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2021 ◽  
pp. 105477382110623
Author(s):  
Chun-Ying Shih ◽  
Hsiang-Chu Pai

This study aimed to examine the factors affecting the relationship between stress and anxiety in critically ill patients. A cross-sectional research paradigm was employed to enroll patients admitted to the medical intensive care unit (ICU) of a medical university hospital. Partial least squares structural equation modeling (PLS-SEM) was used to examine the data. A total of 90 ICU patients were included in this study; 56 were men and 34 were women. The patients’ mean age was 65.3 years. Only the emotional responses dimension of illness was significantly positively correlated with stress. However, the emotional responses dimension of illness representation, acute physiology and chronic health evaluation system (APACHE) score, age, and education level were significantly positively correlated with anxiety. Nevertheless, treatment control was significantly negatively correlated with anxiety. Overall, illness representations (emotional responses and treatment control), APACHE score, age, and education were important predictors of anxiety, with an explanatory power of 37.9%. We recommend that for clinically relevant practice, besides focusing on ICU patients’ illness representation, attention should also be paid to their individual characteristics, such as differences in age and education levels.


2021 ◽  
Author(s):  
Changquan Fang ◽  
Limin Xu ◽  
Junhong Lin ◽  
Yujun Li ◽  
Shuquan Wei ◽  
...  

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) has strong ability to acquire drug resistance genes, which are then rapidly cloned and transmitted, leading to worldwide spread posing a significant treatment challenge. Currently, limited drugs are available for the treatment of XDRAB infection, and their clinical effects are not clear; therefore, the specific factors that affect the treatment response and patient outcome require further exploration. The aim of this was to clarify effective treatment methods during XDRAB infection and the factors affecting patient prognosis according to a retrospective review of cases at our hospital.Methods: Hospital-acquired XDRAB pneumonia cases clinically diagnosed at Guangzhou First Municipal People’s Hospital from January 2016 to December 2017 were selected, and their clinical features, treatment, and prognosis were retrospectively analysed.Results: Forty-eight patients met the diagnostic criteria of hospital-acquired pneumonia caused by XDRAB in the study period, 20 of whom survived and 28 of whom died for an overall mortality rate of 58.3%. There was no significant difference in anti-A. baumannii activity according to the type of antibiotic administered or their combinations between the patients that survived and those that died from the infection. The use of antibacterial drugs during infection did not effectively improve the clinical outcome. Advanced age, multiple organ failure, and disease severity (APACHE score) were significantly negatively correlated with bacterial clearance, whereas effective airway management (tracheotomy and sputum suction during infection) had a positive impact on bacterial clearance. In multivariate analysis, age [odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0–1.3] and APACHE score (OR 1.5, 95% CI 1.1–2.0) were independent risk factors affecting prognosis. Tracheotomy during infection (OR 0.0, 95% CI 0.0–0.55) was a protective factor contributing to survival.Conclusion: XDRAB hospital-acquired pneumonia has a high mortality rate. Advanced age and severe disease are independent risk factors that affect patient prognosis. The use and type of antibacterial drugs for treatment do not appear to substantially affect the prognosis during XDRAB infection. Overall, timely and effective airway management is the key to improving the prognosis of patients with hospital-acquired XDRAB infection.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S113-S114
Author(s):  
Marc R Matthews ◽  
Sara Calder ◽  
Areta Kowal-Vern ◽  
Philomene Spadafore ◽  
Karen J Richey ◽  
...  

Abstract Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.


2021 ◽  
Vol 8 (3) ◽  
pp. 856
Author(s):  
Himangsu Sarma ◽  
Ashwinikumar Kudari

Background: One of the most common intra-abdominal problems faced by general surgeons in their practice remains bowel obstruction. It is important to identify and analyse the clinical presentation and etiology of patients with acute intestinal obstruction. With its multiple etiologies, intestinal obstruction of either the small or large bowel continues to be a major cause of morbidity and mortality.Methods: An observational study was carried out at Narayana Hrudayalaya Hospital, Bangalore between July 2016 and June 2019 involving 190 patients, after approval from Institutional ethics Committee. Predicted mortality rates were calculated using the APACHE II scoring system by linear analysis method. It was then compared with the actual outcomes. Univariate and multivariate analysis was carried to analyze the collected data.Results: The commonest cause in this study was postoperative adhesions [82 patients (43.2%)]. Frequency of mortality in our study was 7.9%. ROC curve analysis to predict the mortality using APACHE score showed sensitivity (80%), specificity (81.14%) and AUROC=0.796. P value was <0.001 which is highly significant. A positive correlation was found between deaths and complications with higher APACHE scores.Conclusions: Successful treatment of acute intestinal obstruction depends upon early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself. The APACHE II score allows for direct comparison between the observed and expected adverse outcome rates. They can also be used to determine prognosis and help family members make informed decisions about the aggressiveness of care.


