 46,6% de los pacientes. Conclusiones: conocer las características de los pacientes en una Unidad de Cardiologia Intensiva, posibilita al equipo de enfermería planear y/o intensificar acciones  de educación en salud, con foco al cambio de hábitos de vida de dicha población.  Descriptores: factores de riesgo; enfermedades cardiovasculares; educación en salud.  

scholarly journals Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

2021 ◽  
Vol 9 (7) ◽  
pp. 1505
Author(s):  
Claire Roger ◽  
Benjamin Louart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Convulsive Status Epilepticus ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Drug Induced ◽  
Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

scholarly journals Associations of Serum Cortisol with Cardiovascular Risk and Mortality in Patients Referred to Coronary Angiography

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Stefan Pilz ◽  
Verena Theiler-Schwetz ◽  
Christian Trummer ◽  
Martin H Keppel ◽  
Martin R Grübler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Natural Killer Cells ◽  
Coronary Angiography ◽  
Cardiovascular Risk Factors ◽  
Natural Killer ◽  
Cardiovascular Mortality ◽  
Serum Cortisol ◽  
Killer Cells ◽  
Coronary Syndrome

Abstract Context Serum cortisol may be associated with cardiovascular risk factors and mortality in patients undergoing coronary angiography, but previous data on this topic are limited and controversial. Objective We evaluated whether morning serum cortisol is associated with cardiovascular risk factors, lymphocyte subtypes, and mortality. Methods This is a prospective cohort study performed at a tertiary care centre in south-west Germany between 1997 and 2000. We included 3052 study participants who underwent coronary angiography. The primary outcome measures were cardiovascular risk factors, lymphocyte subtypes, and all-cause and cardiovascular mortality. Results Serum cortisol was associated with an adverse cardiovascular risk profile, but there was no significant association with coronary artery disease or acute coronary syndrome. In a subsample of 2107 participants, serum cortisol was positively associated with certain lymphocyte subsets, including CD16+CD56+ (natural killer) cells (P < 0.001). Comparing the fourth versus the first serum cortisol quartile, the crude Cox proportional hazard ratios (with 95% CIs) were 1.22 (1.00-1.47) for all-cause and 1.32 (1.04-1.67) for cardiovascular mortality, respectively. After adjustments for various cardiovascular risk factors, these associations were attenuated to 0.93 (0.76-1.14) for all-cause, and 0.97 (0.76-1.25) for cardiovascular mortality, respectively. Conclusions Despite significant associations with classic cardiovascular risk factors and natural killer cells, serum cortisol was not a significant and independent predictor of mortality in patients referred to coronary angiography. These findings might reflect that adverse cardiovascular effects of cortisol could be counterbalanced by some cardiovascular protective actions.

scholarly journals 288 The effects of cardiovascular diseases and treatment on clinical course of hospitalized COVID-19 patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Silvia Prosperi ◽  
Lucia Ilaria Birtolo ◽  
Mia Yarden Revivo ◽  
Sara Monosilio ◽  
Sara Cimino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiovascular Diseases ◽  
Clinical Course ◽  
Beta Blockers ◽  
Coronary Syndrome ◽  
Cardiovascular Evaluation ◽  
Electrocardiogram Ecg ◽  
New Onset

