scholarly journals Predictive modeling to estimate the demand for intensive care hospital beds nationwide in the context of the COVID-19 pandemic

Medwave ◽  
2020 ◽  
Vol 20 (09) ◽  
pp. e8039-e8039
Author(s):  
Víctor Hugo Peña ◽  
Alejandra Espinosa
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Adverse Effects ◽  
Predictive Modeling ◽  
Care Hospital ◽  
Gompertz Function ◽  
Expected Number ◽  
Hospital Beds ◽  
The Media ◽  
Saturation Moment

Introduction SARS CoV-2 pandemic is pressing hard on the responsiveness of health systems worldwide, notably concerning the massive surge in demand for intensive care hospital beds. Aim This study proposes a methodology to estimate the saturation moment of hospital intensive care beds (critical care beds) and determine the number of units required to compensate for this saturation. Methods A total of 22,016 patients with diagnostic confirmation for COVID-19 caused by SARS-CoV-2 were analyzed between March 4 and May 5, 2020, nationwide. Based on information from the Chilean Ministry of Health and ministerial announcements in the media, the overall availability of critical care beds was estimated at 1,900 to 2,000. The Gompertz function was used to estimate the expected number of COVID-19 patients and to assess their exposure to the available supply of intensive care beds in various possible scenarios, taking into account the supply of total critical care beds, the average occupational index, and the demand for COVID-19 patients who would require an intensive care bed. Results A 100% occupancy of critical care beds could be reached between May 11 and May 27. This condition could be extended for around 48 days, depending on how the expected over-demand is managed. Conclusion A simple, easily interpretable, and applicable to all levels (nationwide, regionwide, municipalities, and hospitals) model is offered as a contribution to managing the expected demand for the coming weeks and helping reduce the adverse effects of the COVID-19 pandemic.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

Mortality Review of Children Admitted in Pediatric Intensive Care Unit Over One Year in a Tertiary Care Hospital

2021 ◽  
Vol 6 (1) ◽  
pp. 1369-1372
Author(s):  
Pun Narayan Shrestha ◽  
Sumit Agrawal ◽  
Kosh Raj R C ◽  
Prakash Joshi ◽  
Ajit Rayamajhi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Female Ratio

Introduction: Childhood mortality is still high in developing countries. This can be reduced with good preventive and curative services especially with critical care. The treatment of critically ill children must be focused for better outcome. The pediatrics deaths audit and review provide feedback to health workers and to the institution. The outcome measures of critical care medicine include mortality, morbidity and disability rate. Objectives: The aim of this study is to review the causes and mode of death in children and length of PICU (pediatric intensive care unit) stay. Methodology: A retrospective study was conducted of the patients who were admitted and died within the period of 16 July 2019 to 15 July, 2020 at PICU of Kanti Children Hospital (KCH). Variables recorded were patient's demography, diagnosis, co- morbidities, complications, length of PICU stay (LOS), mode and time of death. Data were tabulated into MS Excel and analyzed using SPSS version 23. Result: Out of 718 admitted children, 99 (13.78%) died with male to female ratio of 1.8:1. The maximum death (75%) was observed in less than five year of age and most of them were from outside the Kathmandu valley. The leading causes of death were pneumonia (28%), sepsis (20%) and congenital heart diseases (21%). The common complications seen were disseminated intravascular coagulation (DIC), multi- organ dysfunction syndrome (MODS), acute kidney injury (AKI) (5.1 %) and acute respiratory distress syndrome (ARDS) (6.1%) and co- morbidities were congenital heart disease (CHD) (18.2%) and global developmental delay (GDD) (9.1%). Mechanical ventilation was needed in 80.8%. Most of the cases (86%) died despite active treatment and (75%) during off hours (4pm-9am). Conclusion: Pneumonia, sepsis and CHD were the main reason of death and most of them were from outside the valley. 

scholarly journals Performance of Pediatric Index of Mortality-2 in a Pediatric Intensive Care Unit of a Tertiary Care Hospital of Nepal

2019 ◽  
Vol 21 (2) ◽  
pp. 89-94 ◽  
Author(s):  
Sangita Puree Dhungana ◽  
P.P. Panta ◽  
S.K. Shrestha ◽  
S. Shrestha
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Scoring System ◽  
College Teaching ◽  
Pediatric Intensive Care ◽  
Care Hospital ◽  
Goodness Of Fit Test ◽  
Pediatric Index Of Mortality

Various scoring system have been developed and are becoming essential part of Pediatric and other critical care units. The Pediatric department wants to introduce Pediatric Index of Mortality-2 (PIM 2) as a predictive scoring system in Pediatric critical care unit of Nepal Medical College Teaching Hospital (NMCTH). This was a prospective cohort study done in Pediatric Intensive Care Unit (PICU) of NMCTH. Study was done from August 2017 to December 2018. All cases admitted in ICU were taken consecutively from term newborn to 14 yrs of age. PIM 2 scoring system was done in all patients. PIM 2 performed well in terms of discrimination with area under curve for PIM 2 scor e was 0.809 with 95% Confidence Interval of 0.0709 to 0.910 and Standard Error of 0.051. Good calibration was observed across deciles of risk as measured by Hosmer-Lemeshow goodness of fit test with P value of 0.163, chi-square value of 11.752 (8). Mortality observed in our PICU was 28.4% with standardized mortality ratio of 1. PIM 2 scoring system performed well in our PICU.

