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Mahrokhian SH, Tostanoski LH, Vidal SJ, Barouch DH. COVID-19 vaccines: Immune correlates and clinical outcomes. Hum Vaccin Immunother 2024; 20:2324549. [PMID: 38517241 PMCID: PMC10962618 DOI: 10.1080/21645515.2024.2324549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/24/2024] [Indexed: 03/23/2024] Open
Abstract
Severe disease due to COVID-19 has declined dramatically as a result of widespread vaccination and natural immunity in the population. With the emergence of SARS-CoV-2 variants that largely escape vaccine-elicited neutralizing antibody responses, the efficacy of the original vaccines has waned and has required vaccine updating and boosting. Nevertheless, hospitalizations and deaths due to COVID-19 have remained low. In this review, we summarize current knowledge of immune responses that contribute to population immunity and the mechanisms how vaccines attenuate COVID-19 disease severity.
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Affiliation(s)
- Shant H. Mahrokhian
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Lisa H. Tostanoski
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J. Vidal
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dan H. Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
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van de Riet L, Aris AM, Verouden NW, van Rooij T, van Woensel JB, van Karnebeek CD, Alsem MW. Designing eHealth interventions for children with complex care needs requires continuous stakeholder collaboration and co-creation. PEC INNOVATION 2024; 4:100280. [PMID: 38596601 PMCID: PMC11002852 DOI: 10.1016/j.pecinn.2024.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Objective Hospital-to-home (H2H) transitions challenge families of children with medical complexity (CMC) and healthcare professionals (HCP). This study aimed to gain deeper insights into the H2H transition process and to work towards eHealth interventions for its improvement, by applying an iterative methodology involving both CMC families and HCP as end-users. Methods For 20-weeks, the Dutch Transitional Care Unit consortium collaborated with the Amsterdam University of Applied Sciences, HCP, and CMC families. The agile SCREAM approach was used, merging Design Thinking methods into five iterative sprints to stimulate creativity, ideation, and design. Continuous communication allowed rapid adaptation to new information and the refinement of solutions for subsequent sprints. Results This iterative process revealed three domains of care - care coordination, social wellbeing, and emotional support - that were important to all stakeholders. These domains informed the development of our final prototype, 'Our Care Team', an application tailored to meet the H2H transition needs for CMC families and HCP. Conclusion Complex processes like the H2H transition for CMC families require adaptive interventions that empower all stakeholders in their respective roles, to promote transitional care that is anticipatory, rather than reactive. Innovation A collaborative methodology is needed, that optimizes existing resources and knowledge, fosters innovation through collaboration while using creative digital design principles. This way, we might be able to design eHealth solutions with end-users, not just for them.
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Affiliation(s)
- Liz van de Riet
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
- On behalf of the Transitional Care Unit Consortium, the Netherlands
| | - Anna M. Aris
- University of Applied Sciences, Digital Society School, Theo Thijssen Huis, Wibautstraat 2, 1091 GM Amsterdam, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Nick W. Verouden
- University of Applied Sciences, Digital Society School, Theo Thijssen Huis, Wibautstraat 2, 1091 GM Amsterdam, the Netherlands
| | - Tibor van Rooij
- Department of Computer Science, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Job B.M. van Woensel
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- On behalf of the Transitional Care Unit Consortium, the Netherlands
| | - Clara D. van Karnebeek
- On behalf of the Transitional Care Unit Consortium, the Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Center for Personalized Medicine, Departments of Pediatrics and Human Genetics, Amsterdam Gastro-Enterology Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Mattijs W. Alsem
- On behalf of the Transitional Care Unit Consortium, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Koyner JL, Arndt C, Baldira Martinez de Irujo J, Coelho S, Garcia-Montesinos de la Peña M, di Girolamo L, Joannidis M, Jorge-Monjas P, Koch C, Lobaz S, Meyer A, Ostermann M, Pertica N, Prowle JR, Silversides J, Zarbock A, Echeverri J, Harenski K, Forni LG. Assessing the role of Chemokine (C-C motif) ligand 14 in AKI: a European consensus meeting. Ren Fail 2024; 46:2345747. [PMID: 38666354 PMCID: PMC11057457 DOI: 10.1080/0886022x.2024.2345747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Urinary Chemokine (C-C motif) ligand 14 (CCL14) is a biomarker associated with persistent severe acute kidney injury (AKI). There is limited data to support the implementation of this AKI biomarker to guide therapeutic actions. METHODS Sixteen AKI experts with clinical CCL14 experience participated in a Delphi-based method to reach consensus on when and how to potentially use CCL14. Consensus was defined as ≥ 80% agreement (participants answered with 'Yes', or three to four points on a five-point Likert Scale). RESULTS Key consensus areas for CCL14 test implementation were: identifying challenges and mitigations, developing a comprehensive protocol and pairing it with a treatment plan, and defining the target population. The majority agreed that CCL14 results can help to prioritize AKI management decisions. CCL14 levels above the high cutoff (> 13 ng/mL) significantly changed the level of concern for modifying the AKI treatment plan (p < 0.001). The highest level of concern to modify the treatment plan was for discussions on renal replacement therapy (RRT) initiation for CCL14 levels > 13 ng/mL. The level of concern for discussion on RRT initiation between High and Low, and between Medium and Low CCL14 levels, showed significant differences. CONCLUSION Real world urinary CCL14 use appears to provide improved care options to patients at risk for persistent severe AKI. Experts believe there is a role for CCL14 in AKI management and it may potentially reduce AKI-disease burden. There is, however, an urgent need for evidence on treatment decisions and adjustments based on CCL14 results.
