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BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaodong Wei ◽  
Tiange Li ◽  
Yunfei Ling ◽  
Zheng Chai ◽  
Zhongze Cao ◽  
...  

Abstract Background Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. Pulmonary regurgitation is the most common and severe comorbidity after transannular patch (TAP) repair of TOF patients. It has not been confirmed whether a TAP repair with monocusp valve reconstruction would benefit TOF patients in perioperative period compared to those without monocusp valve reconstruction. The purpose of the study is to review and analyze all clinical studies that have compared perioperative outcomes of TOF patients undergoing TAP repair with or without monocusp valve reconstruction and conduct a preferable surgery. Methods Eligible studies were identified by searching the electronic databases. The year of publication of studies was restricted from 2000 till present. The primary outcome was perioperative mortality, and secondary outcomes included cardiopulmonary bypass time, aortic cross-clamp time, ventilation duration, ICU length of stay, hospital length of stay, perioperative right ventricular outflow tract (RVOT) pressure gradient, and moderate or severe pulmonary regurgitation (PR). The meta-analysis and forest plots were drawn using Review Manager 5.3. Statistically significant was considered when p-value ≤ 0.05. Results Eight studies were included which consisted of 8 retrospective cohort study and 2 randomized controlled trial. The 10 studies formed a pool of 526 TOF patients in total, in which are 300 undergoing TAP repair with monocusp valve reconstruction (monocusp group) compared to 226 undergoing TAP repair without monocusp valve reconstruction (non-monocusp group). It demonstrated no significant differences between two groups in perioperative mortality (OR = 0.69, 95% CI 0.20–2.41, p = 0.58). It demonstrated significant differences in perioperative cardiopulmonary bypass time (minute, 95% CI 17.93–28.42, p < 0.00001), mean length of ICU stay (day, 95% CI − 2.11–0.76, p < 0.0001), and the degree of perioperative PR (OR = 0.03, 95% CI 0.010.12, p < 0.00001). Significant differences were not found in other secondary outcomes. Conclusion Transannular patch repair with monocusp valve reconstruction have significant advantages on decreasing length of ICU stay and reducing degree of PR for TOF patients. Large, multicenter, randomized, prospective studies which focuse on perioperative outcomes and postoperative differences based on long-term follow-up between TAP repair with and without monocusp valve reconstruction are needed.


2021 ◽  
Vol 24 (6) ◽  
pp. E1018-E1022
Author(s):  
Miaomiao Liu ◽  
Yang Yan ◽  
Gang Li ◽  
Ying Zhang ◽  
Fengwei Guo

Objective: To evaluate the effect of different connection modes of ECMO and CRRT on patients with acute kidney injury (AKI). Methods: Twenty-one patients received ECMO with AKI. These patients were admitted to our center from December 2018 to February 2021, selected, and treated with both ECMO and CRRT. They were divided into A connection mode (pre-membrane–pre-pump connection) and B connection mode (post-membrane–post-pump connection). We compared clinical indicators and outcomes between two connection modes. Results: There were eight cases (38.91%) in A connection mode and 13 cases (61.09%) in B connection mode, with median durations of ECMO assistance of 5 days and 7 days, respectively. Median flow rates of ECMO of 3.0 L/min and 2.5 L/min, respectively; CRRT flow rates of 200 mL/min and 180 mL/min, respectively. CRRT filter lifetime was over 48h in both connection modes. Except for NT-pro BNP, no significant differences in clinical indicators were observed between the two groups before or after the treatment (P > .05). Conclusion: Both connection modes could achieve the therapeutic purpose and need no higher level of anticoagulation for patients simultaneously treated with ECMO and CRRT. Two modes had no impact on treatment effect and clinical indicators in patients. It had no effect on length of ICU stay and prognostic.