Patients' experiences of being in an intensive care unit: a select literature review

2000 ◽  
Vol 9 (1) ◽  
pp. 20-27 ◽  
Author(s):  
J Stein-Parbury ◽  
S McKinley
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Literature Review ◽  
Adverse Effects ◽  
Cognitive Functioning ◽  
Care Staff ◽  
Negative Experiences ◽  
Positive Experiences

A total of 26 research studies on patients' experiences of being in an intensive care unit were reviewed. The studies were selected because they focused on experiences typical in intensive care units. Many patients recalled their time in the intensive care unit, sometimes in vivid detail. Patients recalled not only experiences that were negative but also ones that were neutral and even positive. Positive experiences included a sense of safety and security promoted especially by nurses. Negative experiences included impaired cognitive functioning and discomforts such as problems with sleeping, pain, and anxiety. The review indicates steps critical care staff can take to develop better ways to understand patients' experiences. Meeting such challenges can improve the quality of patients' experiences and reduce anxiety and may offset potential adverse effects of being a patient in an intensive care unit.

Cardiovascular drugs

2019 ◽  
pp. 177-204
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Adverse Effects ◽  
Critically Ill ◽  
Phosphodiesterase Inhibitors ◽  
Antiplatelet Agents ◽  
Cardiovascular Drugs ◽  
Haemodynamic Instability ◽  
Adrenergic Agonists

Haemodynamic instability is one of the main reasons for admission to critical care. Often patients will require medication to provide cardiovascular support. This chapter discusses cardiovascular drugs and includes discussion on β‎-adrenergic agonists, phosphodiesterase inhibitors, vasodilators, vasopressors, antiarrhythmics in intensive care, chronotropes, antianginal agents, antiplatelet agents, diuretics and the critically ill, and levosimendan. These medications are part of the daily practise in intensive care. Knowledge of the indications, interactions, and adverse effects is essential.

scholarly journals Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) infections among patients admitted in critical care units in a tertiary care hospital

2017 ◽  
Vol 5 (6) ◽  
pp. 2362 ◽  
Author(s):  
Arunkumar V. ◽  
Prabagaravarthanan R. ◽  
Bhaskar M.
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Critical Care ◽  
Intensive Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Critical Care Units ◽  
Two Samples

Background: The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) infections in hospital leads to significant morbidity and mortality. Hence the present study was undertaken to estimate the prevalence of MRSA in critical care units (CCUs) at our centre. The objective of this study was to find the prevalence of MRSA infections in CCUs, to determine their antibiotic profile. And to screen for MRSA in the environment of CCUs in order to find whether they act as a source of infection.Methods: The present cross-sectional study included 100 patients admitted to various CCUs in our hospital. The clinical specimens (urine, Sputum, pus, blood and CSF) were collected from the admitted patients along with environmental samples from these CCUs. Two samples were collected from each patient and subjected to culture and antibiotic susceptibility testing.Results: 168 samples from 100 patients were processed. Out of which five pus samples from five different patients admitted in surgical intensive care unit (SICU) were positive for MRSA infection showing 5% prevalence in CCUs. All MRSA strains were sensitive to vancomycin and teicoplanin. Out of 30 environmental swabs, 1 swab taken from paediatric intensive care unit (PICU) showed positivity for MRSA (3%).Conclusions: CCUs in our hospital have shown 5% prevalence of MRSA among the admitted patients. There was no correlation between environmental MRSA presence and infection in the samples from patient.

scholarly journals Pain Assessment, Using the Critical Care Pain Observational Tool in Intensive Care Unit. An Observational Study, Lahore, Pakistan

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Direct Observation ◽  
Pain Assessment ◽  
Chronically Ill ◽  
Staff Nurses ◽  
Care Hospital ◽  
Staff Nurse ◽  
Observational Tool