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Affiliation(s)
- Jay L. Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Christian Arndt
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | | | - Sílvia Coelho
- Intensive Care Department, Hospital Fernando da Fonseca EPE, Amadora, Portugal
| | | | - Luca di Girolamo
- Department of Anesthesia, Critical Care and Emergency, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical Unversity Innsbruck, Innsbruck, Austria
| | - Pablo Jorge-Monjas
- Anesthesiology and Critical Care Department, Clinic University Hospital of Valladolid, Valladolid, Spain
| | - Christian Koch
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Steven Lobaz
- Anaesthetics and Intensive Care, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Alain Meyer
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, Strasbourg, France
| | - Marlies Ostermann
- Department of Critical Care & Nephrology, King’s College London, Guy’s & St Thomas’ Hospital, London, UK
| | - Nicoletta Pertica
- Division of Nephrology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy
| | - John R. Prowle
- Critical Care & Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jon Silversides
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, Belfast, UK
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Kai Harenski
- Baxter Deutschland GmbH, Unterschleissheim, Germany
| | - Lui G. Forni
- Critical Care Unit, Royal Surrey Hospital and School of Medicine, University of Surrey, Guildford, UK
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Kang B, Jia Z, Dong Y, Li W, Zhang W. Recombinant human annexin A5 accelerates diabetic wounds healing by regulating skin inflammation. Regen Ther 2024; 27:342-353. [PMID: 38645281 PMCID: PMC11031805 DOI: 10.1016/j.reth.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/15/2024] [Indexed: 04/23/2024] Open
Abstract
Background One of the key obstacles to the healing of diabetic wound is the persistence of active inflammation. We previously demonstrated the potential of cell-free fat extract (CEFFE) to promote the healing of diabetic wounds, and annexin A5 (A5) is a crucial anti-inflammatory protein within CEFFE. This study aimed to evaluate the therapeutic potential of A5 in diabetic wounds. Methods A5 was loaded into GelMA hydrogels and applied to skin wounds of diabetic mice in vivo. The diabetic wounds with the treatment of GelMA-A5 were observed for 14 days and evaluated by histological analysis. Accessment of inflammation regulation were conducted through anti-CD68 staining, anti-CD86 and anti-CD206 staining, and qRT-PCR of wound tissue. In presence of A5, macrophages stimulated by lipopolysaccharide (LPS) in vitro, and detected through qRT-PCR, flow cytometry, and immunocytofluorescence staining. Besides, epithelial cells were co-cultured with A5 for epithelialization regulation by CCK-8 assay and cell migration assay. Results A5 could promote diabetic wound healing and regulate inflammations by promoting the transition of macrophages from M1 to M2 phenotype. In vitro experiments demonstrated that A5 exerted a significant effect on reducing pro-inflammatory factors and inhibiting the polarization of macrophages from M0 toward M1 phenotype. A5 significantly promoted the migration of epithelial cells. Conclusion Annexin A5 has a significant impact on the regulation of macrophage inflammation and promotion of epithelialization.
