scholarly journals Intraperitoneal Microdialysis as a Monitoring Method in the Intensive Care Unit

2014 ◽  
Vol 99 (6) ◽  
pp. 729-733 ◽  
Author(s):  
Tasiopoulos Konstantinos ◽  
Komnos Apostolos ◽  
Paraforos Georgios ◽  
Tepetes Konstantinos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glucose Concentration ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Monitoring Method ◽  
P Values ◽  
Repeated Measures Analysis ◽  
Low Glucose ◽  
Surgical Condition

Abstract Studies on surgical patients provide some evidence of prompt detection of enteric ischemia with microdialysis. The purpose of the study was to measure intraperitoneal microdialysis values (glucose, glycerol, pyruvate, and lactate) in patients hospitalized in an intensive care unit (ICU) with an underlying abdominal surgical condition and to correlate these values with patients' outcomes. Twenty-one patients, 10 female, were enrolled in the study. The intraperitoneal metabolite values were measured for 3 consecutive days, starting from the first day of ICU hospitalization. Descriptive and inferential statistics were performed. The t-test, repeated measures analysis, Holm's test, and a logistic regression model were applied. Level of statistical significance was set at P = 0.05. Mean age of participants was 68.10 ± 8.02 years old. Survivors exhibited statistically significantly higher glucose values on day 3 (6.61 ± 2.01 against 3.67 ± 1.62; P = 0.002). Mean lactate/ pyruvate (L/P) values were above 20 (35.35 ± 27.11). All non-survivors had a mean three day L/P values greater than 25.94. Low L/P values were related to increased survival possibilities. High microdialysis glucose concentration, high L/P ratio and low glucose concentration were the major findings during the first three ICU hospitalization days in non-survivors. Intraperitoneal microdialysis may serve as a useful tool in understanding enteric ischemia pathophysiology.

Cerebrovascular Dynamics With Head-of-Bed Elevation in Patients With Mild or Moderate Vasospasm After Aneurysmal Subarachnoid Hemorrhage

2006 ◽  
Vol 15 (2) ◽  
pp. 206-216 ◽  
Author(s):  
Patricia A. Blissitt ◽  
Pamela H. Mitchell ◽  
David W. Newell ◽  
Susan L. Woods ◽  
Basia Belza
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Repeated Measures ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Bed Rest ◽  
P Values ◽  
Repeated Measures Design ◽  
Bed Elevation ◽  
Repeated Measures Analysis ◽  
Head Of Bed Elevation

• Background In patients with aneurysmal subarachnoid hemorrhage, elevation of the head of the bed during vasospasm has been limited in an attempt to minimize vasospasm or its sequelae or both. Consequently, some patients have remained on bed rest for weeks. • Objectives To determine how elevations of the head of the bed of 20° and 45° affect cerebrovascular dynamics in adult patients with mild or moderate vasospasm after aneurysmal subarachnoid hemorrhage and to describe the response of mild or moderate vasospasm to head-of-bed elevations of 20° and 45° with respect to variables such as grade of subarachnoid hemorrhage and degree of vasospasm. • Methods A within-patient repeated-measures design was used. The head of the bed was positioned in the sequence of 0°-20°-45°-0° in 20 patients with mild or moderate vasospasm between days 3 and 14 after aneurysmal subarachnoid hemorrhage. Continuous transcranial Doppler recordings were obtained for 2 to 5 minutes after allowing approximately 2 minutes for stabilization in each position. • ResultsNo patterns or trends indicated that having the head of the bed elevated increases vasospasm. As a group, there were no significant differences within patients at the different positions of the head of the bed. Utilizing repeated-measures analysis of variance, P values ranged from .34 to .97, well beyond .05. No neurological deterioration occurred. • Conclusions In general, elevation of the head of the bed did not cause harmful changes in cerebral blood flow related to vasospasm.