2021 ◽  
Vol 17 (8) ◽  
pp. 66-72
Author(s):  
O.V. Filyk ◽  
M.B. Vyshynska

Background. Causes of death due to severe injuries are both injuries incompatible with life and severe bleedings. Trauma-induced coagulopathy is usually found in 46 % of patients at the scene and in 60 % of individuals upon admission to the hospital. The purpose of the study was to establish the relationship between systemic inflammatory response syndrome (SIRS) and vascular-platelet and coagulation hemostasis parameters in patients with polytrauma. Materials and methods. We completed a prospective observational study and included 20 patients aged 19 to 55 years with polytrauma who were admitted to the Department of Anesthesiology with Intensive Care at Lviv City Clinical Hospital No. 8. Patients’ state was evaluated according to the Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation (APACHE II) score. We also took into account the duration of SIRS, the length of intensive care unit (ICU) stay, and hospital stay. Stages of the study: the day of admission to ICU (d1), the third day (d3), the fifth day (d5). The major clinical markers evaluated were: SIRS parameters, vascular-platelet hemostasis (intravascular platelet activation, adrenaline- and adenosine diphosphate-induced platelet aggregation), coagulation hemostasis (international normalized ratio, activated partial thromboplastin time, level of total fibrinogen and D-dimers). Statistical analysis was performed using variation statistics methods. The correlation dependence was performed with Spearman’s rank correlation coefficient. We determined significance level (p), and the differences were considered statistically significant at p < 0.05. Results. We have found a significant (p < 0.05) positive correlation between discocytes to spherocytes ratio and the level of total fibrinogen on stage d1, as well as a tendency (p = 0.09) to the presence of a positive correlation between this ratio and the patient’s body temperature. There was a significant (p < 0.05) inverse correlation between this ratio and the patient’s health status according to APACHE II, and a direct significant (p < 0.05) correlation with the length of ICU stay, as well as trends to an inverse correlation with the severity of injuries according to ISS (p = 0.07) and to a direct correlation with the duration of SIRS (p = 0.12). Conclusions. Patients with polytrauma had a significant (p < 0.05) positive correlation between the discocytes to spherocytes ratio and level of total fibrinogen, a tendency (p = 0.09) to a positive correlation between this ratio and the patient’s body temperature, a significant (p < 0.05) inverse correlation with the patient’s health status according to APACHE II, a direct significant (p < 0.05) correlation with the length of ICU stay, a trend (p = 0.07) to an inverse correlation with the severity of injuries according to ISS and a tendency (p = 0.12) to a direct correlation with duration of SIRS.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Souvik Chaudhuri ◽  
Sagar S. Maddani ◽  
Shwethapriya Rao ◽  
Sirish Gauni ◽  
N. R. Arjun ◽  
...  

Background. There is ambiguity in the literature regarding hypoalbuminemia as a cause of extravascular lung water and acute respiratory distress syndrome (ARDS) outcomes. The aim of the study was to determine if low serum albumin on admission leads to lung deaeration and higher lung ultrasound score (LUSS) in ARDS patients. Patients and Methods. It was a prospective observational study in which 110 ARDS patients aged between 18 and 70 years were recruited. Serum albumin level and lung ultrasound score were assessed on the day of ICU admission. Length of ICU stay and hospital mortality were recorded. Results. The mean and standard deviation of serum albumin level in mild, moderate, and severe ARDS was 2.92 ± 0.65 g/dL, 2.91 ± 0.77 g/dL, and 3.21 ± 0.85 g/dL, respectively. Albumin level was not correlated to the global LUSS (Pearson correlation r −0.006, p = 0.949 ) and basal LUSS (r −0.066, p = 0.513 ). The cut-off value of albumin for predicting a prolonged length of ICU stay (≥10 days) in ARDS patients was <3.25 g/dL with AUC 0.623, p < 0.05 , sensitivity of 86.67%, specificity of 45.45%, and 95% confidence interval (CI) [0.513–0.732], and on multivariate analysis it increased the odds of prolonged ICU stay by 8.9 times (Hosmer and Lemeshow p value 0.810, 95% CI [2.760–28.72]). Serum albumin at admission was not a predictor of mortality. LUSS on the day of admission was not useful to predict either a prolonged length of ICU stay or mortality. Basal LUSS contributed about 56% of the global LUSS in mild and moderate ARDS, and 53% in severe ARDS. Conclusion. Serum albumin level was unrelated to LUSS on admission in ARDS patients. Albumin level <3.25 g/dL increased the chances of a prolonged length of ICU stay (≥10 days) but was not associated with an increase in mortality. LUSS on the day of admission could not predict either a prolonged length of ICU stay or mortality. This trial is registered with CTRI/2019/11/021857.