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Affiliation(s)
- Bijun Kang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, 639 ZhiZaoJu Road, Shanghai 200011, China
| | - Zhuoxuan Jia
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, 639 ZhiZaoJu Road, Shanghai 200011, China
| | - Yushan Dong
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, 639 ZhiZaoJu Road, Shanghai 200011, China
| | - Wei Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, 639 ZhiZaoJu Road, Shanghai 200011, China
| | - Wenjie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, 639 ZhiZaoJu Road, Shanghai 200011, China
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Al Haddad A, Arber A, Cox A, Gallagher A. The Challenges Experienced by ICU Nurses in Kuwait during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100226. [PMID: 39155969 PMCID: PMC11327471 DOI: 10.1016/j.ijnsa.2024.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/05/2024] [Accepted: 07/13/2024] [Indexed: 08/20/2024] Open
Abstract
Background The coronavirus (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide, with intensive care unit (ICU) nurses at the forefront of patient care. To date, there is limited evidence into ICU nurses'experiences of the pandemic in Kuwait. Research question/aims/objectives To elucidate the challenges faced by ICU nurses in Kuwait during the pandemic, by considering two research questions: "What contributed to intensified pressure for the ICU nurses?" and "How were the nurses affected?". Research design This was a qualitative study which utilised semi-structured interviews. Interviews were conducted between January 2021 and June 2022 with ICU nurses who worked during the COVID-19 pandemic. The data were analysed using Charmaz's grounded theory methodology. Participants and research context 25 nurses from three ICUs in Kuwait. Ethical considerations The study was approved by the University Ethics Committee and by the Ministry of Health in Kuwait. Findings/Results The analysis identified two themes (the factors contributing to intensified pressure in the ICU, and the impact on the nurses) and seven sub-themes. The pressure in the ICU intensified due to the rise in the number of patients, staff shortages, and the requirement to adhere to unrealistic new procedures for infection control. Restricted and cancelled leave, as well as impaired autonomy at work, impeded the nurses' ability to recover from stress. The heightened stress also contributed to a worsening in interpersonal relationships between the nurses and their colleagues. The nurses' care was compromised by these challenges, leading to moral distress and a range of mental health symptoms (e.g., stress, anxiety, emotional exhaustion). Conclusions The study accords with other research conducted during the pandemic in revealing a significant mental health toll among healthcare workers during the pandemic. The stressors were similar to those which have been reported in other studies, although there were also context-specific effects relating to the environment of the ICU and the Kuwaiti context.
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Affiliation(s)
| | - Anne Arber
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anna Cox
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ann Gallagher
- Department of Health Sciences, Brunel University London, London, UK
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Liu T, Liu B, Jiang YQ, Ojo O, Jiang XS, Wang YY, Wang C, Wang XH. Effects of different dietary fiber supplement strategies on incidence of acute gastrointestinal injury in ICU patients: A prospective observational study. Intensive Crit Care Nurs 2024; 84:103673. [PMID: 38503580 DOI: 10.1016/j.iccn.2024.103673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/20/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE This study aimed to explore the effects of dietary fiber (DF) supplement strategies on the incidence of acute gastrointestinal injury (AGI) in critically ill patients. DESIGN A prospective observational study. SETTING The study was conducted in the First Affiliated Hospital of Soochow University from April 2021 to March 2023. METHODS Using a five-day dietary log counted the amount of DF supplement. The best fitting trajectories of DF supplement were determined based on the latent class trajectory modelling (LCTM). The data of AGI were evaluated on the day 5 (D5) and day 7 (D7) after intensive care unit admission. RESULTS A total of 179 patients were included in the study. The LCTM yielded a four-trajectories of models, named; Sustained Low - Group, Slowly Rising - Group, Early Supplement & Slowly Rising - Group and Rapidly Rising - Group, respectively. The incidences of AGI on D5 and D7 were 51.4 % and 40.0 %, respectively. There was an increased risk in the grade of AGI in the Sustained Low - Group compared with the Rapidly Rising - Group on D5 [odds ratio (OR), 4.8; 95 % confidence interval (CI), 1.9-12.1] and D7 (OR, 12.0; 95 % CI, 3.9-37.0); and an increased risk in the Slowly Rising - Group on D5 (OR, 3.6; 95 % CI, 1.3-9.9). CONCLUSION The supplement of DF in critically ill patients may be insufficient and the incidence of AGI is high. Sustained low and slow rising DF supplement may be associated with an increased risk in the AGI. IMPLICATIONS FOR CLINICAL PRACTICE The clinical staff could focus on the supplementation of not only the three macronutrients, but also DF in critically ill patients.