2021 ◽  
pp. 088506662198924
Author(s):  
Matthew Schrader ◽  
Matheni Sathananthan ◽  
Niranjan Jeganathan

Introduction: Idiopathic pulmonary fibrosis (IPF) patients admitted to the ICU with acute respiratory failure (ARF) are known to have a poor prognosis. However, the majority of the studies published to date are older and had small sample sizes. Given the advances in ICU care since the publication of these studies, we sought to reevaluate the outcomes and risk factors associated with mortality in these patients. Methods: Retrospective study using a large multi-center ICU database. We identified 411 unique patients with IPF admitted with ARF between 2014-2015. Results: Of all IPF patients admitted to the ICU with ARF, 81.3% required mechanical ventilation (MV): 48.9% invasive and 32.4% non-invasive alone. The hospital mortality rate was 34.5% for all patients; 48.8% in patients requiring invasive MV, 21.8% in those requiring non-invasive MV and 19.5% with no MV. In multiple regression analyses, age, APACHE score, invasive MV, and hyponatremia at admission were associated with increased mortality whereas post-op status was associated with lower mortality. In patients requiring invasive MV, baseline PaO2/FiO2 ratio was also predictive of mortality. Non-pulmonary organ failures were present in less than 20% of the patients. Conclusions: Although the overall mortality rate for IPF patients admitted to the ICU with ARF has improved, the mortality rates for patients requiring invasive MV remains high at approximately 50%. Older age, high APACHE score, and low baseline PaO2/FiO2 ratio are factors predictive of increased mortality in this population.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 17-18
Author(s):  
Richard Whitmill ◽  
Supratik Basu ◽  
Anandadeep Mandal ◽  
Ubon Usung ◽  
Arwa Babai ◽  
...  

Background Long held assumptions of poor prognoses for patients with haematological disease have meant that intensivists are often reluctant to admit them to the intensive care unit (ICU) During the recent Covid pandemic this was heightened further given the increased pressure on the UK's ICU beds. This led us to evaluate our utilisation of our ICU over the last 6 years in order to rationalise our own requests and justify continued ICU support during this pandemic. If ICU access was temporarily withdrawn as it was to a variable extent peak pandemic, how would it have affected outcome of acute leukaemias or aggressive malignancies. Methods Our Institution which is a regional cancer centre admits haematology patients from a population of 750,000. We analysed 65 admissions over last 6 years. The clinical notes were reviewed and we obtained the following data: haematological and other diagnoses, chemotherapy, transplant status, apache score, lactate level, age, laboratory values, level of organ support, ICU and hospital discharge status, overall survival or time to follow up if alive, plus ability to proceed with treatment post ICU. Predictors for overall survival were assessed using Xlstat and Stata software. Results Of 65 ICU admissions from 54 patients, median age was 62 (range 19-86), Apache score median of 8 patients had more than 1 ICU admission (2-4). Reason for admission was predominantly infection/sepsis post chemotherapy with requirement for circulatory or respiratory support 54 episodes out of 65. Other reason for admission included 3 episodes of plasma exchange in unstable patients, airway support for 2 patients with intracranial haemorrhage, support during major haemorrhage and 2 episodes with pulmonary embolism, 2 episodes sedation for seizure control, ventilatory support for differentiation syndrome in APML. Organ support Six (9%) of admissions to ICU didn't recieve any specific ICU level treatments including 1 case that was unsalvageable on arrival, 3 admissions just attended to facilitate urgent plasma exchange. Patients receiving single organ, double organ and triple organ support were 28 (43%), 22 (34%), 6 (9%) respectively. Admissions receiving non-invasive ventilation 29 (47%), invasive ventilation 24 (37%), vasopressors 33 (51%) and filtration 8 (12%). Diseases Acute Myeloid leukaemia 25 (38%) episodes including 3 APML patients,Acute Lymphoblastic leukaemia 3 episodesLymphoma 19 episodes (29%)Myeloma 8 episodes (12%)Others 5 (8%)Post allogenic stem cell transplant 1 patient, 2 episodes Survival The overall survival of all the admissions a mean survival of 445 days is illustrated. 28 (43%) admissions survived to hospital discharge and 16 (25%) survived for a year or more. We compared the outcome of patients admitted to ICU 2013-2015 versus admissions post 2016 in Figure 1 which illustrates a 9% improvement in 1 year survival. Discussion The improvement in survival over the last 6 years is clearly illustrated and consistent with other reports (Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist intensive care unit, British journal of Anaesthesia 108 (3): 452-9 (2012)). The recent longer survival reflects advances in treating haematological malignancies as well as the targeting sepsis campaign. Out of 119 patients with acute leukaemia we treated with induction chemotherapy, 20 required admission to ICU, 8 of these acute leukaemia patients survived for over a year. Admission to ICU is therefore responsible for 7% of our acute leukaemia patients long term survival. Following ICU admission 17 patients (31%) of them were able to receive further chemotherapy including 6 stem cell procedures. Age, 2 or more organ support and Apache 2 score were significant by univariate Chi-squared test in being risk factors for mortality pre-hospital discharge. Multivariate analysis showed 2 or more organ support had an odds ratio of 6 for death within a year as did intubation independently with odds ratio of 3.8 both with p values under 0.05. Neutropenia or thrombocytopenia didn't significantly impact on mortality. No scoring system or prognostic factors reliably separates out those for whom admission to ICU is futile. Our findings challenge the reluctance to admit haematology patients during and post the covid pandemic in the uk. Figure Disclosures No relevant conflicts of interest to declare.