Abstract Aims Significant concern has been raised about the effect of pre-existing cardiovascular diseases (CVD), cardiovascular (CV) risk factors and CV therapies on COVID-19 course. On the other hand, COVID-19 could worse pre-existing CVD or trigger the development of new-onset CVD. The aim of this study was to evaluate the relationship between pre-existing CVD, CV risk factors, and CV therapy with the clinical course of hospitalized COVID-19 patients. Methods and results Consecutive hospitalized COVID-19 patients admitted to the Cardiovascular COVID-19 Unit at Policlinico Umberto I of Rome between December 2020 and April 2021 were enrolled. All patients underwent a cardiovascular evaluation including troponin, electrocardiogram (ECG), and echocardiogram. Data on medical history, pre-existing CVD, CV risk factors, and therapy were collected. Admission to the Intensive Care Unit (ICU) or Cardiac Intensive Care Unit (CICU), as well as the development of new-onset CVD, were considered as endpoint of the study. Among n = 229 patients enrolled, 22 (10%) died. Nearly half of patients (112, 49%) were admitted to the ICU/CICU. The presence of prior ischaemic heart disease nearly doubled the probability of hospitalization in the ICU/CICU (HR: 2.09, 95% CI: 1.132–3.866, P 0.018). In regards of therapy, beta blockers reduced the likelihood of admission in the ICU/CICU (HR: −1016, 95% CI: 0.192–10.682, P 0.002). However, neither the use of RAAS blockers, heparin or dexamethasone influenced the risk of ICU/CICU admission (respectively, HR: 0.85, 95% CI: 0.498–1.450, P 0.551; HR: 0.768, 95% CI: 0.435–1.356, P 0.363; HR: 0.861, 95% CI: 0.453–1.635, P 0.647). N = 89 patients (39%) experienced a new onset CVD including arrythmias (18.3%) with nearly half experiencing atrial fibrillation, acute coronary syndrome (10.9%), acute pulmonary embolism (5.3%), heart failure (HF) (3%), and myocarditis and pericarditis (1.3%). A pre-existing diagnosis of HF substantially increased the likelihood of new onset CVD (HR: 2.380, 95% CI: 1.004–5.638, P 0.049). However, treatment with heparin or dexamethasone reduced the risk of new onset CVD (HR: 0.482 95% CI: 0.268–0.867, P 0.015; HR: 0.487, 95% CI: 0.253–0.937, P 0.031, respectively). Conclusions Our study found that hospitalized COVID-19 patients who have at least one CV risk factor or pre-existing CVD had a greater likelihood of being admitted to the ICU/CICU and experiencing new onset CVD.

scholarly journals Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.

2013 ◽  
Vol 52 (190) ◽  
Author(s):  
Mani Prasad Gautam ◽  
Guruprasad Sogunuru ◽  
Gangapatnam Subramanyam ◽  
Lekhjung Thapa ◽  
Raju Paudel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Heart Disease ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years.  Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%).  Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.

Analysis of Risk Factors for Early-onset Ventilator-associated Pneumonia in a Neurosurgical Intensive Care Unit: A Single-center Retrospective Study

2021 ◽  
Author(s):  
guojie teng ◽  
Ning Wang ◽  
Xiuhong Nie ◽  
Lin Zhang ◽  
Hongjun Liu
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Therapeutic Hypothermia ◽  
Early Onset ◽  
Clinical Manifestations ◽  
Older Age ◽  
Resistant Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Hypothermia Treatment

Abstract Background:Ventilator-associated pneumonia (VAP) is a severe infection among patients in the neurosurgery intensive care unit (NICU).Methods:We retrospectively evaluated risk factors for early-onset ventilator-associated pneumonia (EOVAP) from January 2019 to December 2019 at a NICU. A total of 89 NICU patients who were intubated within 48 hours of onset and whose mechanical ventilation time was longer than 7 days were enrolled. The enrolled patients had no history of chronic lung disease and no clinical manifestations of infection before intubation. Clinical data of patients were recorded, and the incidence of and risk factors for EOVAP were analyzed. Patients were also grouped by age (≥65 vs. <65 years) and whether they had received hypothermia treatment or not.Results:Among 89 mechanically ventilated patients (49 men and 40 women; median age 60.1±14.3 years), 40 patients (44.9%) developed EOVAP in 7 days and 14 patients (15.7%) had multidrug resistant bacteria. Binary logistic regression analysis indicated that older age (≥65years) (odds ratio [OR]: 0.267, 95% confidence interval [CI]: 0.101-0.709, P=0.008) and therapeutic hypothermia (OR: 0.235, CI: 0.075-0.738, p=0.013) were independent predictors of EOVAP. Levels of peripheral blood leukocytes, neutrophils and platelets were lower in the therapeutic hypothermia group than those that did not receive hypothermia treatment.Conclusions:This study found that older age (≥65years) and therapeutic hypothermia were independently associated with the risk of EOVAP in NICU patients.

Interacting risk factors determine the outcome of patients with a prolonged intensive care unit stay after cardiac surgery

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Schöttler ◽  
C Grothusen ◽  
T Attmann ◽  
C Friedrich ◽  
S Freitag-Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay
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