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Affiliation(s)
- Ting Liu
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Bin Liu
- School of Nursing, Medical College, Soochow University, Suzhou 215006, China
| | - Yi-Qing Jiang
- School of Nursing, Medical College, Soochow University, Suzhou 215006, China
| | - Omorogieva Ojo
- Department of Adult Nursing and Paramedic Science, University of Greenwich, London, United Kingdom
| | - Xiao-Song Jiang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yu-Yu Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Can Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Xiao-Hua Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
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Yang M, Peng Z, van Pul C, Andriessen P, Dong K, Silvertand D, Li J, Liu C, Long X. Continuous prediction and clinical alarm management of late-onset sepsis in preterm infants using vital signs from a patient monitor. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108335. [PMID: 39047574 DOI: 10.1016/j.cmpb.2024.108335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/14/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Continuous prediction of late-onset sepsis (LOS) could be helpful for improving clinical outcomes in neonatal intensive care units (NICU). This study aimed to develop an artificial intelligence (AI) model for assisting the bedside clinicians in successfully identifying infants at risk for LOS using non-invasive vital signs monitoring. METHODS In a retrospective study from the NICU of the Máxima Medical Center in Veldhoven, the Netherlands, a total of 492 preterm infants less than 32 weeks gestation were included between July 2016 and December 2018. Data on heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) at 1 Hz were extracted from the patient monitor. We developed multiple AI models using 102 extracted features or raw time series to provide hourly LOS risk prediction. Shapley values were used to explain the model. For the best performing model, the effect of different vital signs and also the input type of signals on model performance was tested. To further assess the performance of applying the best performing model in a real-world clinical setting, we performed a simulation using four different alarm policies on continuous real-time predictions starting from three days after birth. RESULTS A total of 51 LOS patients and 68 controls were finally included according to the patient inclusion and exclusion criteria. When tested by seven-fold cross-validations, the mean (standard deviation) area under the receiver operating characteristic curve (AUC) six hours before CRASH was 0.875 (0.072) for the best performing model, compared to the other six models with AUC ranging from 0.782 (0.089) to 0.846 (0.083). The best performing model performed only slightly worse than the model learning from raw physiological waveforms (0.886 [0.068]), successfully detecting 96.1 % of LOS patients before CRASH. When setting the expected alarm window to 24 h and using a multi-threshold alarm policy, the sensitivity metric was 71.6 %, while the positive predictive value was 9.9 %, resulting in an average of 1.15 alarms per day per patient. CONCLUSIONS The proposed AI model, which learns from routinely collected vital signs, has the potential to assist clinicians in the early detection of LOS. Combined with interpretability and clinical alarm management, this model could be better translated into medical practice for future clinical implementation.
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Affiliation(s)
- Meicheng Yang
- State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Zheng Peng
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Clinical Physics, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Carola van Pul
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Clinical Physics, Máxima Medical Centre, Veldhoven, the Netherlands; Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Peter Andriessen
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Pediatrics, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Kejun Dong
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, United States of America
| | - Demi Silvertand
- Department of Pediatrics, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Jianqing Li
- State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China; School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Chengyu Liu
- State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Xi Long
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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Statlender L, Shochat T, Robinson E, Fishman G, Hellerman-Itzhaki M, Bendavid I, Singer P, Kagan I. Urea to creatinine ratio as a predictor of persistent critical illness. J Crit Care 2024; 83:154834. [PMID: 38781812 DOI: 10.1016/j.jcrc.2024.154834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Persistent critical illness (PCI) is a syndrome in which the acute presenting problem has been stabilized, but the patient's clinical state does not allow ICU discharge. The burden associated with PCI is substantial. The most obvious marker of PCI is prolonged ICU length of stay (LOS), usually greater than 10 days. Urea to Creatinine ratio (UCr) has been suggested as an early marker of PCI development. METHODS A single-center retrospective study. Data of patients admitted to a general mixed medical-surgical ICU during Jan 1st 2018 till Dec 31st 2022 was extracted, including demographic data, baseline characteristics, daily urea and creatinine results, renal replacement therapy (RRT) provided, and outcome measures - length of stay, and mortality (ICU, and 90 days). Patients were defined as PCI patients if their LOS was >10 days. We used Fisher exact test or Chi-square to compare PCI and non-PCI patients. The association between UCr with PCI development was assessed by repeated measures linear model. Multivariate Cox regression was used for 1 year mortality assessment. RESULTS 2098 patients were included in the analysis. Patients who suffered from PCI were older, with higher admission prognostic scores. Their 90-day mortality was significantly higher than non-PCI patients (34.58% vs 12.18%, p < 0.0001). A significant difference in UCr was found only on the first admission day among all patients. This was not found when examining separately surgical, trauma, or transplantation patients. We did not find a difference in UCr in different KDIGO (Kidney Disease Improving Global Outcomes) stages. Elevated UCr and PCI were found to be significantly associated with 1 year mortality. CONCLUSION In this single center retrospective cohort study, UCr was not found to be associated with PCI development.
