Risk Factors of Venous Irritation Induced by Infusion of Nicardipine in ICU Patients

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

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Percutaneous dilatational tracheotomy in high-risk ICU patients

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.152 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

E Luesebrink ◽

S Massberg ◽

M Orban

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

High Risk ◽

Triple Therapy ◽

Bleeding Risk ◽

Icu Patients ◽

Procedural Complications ◽

Multivariable Regression ◽

International Multicenter Study ◽

International Multicenter

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models. Results In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk. Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.

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

Microorganisms ◽

10.3390/microorganisms9071505 ◽

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.

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Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0240 ◽

2019 ◽

Vol 41 (4) ◽

pp. 462-471 ◽

Cited By ~ 4

Author(s):

Kellen Hyde Elias Pinheiro ◽

Franciana Aguiar Azêdo ◽

Kelsy Catherina Nema Areco ◽

Sandra Maria Rodrigues Laranja

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Mortality Rates ◽

Icu Patients ◽

Septic Acute Kidney Injury ◽

Observational Cohort ◽

Worse Prognosis

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

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The risk factors for developing exposure keratopathy in ICU patients

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a731 ◽

2015 ◽

Vol 3 (S1) ◽

Cited By ~ 3

Author(s):

O Kousha ◽

Z Kousha ◽

J Paddle

Keyword(s):

Risk Factors ◽

Icu Patients

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Candida Colonization in Urine Samples of ICU Patients: Determination of Etiology, Antifungal Susceptibility Testing and Evaluation of Associated Risk Factors

Mycopathologia ◽

10.1007/s11046-011-9514-7 ◽

2012 ◽

Vol 174 (2) ◽

pp. 149-155 ◽

Cited By ~ 17

Author(s):

Nidhi Singla ◽

Neelam Gulati ◽

Neelam Kaistha ◽

Jagdish Chander

Keyword(s):

Risk Factors ◽

Susceptibility Testing ◽

Antifungal Susceptibility ◽

Antifungal Susceptibility Testing ◽

Urine Samples ◽

Candida Colonization ◽

Icu Patients ◽

Associated Risk Factors ◽

Testing And Evaluation

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Characteristics and risk factors of postoperative acute kidney injury in ICU patients

International Urology and Nephrology ◽

10.1007/s11255-018-1981-z ◽

2018 ◽

Vol 50 (11) ◽

pp. 2111-2112

Author(s):

Liu-Jia-Zi Shao ◽

Fu-Shan Xue ◽

Rui-Juan Guo ◽

Li Zheng

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Icu Patients

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The independent risk factors of early diarrhoea in enteral nutrition for ICU patients

Journal of International Medical Research ◽

10.1177/0300060519868340 ◽

2019 ◽

Vol 47 (10) ◽

pp. 4929-4939 ◽

Cited By ~ 1

Author(s):

Weiting Chen ◽

Hehao Wang ◽

Yingzi Chen ◽

Danqin Yuan ◽

Renhui Chen

Keyword(s):

Risk Factors ◽

Enteral Nutrition ◽

Critically Ill ◽

Early Stage ◽

Multivariate Logistic Regression Analysis ◽

Severity Of Illness ◽

Icu Patients ◽

Feeding Method ◽

Prokinetic Agents ◽

Independent Risk Factors

Objective To investigate the prevalence of and factors associated with diarrhoea in the early stage of enteral nutrition in critically ill patients in intensive care units (ICUs). Methods This prospective, multicentre, observational study enrolled consecutive patients who were newly admitted to ICUs and received enteral nutrition treatment. Events were observed continuously for 7 days or until patients were transferred out of the ICU after enteral nutrition. Demographic and clinical data, enteral nutrition data, diarrhoea-related data and outcomes were recorded. A multivariate logistic regression analysis was used to analyse the risk factors for diarrhoea. Results The study included 533 patients, of whom 164 (30.8%) developed diarrhoea. Diarrhoea was most commonly observed on the first to third days after starting enteral nutrition treatment. The median (interquartile range) duration of diarrhoea was 2 (1–3) days. The administration of gastrointestinal prokinetic agents, the increase in acute physiological and chronic health scores and the pyloric posterior feeding method were independent risk factors for diarrhoea. Conclusion The increased severity of illness, the administration of gastrointestinal prokinetic agents and the pyloric posterior feeding method were independent risk factors for diarrhoea in critically ill ICU patients undergoing enteral nutrition treatment.

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