scholarly journals Efficacy of Diltiazem for the Control of Blood Pressure in Puerperal Patients with Severe Preeclampsia: A Randomized, Single-Blind, Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Gilberto Arias-Hernández ◽  
Cruz Vargas-De-León ◽  
Claudia C Calzada-Mendoza ◽  
María Esther Ocharan-Hernández
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Severe Preeclampsia ◽  
Secondary Outcome ◽  
Control Group ◽  
Single Blind

Background. Postpartum preeclampsia is a serious disease related to high blood pressure that occurs commonly within the first six days after delivery. Objective. To evaluate if diltiazem improves blood pressure parameters in early puerperium patients with severe preeclampsia. Methodology. A randomized, single-blind longitudinal clinical trial of 42 puerperal patients with severe preeclampsia was carried out. Patients were randomized into two groups: the experimental group (n = 21) received diltiazem (60 mg) and the control group (n = 21) received nifedipine (10 mg). Both drugs were orally administered every 8 hours. Systolic, diastolic, and mean blood pressures as well as the heart rate were recorded and analyzed (two-way repeated measures ANOVA) at baseline and after 6, 12, 18, 24, 30, 36, 42, and 48 hours. Primary outcome measures were all the aforementioned blood pressure parameters. Secondary outcome measures included the number of hypertension and hypotension episodes along with the length of stay in the intensive care unit. Results. No statistical differences were found between groups (diltiazem vs. nifedipine) regarding basal blood pressure parameters. Interarm differences in blood pressure (systolic, diastolic, and mean) and heart rate were statistically significant between treatment groups from 6 to 48 hours. Patients in the diltiazem group had lower blood pressure levels than patients in the nifedipine group. Significantly, patients who received diltiazem had fewer hypertension and hypotension episodes and stayed fewer days in the intensive care unit than those treated with nifedipine. Conclusions. Diltiazem controlled arterial hypertension in a more effective and uniform manner in patients under study than nifedipine. Patients treated with diltiazem had fewer collateral effects and spent less time in the hospital. This trial is registered with NCT04222855.

scholarly journals Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

2019 ◽  
Vol 5 (2) ◽  
pp. 118-122
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Shah Jahirul Hoque Chowdhury ◽  
Mohammad Enayet Hussain ◽  
Mohammad Asaduzzaman ◽  
Md Sirajul Islam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intravenous Immunoglobulin ◽  
Statistical Significance ◽  
Axonal Neuropathy ◽  
Male Predominance ◽  
Icu Stay ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

Microbial Air Contamination in an Intensive Care Unit

2015 ◽  
Vol 4 (3) ◽  
pp. 145
Author(s):  
Chih-Yi Chang ◽  
Liang Tseng ◽  
Lung-Shih Yang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Statistical Significance ◽  
Incidence Density ◽  
Air Contamination ◽  
Care Services ◽  
Air Sampler ◽  
Significant Difference ◽  
Central Taiwan

Unit layout affects every aspect of intensive care services, including patient safety. A previous study has shown that patients admitted to beds adjacent to the sink and to the door of a large bayroom had the highest number of positive blood cultures and the highest blood culture incidence density, respectively. The present study measures microbial air contamination in a medical intensive care unit of a medical center in central Taiwan. Of the 17 rooms, 8 rooms with distinct physical environmental characteristics were selected. Sampling tests were conducted between December 2013 and February 2014 with a microbial air sampler (MAS-100NT). TSA was used for bacteria collection and DG18 for fungi collection. The overall average bacterial and fungal concentrations were 83CFU/m<sup>3</sup> and 69CFU/m<sup>3</sup>, respectively. The ranges were between 8-354 CFU/m<sup>3</sup> and 0-1468 CFU/m<sup>3</sup>, respectively. A significant difference was found in the bacterial concentration (p=.005) between different room locations. The highest concentration was found in the rooms located at the front end of the circulation (99 CFU/m<sup>3</sup>), while the lowest was found in the rooms located at the rear end of the circulation (55CFU/m<sup>3</sup>). Differences in fungal concentrations for different room locations did not reach statistical significance. In addition, differences in bacterial and fungal concentrations for rooms with different sink locations did not reach statistical significance. Even though the microbial concentrations generally complied with standards, the results may help designers and hospital administrators develop a healthier environment for patients.