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Affiliation(s)
- Liran Statlender
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Centre, Petah Tikva, Israel
| | - Eyal Robinson
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Fishman
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hellerman-Itzhaki
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Institute for Nutrition Research, Felsenstein Medical Research Centre, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Bendavid
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pierre Singer
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Institute for Nutrition Research, Felsenstein Medical Research Centre, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kagan
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Institute for Nutrition Research, Felsenstein Medical Research Centre, Petah Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jentzer JC, van Diepen S, Alviar C, Miller PE, Metkus TS, Geller BJ, Kashani KB. Arterial hyperoxia and mortality in the cardiac intensive care unit. Curr Probl Cardiol 2024; 49:102738. [PMID: 39025170 DOI: 10.1016/j.cpcardiol.2024.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Arterial hyperoxia (hyperoxemia), defined as a high arterial partial pressure of oxygen (PaO2), has been associated with adverse outcomes in critically ill populations, but has not been examined in the cardiac intensive care unit (CICU). We evaluated the association between exposure to hyperoxia on admission with in-hospital mortality in a mixed CICU cohort. METHODS We included unique Mayo Clinic CICU patients admitted from 2007 to 2018 with admission PaO2 data (defined as the PaO2 value closest to CICU admission) and no hypoxia (PaO2 < 60mmHg). The admission PaO2 was evaluated as a continuous variable and categorized (60-100 mmHg, 101-150 mmHg, 151-200 mmHg, 201-300 mmHg, >300 mmHg). Logistic regression was used to evaluate predictors of in-hospital mortality before and after multivariable adjustment. RESULTS We included 3,368 patients with a median age of 70.3 years; 70.3% received positive-pressure ventilation. The median PaO2 was 99 mmHg, with a distribution as follows: 60-100 mmHg, 51.9%; 101-150 mmHg, 28.6%; 151-200 mmHg, 10.6%; 201-300 mmHg, 6.4%; >300 mmHg, 2.5%. A J-shaped association between admission PaO2 and in-hospital mortality was observed, with a nadir around 100 mmHg. A higher PaO2 was associated with increased in-hospital mortality (adjusted OR 1.17 per 100 mmHg higher, 95% CI 1.01-1.34, p = 0.03). Patients with PaO2 >300 mmHg had higher in-hospital mortality versus PaO2 60-100 mmHg (adjusted OR 2.37, 95% CI 1.41-3.94, p < 0.001). CONCLUSIONS Hyperoxia at the time of CICU admission is associated with higher in-hospital mortality, primarily in those with severely elevated PaO2 >300 mmHg.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Carlos Alviar
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York, United States
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Thomas S Metkus
- Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Bram J Geller
- Division of Cardiovascular Medicine and Division of Cardiovascular Critical Care, Maine Medical Center, Portland, ME, United States
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States
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Sears SM, Coughlin AK, Nelson K, Stillwell T, Carlton EF, Flori HR. Barriers and facilitators to effective electronic health record-based sepsis screening in the pediatric intensive care unit. JAMIA Open 2024; 7:ooae048. [PMID: 38978714 PMCID: PMC11229986 DOI: 10.1093/jamiaopen/ooae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S. Mott Children's Hospital Pediatric Intensive Care Unit deployed an electronic medical record (EMR)-based screening for early recognition and treatment of sepsis. Materials and Methods We analyzed all automated primary sepsis alerts, secondary screens, and bedside huddles from November 2019 to January 2020 (Cohort 1) and from November 2020 to January 2021 (Cohort 2) to identify barriers and facilitators for the use of this tool. We distributed surveys to frontline providers to gather feedback on end-user experience. Results In Cohort 1, 895 primary alerts were triggered, yielding 503 completed secondary screens and 40 bedside huddles. In Cohort 2, 925 primary alerts were triggered, yielding 532 completed secondary screens and 12 bedside huddles. Surveys assessing end-user experience identified the following facilitators: (1) 73% of nurses endorsed the bedside huddle as value added; (2) 74% of medical providers agreed the bedside huddle increased the likelihood of interventions. The greatest barriers to successful implementation included the (1) overall large number of primary alerts from the automated tool and (2) rate of false alerts, many due to routine respiratory therapy interventions. Discussion Our data suggests that the successful implementation of EMR-based sepsis screening tools requires countermeasures focusing on 3 key drivers for change: education, technology, and patient safety. Conclusion While both medical providers and bedside nurses found merit in our EMR-based sepsis early recognition system, continued refinement is necessary to avoid sepsis alert fatigue.
