scholarly journals Treatment of critically ill COVID-19 patients: Practical guidelines

2021 ◽  
Vol 72 (3) ◽  
pp. 49-64
Author(s):  
Predrag Stevanović
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Health Workers ◽  
Extensive Experience ◽  
Treatment Protocols ◽  
Care Clinic ◽  
Number Of Patients ◽  
Short Period ◽  
Practical Guidelines

The coronavirus disease pandemic (2019) has burdened health systems around the world with a large number of severe patients in a short period of time. According to the law of large numbers, a significant number of critically ill COVID-19 patients appear in such conditions which require treatment in the intensive care unit. That percentage of those patients is around 3 - 5% in different countries. It is similar in Serbia; however, every rule has its exceptions. KBC "Dr Dragiša Mišović-Dedinje" in Belgrade has been determined to take care of the most difficult COVID-19 patients since the beginning of the epidemic due to its space, organizational and personnel possibilities. Out of the total number of patients treated in KBC "Dr Dragiša Mišović-Dedinje", about 25% of patients were treated in the intensive care unit for the above mentioned reasons. Guided by valid treatment protocols, Anesthesiology and Intensive Care clinic of the KBC "Dr Dragiša Mišović-Dedinje" has developed its own work protocols for rapid diagnosis, isolation and clinical management of such difficult patients. These protocols are important not only for the treatment of the most severe COVID-19 patients, but also for the best utilization of hospital resources, as well as for the prevention of the spread of the infection to the medical staff. Extensive experience in the treatment of critically ill patients was gained from the entire engagement during the epidemic, experienced doctors, anesthesiologists-intensivists with great knowledge in the field of work in the intensive care unit, but also managers of clinics and institutions, who can share their experience with health care policy makers. It is clear that in the future, the capacities and organization of work in the field of intensive care medicine should be redefined, as well as health workers should be trained to work in the most demanding field of medicine. Expert experience in the form of practical guidelines, derived from over fourteen months of continuous work in the red zone of COVID-19, where they fought for every breath of the patient, in this review are translated into simplified guidelines for orientation of those who find themselves in a similar situation.

scholarly journals MO887THE IMPACT OF A MULTI-DISCIPLINARY CLINIC ON THE OUTCOMES OF INCIDENT DIALYSIS PATIENTS IN A REGIONAL HOSPITAL IN SINGAPORE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boon Cheok Lai ◽  
Mayank Chawla ◽  
Shashidahar Baikunje ◽  
Lee Ying Yeoh ◽  
Marie Tan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Group Versus ◽  
Dialysis Initiation ◽  
Conventional Group ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Care Clinic ◽  
Number Of Patients ◽  
Initiation Of Dialysis

Abstract Background and Aims Institution of a pre-dialysis programme has been shown to improve the outcome of the chronic kidney disease (CKD) patients approaching end stage renal disease (ESRD). A renal multidisciplinary clinic (MDC) aimed at reducing unprepared dialysis initiation is known to reduce morbidity in such patients and reduce the risks of complications once the patient initiates dialysis. The design of this service is of paramount importance to ensure efficient delivery and to achieve optimal utilization of the resources. The number of patients requiring urgent initiation of dialysis is alarmingly high in Singapore as compared to elective initiation, and our hospital was no exception when we started the renal service in 2018. Patients with unplanned initiation of RRT either because of lack of referral/late referral, infrequent follow up with the nephrologist or because of other factors such as inadequate knowledge of disease trajectory, or poor compliance to medications, tended to have worse outcomes. Method We recruited the patient who initiated dialysis between July 2018 to July 2020 in our Quality Improvement (QI) project. In the MDC group, the patient will be reviewed by a dedicated team of nephrologists, renal coordinators (RC) and medical social workers (MSW) and comprises of 2 mutually exclusive components: low clearance clinic (LCC) and transitional care clinic (TCC). In the MDC, nephrologist takes a lead role for the patient’s overall medical assessment and treatment. Renal coordinator provides the CKD and dialysis education to empower patient to make the correct RRT choice. MSW provides psychosocial support and financial counselling. The LCC became operational from 07th September 2018 while the TCC was initiated on 12th July 2019. CKD patients who are deemed likely to need RRT in the coming one year by the primary nephrologist are scheduled to attend LCC. Upon initiation of haemodialysis, all patients are referred to the TCC in the first month of their discharge. In the conventional group, we recruited the patient who have not attended MDC before or after dialysis initiation. Retrospectively, their data including baseline demographic and morbidity parameters were collected in the MDC group and conventional group. Morbidity outcome like definitive dialysis access, needs of intensive care unit (ICU) admissions, complications like catheter related blood stream infections (CRBSI) and other infections, stroke and myocardial infarction (MI) were analysed. Results There are 130 patients initiated on RRT between July 2018 to July 2020. The percentage of patient started dialysis with a definitive access was greater in the MDC group (25%) as compared to the conventional group (9%) (p=0.03). Although statistically not significant, the incidence of intensive care unit (ICU) admission was also lower in the MDC group (10%) than the conventional group (31%) (p=0.06). After initiation of dialysis, the patients in the MDC group had lower rates of CRBSI (5.6%) than the conventional group (14%) (p=0.17). These patients also had lower rates of other infections and major adverse cardiovascular outcomes (13% in MDC group versus 37% in conventional group) (p=002). The rate of recurrent admission, defined as frequent admissions up to 3 times per year, was lower as well in the MDC group (13%) as compared to the conventional group (35%) (p=0.003). Conclusion This QI project has demonstrated the benefit of MDC in improving the lives of the incident dialysis patients. Moving forward, we aim to continue to evolve this clinic in order to match the changing needs of our patients, with a view to increase its uptake, and to increase the percentage of patients having elective starts with a definitive dialysis access to at least 65% as per target set in NKF-KDOQI 2009 guidelines, in order to help them achieve the maximum benefit out of this endeavour.