2021 ◽  
Author(s):  
Shinya IWASE ◽  
Taka-aki Nakada ◽  
Tadanaga Shimada ◽  
Takehiko Oami ◽  
Takashi Shimazui ◽  
...  

Abstract Background: Machine learning can predict outcomes and determine variables contributing to precise prediction, and can thus classify patients with different risk factors of outcomes. This study aimed to investigate the predictive accuracy for mortality and length of stay in intensive care unit (ICU) patients using machine learning, and to identify the variables contributing to the precise prediction or classification of patients.Methods: Patients (n=12,747) admitted to the ICU at Chiba University Hospital were randomly assigned to the training and test cohorts. After learning using the variables on admission in the training cohort, the area under the curve (AUC) was analyzed in the test cohort to evaluate the predictive accuracy of the supervised machine learning classifiers, including random forest (RF) for outcomes (primary outcome, mortality; secondary outcome, and length of ICU stay). The rank of the variables that contributed to the machine learning prediction was confirmed, and cluster analysis of the patients with risk factors of mortality was performed to identify the important variables associated with patient outcomes.Results: Machine learning using RF revealed a high predictive value for mortality, with an AUC of 0.945. In addition, RF showed high predictive value for short and long ICU stays, with AUCs of 0.881 and 0.889, respectively. Lactate dehydrogenase (LDH) was identified as a variable contributing to the precise prediction in machine learning for both mortality and length of ICU stay. LDH was also identified as a contributing variable to classify patients into sub-populations based on different risk factors of mortality.Conclusion: The machine learning algorithm could predict mortality and length of stay in ICU patients with high accuracy. LDH was identified as a contributing variable in mortality and length of ICU stay prediction and could be used to classify patients based on mortality risk.


2021 ◽  
Author(s):  
Gen Aikawa ◽  
Akira Ouchi ◽  
Hideaki Sakuramoto ◽  
Tetsuya Hoshino ◽  
Yuki Enomoto ◽  
...  

Abstract Constipation and diarrhea are both associated with poor outcomes in critically ill patients. Although constipation and diarrhea are closely related, few studies have examined them simultaneously. The purpose of this study was to describe patient defecation status after intensive care unit (ICU) admission and determine the association of early-onset constipation and diarrhea after ICU admission with outcomes for critically ill ventilated patients. Critically ill patients were retrospectively investigated and their defecation status was assessed during the first week after admission. The patients were divided into three groups: normal defecation, constipation, and diarrhea, and multiple comparison tests were performed. Additionally, multivariable analysis was performed for mortality and length of stay. Of the 85 critically ill ventilated patients, 47 (55%) experienced constipation, and 12 (14%) experienced diarrhea during the first week of ICU admission. Patients with normal defecation and diarrhea increased from the fourth and fifth day of ICU admission. Diarrhea was significantly associated with the length of ICU stay (B=7.534, 95% confidence interval: 0.116-14.951). Early-onset constipation and diarrhea were common in critically ill ventilated patients, and early-onset diarrhea was associated with the length of ICU stay. Prevention of constipation and diarrhea before the fifth day of ICU admission is essential.


2021 ◽  
Author(s):  
Selda Murat ◽  
Bektas Murat ◽  
Muhammet Dural ◽  
Gurbet Ozge Mert ◽  
Yuksel Cavusoglu

Aim: In the present study, the relationship between D-dimer/fibrinogen ratio (DFR) and in-hospital outcomes was evaluated in patients with COVID-19 and a diagnosis of heart failure (HF). Materials & methods: In-hospital outcomes were compared in patients with high and low DFR values. Results: With regard to in-hospital outcomes, patients in the third tertile of DFR had a higher rate of mechanical ventilation, cardiogenic shock and death (p < 0.001). The length of ICU stay was longer in the third tertile group (p < 0.001). When evaluated together with infection markers, DFR was found to be an independent predictor of outcomes. Conclusion: DFR can be used as a prognostic marker in patients with COVID-19 with a diagnosis of HF, and perhaps more valuable than other infection markers.