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Affiliation(s)
- Stacey M Sears
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
- School of Nursing, Wayne State University, Detroit, MI 48202, United States
| | - Anisha K Coughlin
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Kathryn Nelson
- University of Michigan School of Nursing, Ann Arbor, MI 48109, United States
| | - Terri Stillwell
- Department of Pediatrics, Division of Infectious Disease, University of Michigan Health System, Ann Arbor, MI 48109, United States
| | - Erin F Carlton
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Heidi R Flori
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
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11
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Bayuo J. Revisiting the philosophy of technology and nursing: Time to move beyond romancing resistance or resisting romance. Nurs Philos 2024; 25:e12503. [PMID: 39186482 DOI: 10.1111/nup.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
Technology remains enmeshed in our daily lives and given its continuing presence in clinical practice and rapid technological proliferation; it becomes relevant for nurses to examine techno-onto-epistemology in relation to the discipline of nursing. This is critical considering the intersection of technology and nursing remains an area of ongoing discussion revealing a need for further philosophical reflection. To this end, this paper sought to examine the philosophy of technology from the engineering and humanities perspectives to contribute to the discussion regarding its intersection with the onto-epistemology of nursing. Although technology seems to be constantly present in nursing practice, two opposing perspectives reflecting a love-hate relationship is highlighted: technological optimism (promotes technology) and technological romanticism (dissuades technology). Based on Mitcham's interpretation of 'mutual relationship' and 'being-with', a potential way to break away from the binary perspectives is to view the intersection of/relationship between technology and nursing as being on a continuum rather than entirely monolithic entities. Caring is presented as multidimensional reflecting actions and attitudes. Arguably, some caring actions may intersect with the engineering perspective to suggest that technology can support nurses in their roles, that is, by imitating some of what nurses do, but not to replace them. From the humanities perspective, technology is presented as a way of being with humans exercising control over what technology has to offer. Put together, it is clearly time to break away from the love-hate relationship between nursing and technology. Although this emphasises a great need to build the technological competency of nurses, there is an even greater call for nurses to reflect on and voice the epistemological, ontological, axiological, and ethical issues that the application of technology raises for the discipline.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Nursing, University of Health and Allied Sciences, Ho, Ghana
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12
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Meiers S, de Goumoëns V, Thirsk L, Abbott-Anderson K, Brysiewicz P, Eggenberger S, Heitschmidt M, Kiszio B, Mcandrew NS, Morman A, Richardson S. Nursing strategies to mitigate separation between hospitalized acute and critical care patients and families: A scoping review. Intensive Crit Care Nurs 2024; 84:103773. [PMID: 39067380 DOI: 10.1016/j.iccn.2024.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To describe the nursing strategies used to mitigate the impact of forced separation between hospitalized acute and critical care patients and their families during the COVID-19 pandemic. RESEARCH METHODOLOGY/DESIGN A scoping review was performed in accordance with JBI methodology. SETTINGS Those acute and critical care areas in which sudden, often unexpected, emergent episodes of illness or injury were treated. MAIN OUTCOME MEASURES Articles written in English and French between March 2020 and September 2023 in Medline, CINAHL Complete, APA PsycInfo, Embase and the Cochrane COVID-19 study register databases that met our inclusion criteria were included. Gray literature included dissertations, theses and Base Bielefeld Academic Search Engines. RESULTS Among the 1,357 articles screened, 46 met the criteria for inclusion. Most of the articles were published in North America. Adult critical care units were the most frequently reported settings, followed by neonatal intensive care units. The most frequently reported strategies were virtual telephone or video communications. A majority of the innovative strategies involved interprofessional collaboration at the unit level. Core components included the provision of relational nursing practices, virtual visits, tailored information, fostering relationships between family members, palliative care support regarding end of life, and general information about hospitalization and COVID-19. Pediatric care settings were more likely than adult care settings to accommodate physical visitation. CONCLUSION Nurses used synchronous, episodic, and structured virtual interactions, either alone or as part of an interprofessional team, to mitigate separation between patients and families during the COVID-19 pandemic in acute and critical care settings. IMPLICATIONS FOR CLINICAL PRACTICE Permanent policy changes are needed across acute and critical care settings to provide support for nurses in mitigating patient and family separation. We recommend that family members be considered as caregivers and care receivers, not visitors in patient and family-centered care in acute and critical care settings.