Lupus ◽  
2020 ◽  
Vol 29 (11) ◽  
pp. 1364-1376
Author(s):  
Ana Suárez-Avellaneda ◽  
Jhon H Quintana ◽  
Cristian C Aragón ◽  
Linda M Gallego ◽  
Cindy-Natalia Gallego ◽  
...  

Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections. The main factors associated with mortality are a high Acute Physiology and Chronic Health Evaluation (APACHE) score, the need for mechanical ventilation, and vasoactive and inotropic agent use. Reported mortality rates are 18.4%–78.5%. Therefore, it is important to evaluate SLE disease severity for optimizing clinical management and patient outcomes.


2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Harshwant Grover ◽  
Puneet Dhillon ◽  
Neethu Gopisetti ◽  
Daniel Evan Rosenberg ◽  
Rajeshkumar Patel

Abstract Objectives: To determine whether the degree of diabetes control correlates with the admission severity of diabetic ketoacidosis (DKA). Methods: A Retrospective chart review was performed for patients admitted with DKA to the medical ICU at Abington Memorial Hospital between January 1, 2017 and January 1, 2018. Laboratory Data required to determine an acute physiology and chronic health evaluation (APACHE) score, hemoglobin A1C, length of hospital stay was recorded. The APACHE score was used to determine the severity of disease at admission. Patients were divided into two groups: low severity (APACHE &lt;15) and high severity (APACHE &gt;15). Results: A total of 50 patients were included in the analysis. The mean age of the patients was 47 yrs (range 17-85 yrs). 52%(n=26) of the population were males. The overall mean APACHE II at admission was 15 (range 3-28). The low severity group (APACHE &lt;=15) and high severity group (APACHE &gt;15) were equally matched at 25 patients each. The mean APACHE scores were 9.9 and 18.7 for the low and high severity groups respectively. The mean hemoglobin A1C values for the low and high severity groups were 10.5 and 15 respectively. The average length of ICU/hospital stay was 1.6/3.65 and 1.54/3.61 days for the low and high severity groups respectively. Conclusions: According to our study, a higher severity of DKA (higher APACHE) was associated with a higher hemoglobin A1C level. However, the study did not find any difference in the average length of ICU/hospital stay between the two groups.


Kidney360 ◽  
2020 ◽  
Vol 1 (4) ◽  
pp. 232-240
Author(s):  
Samantha Gunning ◽  
Fouad Kutuby ◽  
Rebecca Rose ◽  
Sharon Trevino ◽  
Tae Song ◽  
...  

BackgroundVolume overload is increasingly being understood as an independent risk factor for increased mortality in the setting of AKI and critical illness, but little is known about its effect in the setting of extracorporeal membrane oxygenation (ECMO). We sought to evaluate the incidence of AKI and volume overload and their effect on all-cause mortality in adults after ECMO cannulation.MethodsWe identified all adult patients who underwent ECMO cannulation at the University of Chicago between January 2015 and March 2017. We evaluated the incidence of KDIGO-defined AKI, RRT, and volume overload. Volume overload was defined as achieving a positive fluid balance of 10% above admission weight over the first 72 hours after ECMO cannulation. The primary outcome collected was 90 day all-cause mortality. Secondary outcomes included 30-day mortality, duration of ECMO and RRT therapy, length of stay, and dialysis independence at 90 days.ResultsThere were 98 eligible patients, 83 of whom developed AKI (85%); 48 (49%) required RRT and 19 (19%) developed volume overload at 72 hours. Patients with volume overload had increased risk of death at 90 days compared with those without volume overload (HR, 2.3; 95% CI, 1.3 to 4.2; P=0.004). Patients with AKI-D had increased risk of death at 90 days compared with those without AKI-D (HR, 2.2; 95% CI, 1.3 to 3.8; P=0.004). Volume overload remained an independent predictor of 90-day mortality when adjusting for RRT, APACHE score, weight (kg), diabetes, and heart failure (HR, 2.9; 95% CI, 1.4 to 6.0; P=0.003).ConclusionsVolume overload and AKI are common and have significant prognostic value in patients treated with ECMO. Initiating RRT may help to control the deleterious effects of volume overload and improve mortality.


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