scholarly journals Incidence and outcomes of acute lung injury in the surgical intensive care unit of a tertiary care hospital in Bangkok, Thailand

2017 ◽  
Vol 10 (4) ◽  
pp. 379-385
Author(s):  
Onuma Chaiwat ◽  
Worawan Suwannasri ◽  
Jedsadayoot Sak-aroonchai ◽  
Sawita Kanavitoon ◽  
Annop Piriyapathsom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Lung Injury ◽  
Mortality Rate ◽  
Lung Injury ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Surgical Intensive Care

Abstract Background Although the pathophysiology and treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well established, the incidence and outcomes of ALI have not been extensively reported. Variations in healthcare systems, demographics, socioeconomics, and levels of intensive care units (ICU) may explain remarkable differences in outcomes reported. Objectives To evaluate the incidence and outcomes of ALI/ARDS at the surgical ICU (SICU) at Siriraj Hospital of Mahidol University, Bangkok. Methods We included patients aged ≥18 years admitted to the general SICU between June 1, 2010 and May 31, 2013 in this prospective, cohort observational study. All patients required ≥24 h of ventilatory support. The study outcomes were the incidence of ALI/ARDS, SICU length of stay, and mortality rate. Results Of 2523 patients admitted to the SICU, 495 (20%) required ≥24 h ventilatory support, and 15 (3%) developed ALI/ARDS. ALI/ARDS occurred on day 2 of ventilatory support. ARDS was caused by sepsis and pneumonia. The patients who developed ALI/ARDS had a higher APACHE II score (P = 0.001) and end-stage renal disease (P = 0.01). Pneumonia and acute kidney injury were more severe in patients with ALI and ARDS (40% vs 9%, P = 0.002; 33% vs 10%, P = 0.02, respectively). Ventilatory support duration, SICU lengths of stay and hospital mortality were higher in the ALI/ARDS group. Conclusions The incidence of ALI/ARDS in the SICU was low, but the mortality rate was high. A larger sample size is necessary to identify independent risk factors for ALI/ARDS.

scholarly journals A COMPARATIVE STUDY ON DRUG USE OF ANTIMICROBIAL AGENTS IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL.

2018 ◽  
Vol 11 (1) ◽  
pp. 310
Author(s):  
Nimin Paul ◽  
Santhosh Kumar V
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Total Drug ◽  
Surgical Intensive Care

 Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs.Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1st 2016 to March 1st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed.Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test.Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent’s usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.

scholarly journals Incidence and risk factors of delirium in surgical intensive care unit

2021 ◽  
Vol 6 (1) ◽  
pp. e000564
Author(s):  
Muhammad Asghar Ali ◽  
Madiha Hashmi ◽  
Waqas Ahmed ◽  
Syed Amir Raza ◽  
Muhammad Faisal Khan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Low Income ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care

BackgroundTo evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.MethodsWe conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for >24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors.ResultsThe average patient age was 43.29±17.38 and body mass index was 26.25±3.57 kg/m2. Delirium was observed in 19 of 87 patients with an incidence rate of 21.8%. Multivariable analysis showed chronic obstructive pulmonary disease, pain score >4 and hypernatremia were strong predictors of delirium. Midazolam (adjusted OR (aOR)=7.37; 95% CI 2.04 to 26.61) and propofol exposure (aOR=7.02; 95% CI 1.92 to 25.76) were the strongest independent predictors of delirium while analgesic exposures were not statistically significant to predict delirium in multivariable analysis.ConclusionDelirium is a significant risk factor of poor outcome in SICU. There was an independent association between pain, sedation, COPD, hypernatremia and fever in developing delirium.Level of evidenceIV.

scholarly journals Outcome of Patients Admitted with Exertional Heat Related Illness in Intensive Care Unit of Tertiary Care Hospital

2019 ◽  
Vol 3 (3) ◽  
pp. 524-527
Author(s):  
Bishwo Ram Amatya ◽  
Bikal Shrestha ◽  
Mallika Rayamajhi ◽  
Nagendra Bahadur K.C. ◽  
Pranaya Karki
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Tertiary Care Hospital ◽  
Heat Stroke ◽  
Tertiary Care ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Stroke Patients ◽  
Heat Exhaustion

Introduction: Exertional heat related illness particularly heat stroke is very common life threatening condition that frequently occur in young military trainee due to high ambient temperature and humidity. Objective: The study was undertaken to identify its outcome in recruits admitted in intensive care units of military tertiary care hospital. Methods: An observational cross-sectional descriptive study was done among those recruits admitted in Intensive Care Unit of military tertiary care hospital with diagnosis of heat related illness from June 2016 to August 2017 A.D. Data based on hospital case records were collected and analyzed using SPSS version 22. Primary outcome studied was mortality. Secondary outcomes studied were length of stay in ICU, hospital and on ventilator. Results: Out of 17 recruits, 12 were diagnosed as heat exhaustion and 5 were diagnosed as heat stroke. SOFA score for heat stroke and heat exhaustion patients ranged from 2-16 and 0- 2 with respective mortality rate 7-95% and 0-7%. APACHE II score for heat stroke and heat exhaustion patients ranged from 5-33 and 0-5 with respective mortality rate 5.80-73% and 0-5.80%. There was no mortality among 12 heat exhaustion patients. Out of 5 heat stroke patients, 3 died with 60% mortality rate. Heat stroke patients had maximum stay of 4 days in ICU, hospital for 5 days and ventilator for 4 days. Conclusion: Exertional heat related illness is common in young military trainee with heat exhaustion and heat stroke being common causes for ICU admission. Heat stroke has higher mortality rate due to multiple organ dysfunction. 

An Outbreak ofAcinetobacter baumannii:The Importance of Cross-Transmission

2000 ◽  
Vol 21 (9) ◽  
pp. 588-591 ◽  
Author(s):  
Erika M.C. D'Agata ◽  
Valerie Thayer ◽  
William Schaffner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infections ◽  
Attack Rate ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Number Of Patients ◽  
Cross Transmission

AbstractObjective:To investigate an outbreak of nosocomial infections due to multidrug-resistant (MDR)Acinetobacter baumanniiand to analyze the contribution of cross-transmission in the rise in infection rates.Design:Epidemiological investigation; molecular typing using pulsed-field gel electrophoresis (PFGE); matched case-control study to identify risk factors for infection.Setting:A 34-bed surgical intensive care unit at a tertiary-care hospital.Patients:Eighteen patients who developed MDRA baumanniinosocomial infection were matched to 36 patients who were admitted to the same surgical intensive care unit (SICU) room and did not develop an infection during the outbreak period.Results:Prior to the outbreak, the baseline attack rate of MDRA baumanniinosocomial infections was 3 per 100 patients per month. From February 1 through March 22, 1998, the attack rate rose to 16 per 100 patients per month, with a total of 18 infections. All isolates had indistinguishable PFGE patterns. Seventy environmental cultures were negative for MDRA baumannii. Following intense infection control education, the attack rate decreased to 4 per 100 patients per month. By conditional logistic regression, cases were exposed to a significantly higher number of patients with MDRA baumanniiinfections compared to controls (odds ratio, 1.1; 95% confidence interval, 1.01-1.2;P=.02), even after adjusting for length of SICU admission and exposure to antibiotics and invasive devices.Conclusion:Cross-transmission between patients contributed to the rise in rates of MDRA baumanniiinfections. A common environmental source was not detected.

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