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Affiliation(s)
- Sonja Meiers
- College of Nursing, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702-4004, USA; Department of Graduate Nursing, Winona State University, 400 South Broadway, Suite 204, Rochester, MN 55904, USA.
| | - Véronique de Goumoëns
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, Lausanne, Switzerland; Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Center of Excellence, Avenue Alexandra Vinet 30 - 1004, Lausanne, Switzerland.
| | - Lorraine Thirsk
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta T9S 3A3, Canada.
| | - Kristen Abbott-Anderson
- College of Nursing, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702-4004, USA.
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban 4041, South Africa.
| | - Sandra Eggenberger
- Glen Taylor Nursing Institute for Family and Society, Minnesota State University, 360 Wissink Hall (WH 360), Mankato, Mankato, MN, USA.
| | - Mary Heitschmidt
- RUSH System for Health, Center for Clinical Research and Scholarship, 600 South Paulina, Suite 1080 AAC, Chicago, IL 60612, USA; Rush College of Nursing, 600 South Paulina, Suite 1080 AAC, Chicago, IL 60612, USA.
| | - Blanche Kiszio
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, Lausanne, Switzerland; Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Center of Excellence, Avenue Alexandra Vinet 30 - 1004, Lausanne, Switzerland.
| | - Natalie S Mcandrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI 53211, USA; Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Aspen Morman
- College of Nursing, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702-4004, USA.
| | - Sandra Richardson
- Emergency Department, Christchurch Hospital, Canterbury - Te Waipounamu - Waitaha, Health New Zealand - Te Whatu Ora, New Zealand.
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Marcy F, Goettfried K, Enghard P, Piper SK, Kunz JV, Schroeder T. Impact of AKI on metabolic compensation for respiratory acidosis in ICU patients with AECOPD. J Crit Care 2024; 83:154846. [PMID: 38936337 DOI: 10.1016/j.jcrc.2024.154846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can result in severe respiratory acidosis. Metabolic compensation is primarily achieved by renal retention of bicarbonate. The extent to which acute kidney injury (AKI) impairs the kidney's capacity to compensate for respiratory acidosis remains unclear. MATERIALS AND METHODS This retrospective analysis covers clinical data between January 2009 and December 2021 for 498 ICU patients with AECOPD and need for respiratory support. RESULTS 278 patients (55.8%) presented with or developed AKI. Patients with AKI exhibited higher 30-day-mortality rates (14.5% vs. 4.5% p = 0.001), longer duration of mechanical ventilation (median 90 h vs. 14 h; p = 0.001) and more severe hypercapnic acidosis (pH 7.23 vs. 7.28; pCO2 68.5 mmHg vs. 61.8 mmHg). Patients with higher AKI stages exhibited lower HCO3-/pCO2 ratios and did not reach expected HCO3- levels. In a mixed model analysis with random intercept per patient we analyzed the association of pCO2 (independent) and HCO3- (dependent variable). Lower estimates for averaged change in HCO3- were observed in patients with more severe AKI. CONCLUSION AKI leads to poor outcomes and compromises metabolic compensation of respiratory acidosis in ICU patients with AECOPD. While buffering agents may aid compensation for severe AKI, their use should be approached with caution.
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Affiliation(s)
- Florian Marcy
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany.
| | - Katharina Goettfried
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Philipp Enghard
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Sophie K Piper
- Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Strasse 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Medical Informatics Berlin, Germany
| | - Julius Valentin Kunz
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Tim Schroeder
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
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14
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Lee JJ, Mathur S, Gerhart J, Glover CM, Ritz E, Basapur S, Greenberg JA. Written communication and the ICU team experience (WRITE): A pre-post intervention study. Intensive Crit Care Nurs 2024; 84:103753. [PMID: 38924848 DOI: 10.1016/j.iccn.2024.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Families of critically ill patients may benefit from receiving a written update of patient care each day. Our objective was to develop a system to facilitate care provider creation of written updates and to determine the effect of implementing this process on the care provider experience. DESIGN The experiences of ICU care providers (nurses, advanced practice providers, and physicians) were measured monthly during a 3-month pre-intervention and a 3-month intervention period. During the intervention period, written updates were sent to families each day and posted in the electronic medical record. Study investigators assisted by editing and distributing the written communication to families. SETTING An urban academic medical center in the United States. MAIN OUTCOME MEASURES Nurse-Physician Collaboration Scale (NPCS) and Maslach Burnout Inventory (MBI). RESULTS Over the 3-month intervention period, care providers created written communication for families of 152 patients (average 5 ICU days per family). NPCS scores among the 65 participating care providers were significantly lower, indicating greater collaboration during the intervention vs. pre-intervention period: 49.9 (95 % CI 46.4-53.6) vs. 55.4 (95 % CI 51.5-59.3), p = 0.002. MBI scores were similar during the intervention vs. pre-intervention periods. A subset of care providers participated in individual interviews. Care providers reported that the process of creating written communication was acceptable and had clear benefits for both families and the medical team. CONCLUSIONS Use of written communication as a supplement to verbal communication improves collaboration among ICU care providers without affecting symptoms of burnout. IMPLICATIONS FOR PRACTICE We created a system to facilitate written communication with ICU families that was acceptable to care providers and improved aspects of their experience. In the future, use of written communication can be enhanced with refinements to the process that reduce the time spent creating written updates while highlighting the benefits to families and care providers.
