scholarly journals Risk Factors for Acute Delirium in Critically Ill Adult Patients: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Ihsan Mattar ◽  
Moon Fai Chan ◽  
Charmaine Childs
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Functional Decline ◽  
Older Age ◽  
Adult Patients ◽  
Critically Ill Patient ◽  
Surgical Intensive Care ◽  
Mini Mental Status Examination ◽  
Reversible Condition

Background. Delirium is characterized by disturbances of consciousness, attention, cognition, and perception. Delirium is a serious but reversible condition associated with poor clinical outcomes. This has implications for the critically ill patient; the effects of delirium cause long term sequelae, principally cognitive deficits, and functional decline. Objectives. The objective of the paper was to describe risk factors associated with delirium in critically ill adult patients. Methods. Published and unpublished literature from 1990 to 2012, limited to English, was searched using ten databases. Results. Twenty-two studies were included in this paper. A large number of risk factors were presented in the literature; some of these were common across all settings whilst others were exclusive to the type of setting. Benzodiazepines and opioids were shown to be risk factors for delirium independent of setting. Conclusion. With regard to patients admitted to medical and surgical intensive care units, risk factors of older age and comorbidity were common. In the cardiac ICU, older age and lower Mini-Mental Status Examination scores were cited most often as risk factors for delirium, but other risk factors exclusive to the setting were also significant. Benzodiazepines were identified as the most significant pharmacological risk factor for delirium.

scholarly journals Patient-Ventilator Asynchrony in Critically-Ill Adult Patients Undergoing Invasive Mechanical Ventilation: Incidence, Risk Factors and Outcomes

2020 ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R Holets ◽  
Man Li ◽  
Gustavo A Cortes Puentes ◽  
Todd J Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Incidence Risk ◽  
History Of

Abstract Background: Patient-ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background.Methods: A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥12 hours.Results: A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P<0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P<0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P<0.01).Conclusion: Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

Long-Term Cognitive Decline After Stroke: An Individual Participant Data Meta-Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Jessica W. Lo ◽  
John D. Crawford ◽  
David W. Desmond ◽  
Hee-Joon Bae ◽  
Jae-Sung Lim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Older Age ◽  
Individual Participant Data ◽  
Individual Participant ◽  
Global Cognition

Background and Purpose: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium. Methods: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects. Results: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th–75th percentile: 1.21–4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (−0.053 SD/year [95% CI, −0.073 to −0.033]; P <0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=−0.078 SD/year [95% CI, −0.11 to −0.045]; P <0.001 for global cognition in a subgroup analysis). Conclusions: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.

Risk Factors and Outcomes for Vancomycin-ResistantEnterococcusBloodstream Infection in Children

2010 ◽  
Vol 31 (10) ◽  
pp. 1038-1042 ◽  
Author(s):  
Eric J. Haas ◽  
Theoklis E. Zaoutis ◽  
Priya Prasad ◽  
Mingyao Li ◽  
Susan E. Coffin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Older Age ◽  
The Difference ◽  
Nested Case Control ◽  
Epidemiological Characteristics

Background and Objective.Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistantEnterococcus(VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptibleEnterococcus(VSE) BSI in this population.Methods.A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.Results.We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]).Conclusion.Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

Does long-term continuous administration of pentoxifylline affect platelet function in the critically ill patient?

1996 ◽  
Vol 22 (7) ◽  
pp. 644-650 ◽  
Author(s):  
J. Boldt ◽  
M. M�ller ◽  
M. Heesen ◽  
S. Heyn ◽  
G. Hempelmann
Keyword(s):  
Critically Ill ◽  
Platelet Function ◽  
Critically Ill Patient ◽  
Continuous Administration

Does long-term continous administration of pentoxifylline affect platelet function in the critically ill patient?

1996 ◽  
Vol 22 (7) ◽  
pp. 644-650 ◽  
Author(s):  
J. Boldt ◽  
M. Müller ◽  
M. Heesen ◽  
S. Heyn ◽  
G. Hempelmann
Keyword(s):  
Critically Ill ◽  
Platelet Function ◽  
Critically Ill Patient

Long-term Enteral Access in Aspiration-prone Patients

1995 ◽  
Vol 10 (4) ◽  
pp. 179-186 ◽  
Author(s):  
Alex C. Cech ◽  
Jon B. Morris ◽  
James L. Mullen ◽  
Gary W. Crooks
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Nutrition Support ◽  
Enteral Access ◽  
Enteral Nutrition Support

Aspiration pneumonia is a serious complication of enteral feeding. Many critically ill patients are particularly at risk for aspiration. Few studies have rigorously compared various access devices. Risk factors for aspiration and studies examining aspiration associated with enteral feeding devices are reviewed. We recommend a surgical jejunostomy for all patients at high risk for aspiration who require more than 3 weeks of enteral nutrition support.

scholarly journals Long-Term Outcome of Patients Followed by Nephrologists after an Acute Tubular Necrosis Episode

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
G. A. Brito ◽  
A. L. Balbi ◽  
J. M. G. Abrão ◽  
D. Ponce
Keyword(s):  
Risk Factors ◽  
Acute Tubular Necrosis ◽  
Older Age ◽  
Chronic Dialysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Late Mortality ◽  
Factors Associated ◽  
Tubular Necrosis

Aims of our study were to describe the long-term survival in patients surviving an acute tubular necrosis (ATN) episode and determine factors associated with late mortality. We performed a prospective cohort study that evaluated the long-term outcome of 212 patients surviving an ATN episode. Mortality at the end of followup was 24.5%, and the probability of these patients being alive 5 years after discharge was 55%. During the followup, 4.7% of patients needed chronic dialysis. Univariate analysis showed that previous CKD (), cardiovascular disease (), age greater than 60 years (), and higher SCr baseline (), after 12 months () and 36 months (), were predictors of long-term mortality. In multivariate analysis, older age (HR = 6.4, CI 95% = 1.2–34.5, ) and higher SCr after 12 months (HR = 2.1, 95% CI 95% = 1.14–4.1, ) were identified as risk factors associated with late mortality. In conclusion, 55% of patients surviving an ATN episode were still alive, and less than 5% required chronic dialysis 60 months later; older age and increased Scr after 12 months were identified as risk factors associated with late death.

scholarly journals A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial

2012 ◽  
Vol 92 (12) ◽  
pp. 1580-1592 ◽  
Author(s):  
Nathan E. Brummel ◽  
James C. Jackson ◽  
Timothy D. Girard ◽  
Pratik P. Pandharipande ◽  
Elena Schiro ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Functional Outcomes ◽  
Cognitive Rehabilitation ◽  
Rehabilitation Program ◽  
Physical Rehabilitation ◽  
Surgical Intensive Care

Background In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. Objective The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. Design This is a randomized controlled trial. Setting The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. Patients The participants will be patients who are critically ill with respiratory failure or shock. Intervention Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter-number sequences, pattern recognition). Daily physical rehabilitation sessions will advance patients from passive range of motion exercises through ambulation. Patients with cognitive or physical impairment at discharge will undergo a 12-week, in-home cognitive rehabilitation program. Measurements A battery of neurocognitive and functional outcomes will be measured 3 and 12 months after hospital discharge. Conclusions If feasible, these interventions will lay the groundwork for a larger, multicenter trial to determine their efficacy.

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