Machine Learning for Outcome Prediction in Electroencephalograph (EEG)-Monitored Children in the Intensive Care Unit

2018 ◽  
Vol 33 (8) ◽  
pp. 546-553 ◽  
Author(s):  
Iván Sánchez Fernández ◽  
Arnold J. Sansevere ◽  
Marina Gaínza-Lein ◽  
Kush Kapur ◽  
Tobias Loddenkemper
Keyword(s):  
Machine Learning ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Explanatory Models ◽  
Critically Ill Children ◽  
Support Vector ◽  
Discriminative Performance ◽  
Number Of Patients

The aim of this study was to evaluate the performance of models predicting in-hospital mortality in critically ill children undergoing continuous electroencephalography (cEEG) in the intensive care unit (ICU). We evaluated the performance of machine learning algorithms for predicting mortality in a database of 414 critically ill children undergoing cEEG in the ICU. The area under the receiver operating characteristic curve (AUC) in the test subset was highest for stepwise selection/elimination models (AUC = 0.82) followed by least absolute shrinkage and selection operator (LASSO) and support vector machine with linear kernel (AUC = 0.79), and random forest (AUC = 0.71). The explanatory models had the poorest discriminative performance (AUC = 0.63 for the model without considering etiology and AUC = 0.45 for the model considering etiology). Using few variables and a relatively small number of patients, machine learning techniques added information to explanatory models for prediction of in-hospital mortality.

scholarly journals Pengetahuan, Sikap dan Persepsi Petugas Gawat Darurat Terhadap Kesalahan Medik

2009 ◽  
Vol 3 (6) ◽  
pp. 270
Author(s):  
Refi Fitri Hamdani Nasution
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Error ◽  
Health Workers ◽  
Emergency Unit ◽  
Depth Interview ◽  
Number Of Patients ◽  
Study Results ◽  
Compare Study ◽  
Document Review