The Effect of Music and White Noise on Electroencephalographic (EEG) Functional Connectivity in Neonates in the Neonatal Intensive Care Unit

2020 ◽  
Vol 36 (1) ◽  
pp. 38-47
Author(s):  
Akiyoshi Akiyama ◽  
Jeng-Dau Tsai ◽  
Emily W. Y. Tam ◽  
Daphne Kamino ◽  
Cecil Hahn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Functional Connectivity ◽  
Neonatal Intensive Care Unit ◽  
White Noise ◽  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Synchronization Likelihood ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

The purpose of this study is to investigate whether listening to music and white noise affects functional connectivity on scalp electroencephalography (EEG) in neonates in the neonatal intensive care unit. Nine neonates of ≥34 weeks’ gestational age, who were already undergoing clinical continuous EEG monitoring in the neonatal intensive care unit, listened to lullaby-like music and white noise for 1 hour each separated by a 2-hour interval of no intervention. EEG segments during periods of music, white noise, and no intervention were band-pass filtered as delta (0.5-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz). Synchronization likelihood was used as a measure of connectivity between any 2 electrodes. In theta, lower alpha, and upper alpha frequency bands, the synchronization likelihood values yielded statistical significance with sound (music, white noise and no intervention) and with edge (between any 2 electrodes) factors. In theta, lower alpha, and upper alpha frequency bands, statistical significance was obtained between music and white noise ( t = 3.12, 3.32, and 3.68, respectively; P < .017), and between white noise and no intervention ( t = 4.51, 3.09, and 2.95, respectively, P < .017). However, there was no difference between music and no intervention. Although limited by a small sample size and the 1-time only auditory intervention, these preliminary results demonstrate the feasibility of EEG connectivity analyses even at bedside in neonates on continuous EEG monitoring in the neonatal intensive care unit. They also point to the possibility of detecting significant changes in functional connectivity related to the theta and alpha bands using auditory interventions.

Do neonates, infants and young children need a higher dose of enoxaparin in the cardiac intensive care unit?

2010 ◽  
Vol 20 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Joan Sanchez de Toledo ◽  
Sriya Gunawardena ◽  
Ricardo Munoz ◽  
Richard Orr ◽  
Donald Berry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Young Children ◽  
Statistical Significance ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
Bleeding Complications ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

AbstractBackgroundThromboembolic events are a serious complication occurring in critically ill children admitted to the cardiac intensive care unit. Although enoxaparin is one of the current anticoagulants of choice, dosages in children are extrapolated from adult guidelines. Recent data suggest that this population may need a higher dose than what is currently recommended to achieve target anti-factor Xa levels. The purpose of this study was to evaluate whether children less than 2 years old admitted to the cardiac intensive care unit require a higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.MethodsRetrospective chart review including patients who received enoxaparin for the treatment or prophylaxis of venous thrombosis between January, 2005 and October, 2007. Patients were classified as younger and older as well as prophylactic and therapeutic on the basis of age and enoxaparin dose, respectively. Younger patients were those 2 month old or less and older patients were those older than 2 months of age.ResultsA total of 31 patients were identified; 13 (42%) were 2 months or younger and 25 (81%) were postoperative patients. Ten (32%) received prophylactic and 21 (68%) received therapeutic enoxaparin doses. To achieve optimal anti-factor Xa levels, enoxaparin dose was increased in all groups and reached statistical significance in all patients except those older than 2 months who received prophylactic enoxaparin. An average of 2.8 dosage adjustments was needed. No bleeding complications were reported.ConclusionsYoung children, infants, and neonates admitted to the cardiac intensive care unit required a significantly higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.

scholarly journals AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

2020 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Sebastian Hafner ◽  
Florian Balling ◽  
Eberhard Barth
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Acetylcholinesterase Activity ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Baseline Values

Abstract Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020

Factors Associated with the Outcome of Older Patients Admitted in Geriatric Intensive Care Unit