Author(s):  
Marta Villa ◽  
Silvia Villa ◽  
Simona Vimercati ◽  
Mara Andreossi ◽  
Fabrizia Mauri ◽  
...  

In Intensive Care Unit (ICU) survivors, critical illness has an impact on an individual’s long-term health status and quality of life. Adults who have recovered from intensive care management could develop muscle weakness, neurocognitive impairment, difficulties in managing activities of daily living and to returning to work, and psychological problems such as depression and anxiety. A prospective, observational study was designed. Data were collected from January to December 2018 from a structured follow-up program, at 3 time points after ICU discharge: at seven days, a visit in the general ward, a phone interview at three months and an ambulatory visit at six months. A total of 95 patients were enrolled, 36% female, with a median age of 65 (55–73) years and a median ICU length of stay of 13 (8–20) days. At the seven days follow-up, patients who had a positive Hospital Anxiety and Depression Scale showed a significantly longer time of intubation (p = 0.048) and length of ICU stay (p = 0.023). At three months, we observed a significant relationship between a positive Hospital Anxiety and Depression Scale and a median value of EuroQol-5D (p = 0.048). At six months, we observed that patients who had a positive Post-Traumatic Symptom Scale were significantly younger than the other group. Findings from the present study suggest that a longer time of intubation and length of ICU stay are associated with a higher level of anxiety and depression immediately after ICU discharge. Follow-up programs are recommended to assess and rehabilitate cognitive function at ICU discharge.


Author(s):  
Qian Chen ◽  
Junjun Zou ◽  
Beilei Zhang ◽  
Feifei Cui ◽  
Meifen Shen ◽  
...  

IntroductionReducing the extubation failure is vital to the early recovery of patients with mechanical ventilation(MV). We aimed to explore the predictive value of the change of intra-abdominal pressure(ΔIAP) before extubation on the extubation failure in MV patients.Material and methodsPatients undergone MV for more than 24 hours were selected. We used a urodynamic monitor to measure ΔIAP 30 minutes before extubation. The characteristics and prognosis of MV patients were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.ResultsA total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in ΔIAP≤21mmHg group was 5.7 times that of the ΔIAP≥38mmHg group (OR 5.7, 95%CI 1.5-22.0), the risk of extubation failure in ΔIAP 22~37 mmHg group was 3.8 times that of the ΔIAP≥38mmHg group (OR 3.8, 95%CI 1.0-15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31mmHg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all P>0.05).ConclusionsThe ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP≤31mmHg, they may have higher risk of extubation failure, early alert and interventions are highlighted for those patients.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Anshan Yu ◽  
Yanmei Xie ◽  
Meixin Zhong ◽  
Fen Wang ◽  
Huachun Huang ◽  
...  

Objective. To investigate the better time of initiation of enteral nutrition for critically ill patients, such as at admission or 24 to 48 hours after admission. Methods. This was a prospective, randomized, parallel-controlled, single-blind, interventional clinical trial. A total of 100 patients admitted to the intensive care unit (ICU) of our hospital between January 2017 and December 2018 were recruited in this study. These patients had been divided into the control group or intervention group by a computer-generated random number table, and each group had 50 patients. For the control group, a gastric tube was inserted to start enteral nutrition at 24 to 48 hours after admission. For the intervention group, a nasojejunal tube was placed to start enteral nutrition at admission. The main endpoints included serum albumin and prealbumin at admission and on days 3, 7, and 14 after admission, length of ICU stay, ventilator time, and complications such as diarrhea, gastric retention, esophageal reflux, and pulmonary infection. Results. The results showed that serum albumin and prealbumin were significantly higher in the intervention group than in the control group ( P  < 0.05). The length of ICU stay ( P  < 0.05) and ventilator time ( P  < 0.05) were both significantly shorter in the intervention group than in the control group. The incidences of gastric retention, esophageal reflux, and pulmonary infection were significantly lower in the intervention group than those in the control group ( P  < 0.05). Conclusion. In the absence of contraindications, enteral nutrition can be initiated immediately after admission to the ICU (within 6 hours), and feeding nasojejunal tube is recommended. It can improve the nutritional status and prognosis of critical patients, improve the feeding effect, shorten the length of stay in the ICU and the use of the ventilator, and reduce the incidence of complications.


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