Kesalahan medik serius paling sering terjadi di intensive care unit, ruang operasi, dan unit gawat darurat. Tujuan penelitian ini mendapat informasi tentang pengetahuan, sikap, dan persepsi tenaga kesehatan terhadap kesalahan medik. Penelitian dilakukan terhadap manajer, kepala seksi, kepala ruangan, ke- tua kelompok perawat, dokter dan perawat pelaksana. Metode yang digunakan adalah metode kualitatif meliputi wawancara mendalam, observasi, dan telaah dokumen. Metode analisis yang digunakan adalah analisis konten yg membandingkan hasil penelitian dengan teori. Ditemukan bahwa pengetahuan, sikap, dan persepsi tenaga kesehatan cukup baik, tetapi belum diikuti tindakan, sarana prasarana dan pengawasan yang memadai. Sistem rujukan pasien yang kurang baik menyulitkan keluarga pasien. Kesalahan medik dipengaruhi oleh kasus sulit, pasien banyak dan tindakan tergesa-gesa. Sumber kesalahan medik adalah manusia, komunikasi, pasien. Keterampilan SDM dan kondisi fasilitas telah memadai. Namun, ruangan yang belum memadai dinilai sebagai sumber kesalahan medis. Selain itu, sikap antispasi atasan terhadap kesalahan medik kurang memadai. Untuk memperkecil kesalahan medik yang dilakukan upaya-upaya pelatihan, refreshing keilmuan, kolaborasi sesama tim, perbaikan komunikasi, dan mengikuti SOP.Kata kunci : Kesalahan medik, unit gawat darurat, pengetahuan, sikap, tenaga medisMedical error is known to occur mostly in the intensive care unit, operation room, and emergency unit. The objective of this study is to obtain information on knowledge, attitude, and perception of health workers on medical error. Study was conducted to manager, head of section, head of room, head of nursing team, doctors, and nurse. Qualitative method was employed including in-depth interview, observation, and document review. Analysis was conducted using content analysis that compare study results with theory. The study found that knowledge, attitude, and perception are relatively good, but has not been fol- lowed by appropriate action and not supported by sufficient facilities and monitoring system. Not very good referral system was an obstacle for patient’s fa- mily. Medical error was infleunced to happen by the presence of difficult cases, big number of patients, and in hurry action. The source of medical error was human factor, communication, and patient. Insufficiency or less equipped room was also perceived as source of medical error. Moreover, the attitude of ma- nagement regarding medical error was not really appropriate. To minimize medical error, it is necessary to conduct trainings, refreshing course, collaboration between teams, communication improvement, and SOP compliance.Key words : Medical error, emergency unit, knowledge, attitude, health workers

scholarly journals Rapid Intensive Care Unit Onboarding in Response to a Pandemic

2021 ◽  
Vol 8 ◽  
pp. 238212052110207
Author(s):  
Fahad Alroumi ◽  
Donna Cota ◽  
Jonathan Chinea ◽  
Nakul Ravikumar ◽  
Bogdan Tiru ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Practical Knowledge ◽  
Cognitive Learning ◽  
Bedside Teaching ◽  
Short Period

Background: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, hospital resources have been stretched to their limits. We introduced an innovative course to rapidly on-board a group of non-intensive care unit (ICU) nurse practitioners as they begin to practice working in a critical care setting. Objective: To assess whether a brief educational course could improve non-ICU practitioners’ knowledge and comfort in practicing in an intensive care setting. Methods: We implemented a multi-strategy blended 12-week curriculum composed of bedside teaching, asynchronous online learning and simulation. The course content was a product of data collected from a targeted needs assessment. The cognitive learning objectives were taught through the online modules. Four simulation sessions were used to teach procedural skills. Bedside teaching simultaneously occurred from critical care faculty during daily rounds. We assessed learning through a pre and post knowledge multiple choice question (MCQ) test. Faculty assessed learners by direct observation and review of clinical documentation. We evaluated learner reaction and comfort in critical practice by comparing pre and post surveys. Results: All 7 NPs were satisfied with the course and found the format to work well with their clinical schedules. The course also improved their self-reported comfort in managing critically ill patients in a medical ICU. There was an increase in the mean group score from the pre-to the post-course MCQ (60% vs 73%). Conclusions: The COVID-19 Critical Care Course (CCCC) for NPs was implemented in our ICU to better prepare for an anticipated second surge. It focused on delivering practical knowledge and skills as learners cared for critically ill COVID-19 patients. In a short period of time, it engaged participants in active learning and allowed them to feel more confident in applying their education.

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

scholarly journals Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Stephana J. Moss ◽  
Krista Wollny ◽  
Therese G. Poulin ◽  
Deborah J. Cook ◽  
Henry T. Stelfox ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Critically Ill Patients ◽  
Informal Caregivers ◽  
Post Traumatic Stress ◽  
Bereavement Support ◽  
Complex Needs ◽  
Post Traumatic

Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

Usefulness of procalcitonin in differentiating Candida and bacterial blood stream infections in critically ill septic patients outside the intensive care unit

2017 ◽  
Vol 12 (5) ◽  
pp. 629-635 ◽  
Author(s):  
Filippo Pieralli ◽  
Lorenzo Corbo ◽  
Arianna Torrigiani ◽  
Dario Mannini ◽  
Elisa Antonielli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Blood Stream ◽  
Blood Stream Infections
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