Aim: Aim this study is to determine impact of enforcement of the critical Care Pain Observation Tool (CPOT) on the quantity and frequency of ICU’s management of analgesic. Background: Severely critically admitted patients to the Intensive care unit may also experience from specific painful stimuli, but the evaluation of pain is difficult due to the fact that the maximum number of patients are almost sedated and also unable to self report. Thus, optimizing pain assessment in those sufferers is far-reaching. Pain control or management of the pain is one of furthermost important obligations of staff nurses in an extensive care unit. The Critical Care Pain Observational Tool (CPOT) is the one of important behavioral pain scale that have been developed and tested to detect pain in significantly ill nonverbal adults. Methods: A observational quantitative study is done in a tertiary care hospital in Lahore. Study duration is 4 months, from January 2020 to May 2020. The target population of study is nurses who are working in different type of (Icu) units. Sample size is 200. An observational checklist consisted of 22 items is used as research instrument. Result: No any pain assessment or used any pain tool or intervention done by any staff nurse. Pain assessment checked through direct observation in first phase, In this phase observe nurses pain assessment in 24 hours, physician pain assessment in 24 hours, After direct observation there was held a educational session about pain assessment and pain management according pain observation tool, And then We then carried out this empirical analysis in order to verify the CPOT validity and feasibility through questioners and make it accessible around the staff nurses. Mostly nurses believed that there was sufficient helpful in assessing patients pain by using of CPOT in nursing practice. Conclusion: lThe results of this research indicate that the Critical Care Pain Monitoring Method may be used as a reliable method for pain appraisal in chronically ill adult intubated patients. This method is effective and efficient in patients who are chronically ill with a regimen of analgo-sedation focused on no-hypnotic, opioid-infusion. CPOT ratings were well associated with the self-reported pain experience of patients, and demonstrated outstanding reliability amongst raters. That makes the CPOT’s a powerful method for pain evaluation.

Framework for Biosignal Interpretation in Intensive Care and Anesthesia

1997 ◽  
Vol 36 (04/05) ◽  
pp. 340-344 ◽  
Author(s):  
I. Korhonen ◽  
M. van Gils ◽  
A. Kari ◽  
N. Saranummi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Data Management ◽  
Clinical Evaluation ◽  
Patient Monitoring ◽  
Research Community ◽  
Clinical Routine ◽  
The Poor ◽  
Outcomes Of Care

Abstract:Improved monitoring improves outcomes of care. As critical care is “critical”, everything that can be done to detect and prevent complications as early as possible benefits the patients. In spite of major efforts by the research community to develop and apply sophisticated biosignal interpretation methods (BSI), the uptake of the results by industry has been poor. Consequently, the BSI methods used in clinical routine are fairly simple. This paper postulates that the main reason for the poor uptake is the insufficient bridging between the actors (i.e., clinicians, industry and research). This makes it difficult for the BSI developers to understand what can be implemented into commercial systems and what will be accepted by clinicians as routine tools. A framework is suggested that enables improved interaction and cooperation between the actors. This framework is based on the emerging commercial patient monitoring and data management platforms which can be shared and utilized by all concerned, from research to development and finally to clinical evaluation.

The Association of Pediatric Critical Care Medicine Training Programs with Research Publication Productivity and Employment Outcomes of Their Graduates

2020 ◽  
Author(s):  
Sonali Basu ◽  
Robin Horak ◽  
Murray M. Pollack
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Medical School ◽  
Training Programs ◽  
Fellowship Training ◽  
Publication Productivity ◽  
Research Publication ◽  
Pediatric Critical Care ◽  
Publication Success ◽  
Fellowship Programs

AbstractOur objective was to associate characteristics of pediatric critical care medicine (PCCM) fellowship training programs with career outcomes of PCCM physicians, including research publication productivity and employment characteristics. This is a descriptive study using publicly available data from 2557 PCCM physicians from the National Provider Index registry. We analyzed data on a systematic sample of 690 PCCM physicians representing 62 fellowship programs. There was substantial diversity in the characteristics of fellowship training programs in terms of fellowship size, intensive care unit (ICU) bed numbers, age of program, location, research rank of affiliated medical school, and academic metrics based on publication productivity of their graduates standardized over time. The clinical and academic attributes of fellowship training programs were associated with publication success and characteristics of their graduates' employment hospital. Programs with greater publication rate per graduate had more ICU beds and were associated with higher ranked medical schools. At the physician level, training program attributes including larger size, older program, and higher academic metrics were associated with graduates with greater publication productivity. There were varied characteristics of current employment hospitals, with graduates from larger, more academic fellowship training programs more likely to work in larger pediatric intensive care units (24 [interquartile range, IQR: 16–35] vs. 19 [IQR: 12–24] beds; p < 0.001), freestanding children's hospitals (52.6 vs. 26.3%; p < 0.001), hospitals with fellowship programs (57.3 vs. 40.3%; p = 0.01), and higher affiliated medical school research ranks (35.5 [IQR: 14–72] vs. 62 [IQR: 32, unranked]; p < 0.001). Large programs with higher academic metrics train physicians with greater publication success (H index 3 [IQR: 1–7] vs. 2 [IQR: 0–6]; p < 0.001) and greater likelihood of working in large academic centers. These associations may guide prospective trainees as they choose training programs that may foster their career values.

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