2019 ◽  
Vol 15 (2) ◽  
pp. 53-58
Author(s):  
D. Thangam ◽  
S. Deepa
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Older Patients ◽  
Statistical Significance ◽  
Geriatric Medicine ◽  
Ventilatory Support ◽  
Cross Sectional ◽  
Duration Of Stay ◽  
Factors Associated ◽  
Study Participants

Objective: To determine the factors associated with the outcome of older patients admitted in Geriatric Intensive Care Unit. Materials and Methods: This cross-sectional, observational study was conducted in the Geriatric Intensive Care Unit of the Department of Geriatric Medicine, Madras Medical College, Chennai. one hundred and seventy two patients, aged 60 and above, admitted in the Geriatric ICU during the period of 6 months, from January 2017 to June 2017, were selected to participate in this study. Data regarding age, sex, number of comorbidities, major organ system involved, duration of stay and procedures underwent in the ICU were collected and analyzed. Results: Out of the 172 samples, 92 were males, and 80 were females. The mean age of the study population was 70.1 ± 8.3 years. We found no association between age and survival (p=0.581), gender and survival (p=0.298). 30.2% of the samples who expired had four comorbidities. We found a statistically significant association between the number of comorbidities and outcome (p<0.008). Around 44 patients (25.6%) had respiratory problems, and it was the commonest cause of admission to ICU in this study. We found no association between major system involved and outcome (p=0.089). Sixty of the study participants (34.9%) needed mechanical ventilatory support. We found a statistical significance between procedure underwent and outcome (p<0.001). 57.5% of the study participants stayed in the GICU up to 1 week. We found a statistical significance between the duration of stay and outcome (p=0.022). In this study, 71.5% of the study participants survived, 3.5% of them went against medical advice, and 25% of them expired. Conclusion: In this study, the outcome of older patients admitted in Geriatric Intensive Care Unit depended on the number of preexisting comorbidities, length of stay and procedure underwent during the ICU stay but not the chronological age. In this study, only one in four died after undergoing treatment in the Geriatric Intensive care unit. Geriatric intensive care services can improve the outcome of older patients admitted with a critical illness.

Experience in a Neonatal Intensive Care Unit Affects Pain Response

PEDIATRICS ◽  
1996 ◽  
Vol 98 (5) ◽  
pp. 925-930 ◽  
Author(s):  
C. Céleste Johnston ◽  
Bonnie J. Stevens
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Oxygen Saturation ◽  
Repeated Measures ◽  
Neonatal Intensive Care ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Pain Response ◽  
Invasive Procedures

Objective. To determine the effect of being in the neonatal intensive care unit (NICU) on pain responses in infants of 32 weeks' postconceptual age (PCA). Design. A cross-sectional comparative design was used. Setting. Two level III NICUs, each in metropolitan, university teaching hospitals. Patients. Infants of 32 weeks' PCA born within the past 4 days (the newly born group; n = 53) were compared with infants of the same PCA who had been born 4 weeks earlier (the earlier-born group; n = 36) and had spent that time in an NICU. Outcome Measures. Heart rate, oxygen saturation levels, and facial actions were used as outcomes in a between-group repeated measures analysis of variance across the heel stick procedure. Background variables of Apgar, weight at birth and data collection, severity of illness, age group, and total number of invasive procedures were entered into a stepwise regression. Results. The two groups responded differently to the heel stick: the earlier-born infants had less behavioral manifestations of pain than the newly born infants. The number of invasive procedures was the primary factor that explained those behavioral differences, with Apgar as a second explanatory factor. The earlier-born infants had higher heart rates and lower oxygen saturation than the newly born infants before as well as during the procedure. These physiological differences were explained by the perinatal factors of age at birth and birth weight. Conclusion. Preterm infants who spend PCA weeks 28 through 32 in an NICU are less mature in their pain response than newborn premature infants of 32 weeks' PCA. Greater frequency of invasive procedures is associated with behavioral immaturity, whereas birth factors are associated with physiological immaturity.

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