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Affiliation(s)
| | - Shubha Mathur
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Crystal M Glover
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ethan Ritz
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL, USA
| | - Santosh Basapur
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jared A Greenberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
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15
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Dantan E, Foucher Y, Simon-Pimmel J, Léger M, Campfort M, Lasocki S, Lakhal K, Bouras M, Roquilly A, Cinotti R. Long-term survival of traumatic brain injury and intra-cerebral haemorrhage patients: A multicentric observational cohort. J Crit Care 2024; 83:154843. [PMID: 38875914 DOI: 10.1016/j.jcrc.2024.154843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/13/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Mortality is often assessed during ICU stay and early after, but rarely at later stage. We aimed to compare the long-term mortality between TBI and ICH patients. MATERIALS AND METHODS From an observational cohort, we studied 580 TBI patients and 435 ICH patients, admitted from January 2013 to February 2021 in 3 ICUs and alive at 7-days post-ICU discharge. We performed a Lasso-penalized Cox survival analysis. RESULTS We estimated 7-year survival rates at 72.8% (95%CI from 67.3% to 78.7%) for ICH patients and at 84.9% (95%CI from 80.9% to 89.1%) for TBI patients: ICH patients presenting a higher mortality risk than TBI patients. Additionally, we identified variables associated with higher mortality risk (age, ICU length of stay, tracheostomy, low GCS, absence of intracranial pressure monitoring). We also observed anisocoria related with the mortality risk in the early stage after ICU stay. CONCLUSIONS In this ICU survivor population with a prolonged follow-up, we highlight an acute risk of death after ICU stay, which seems to last longer in ICH patients. Several variables characteristic of disease severity appeared associated with long-term mortality, raising the hypothesis that the most severe patients deserve closer follow-up after ICU stay.
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Affiliation(s)
- E Dantan
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France.
| | - Y Foucher
- Poitiers Université, CHU de Poitiers, CIC INSERM 1402, Poitiers, France
| | - J Simon-Pimmel
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - M Léger
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - M Campfort
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - S Lasocki
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - K Lakhal
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Laennec, Nantes F-44093, France
| | - M Bouras
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR, 1064 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC0004, 1413 Nantes, France
| | - A Roquilly
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR, 1064 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC0004, 1413 Nantes, France
| | - R Cinotti
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes F-44093, France
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Ueno R, Reddy MP, Jones D, Pilcher D, Subramaniam A. The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest. J Crit Care 2024; 83:154842. [PMID: 38865757 DOI: 10.1016/j.jcrc.2024.154842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/18/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is a serious medical emergency. When IHCA occurs in patients with frailty, short-term survival is poor. However, the impact of frailty on long-term survival is unknown. METHODS We performed a retrospective multicentre study of all critically ill adult (age ≥ 16 years) patients admitted to Australian intensive care units (ICU) between 1st January 2018 to 31st March 2022. We included all patients who had an IHCA within the 24 h before ICU admission with a documented Clinical Frail Scale (CFS). The primary outcome was median survival up to one year following ICU admission. The effect of frailty on one-year survival was assessed using a Cox proportional hazards model, adjusting for age, sex, comorbidities, sequential organ failure assessment (SOFA) score, and hospital type. RESULTS We examined 3769 patients, of whom 30.8% (n = 1160) were frail (CFS ≥ 5). The median survival was significantly shorter for patients with frailty (median [IQR] days 19 [1-365] vs 302 [9-365]; p < 0.001). The overall one-year mortality was worse for the patients with frailty when compared to the non-frail group (64.8% [95%CI 61.9-67.5] vs 36.4% [95%CI 34.5-38.3], p < 0.001). Each unit increment in the CFS was associated with 22% worse survival outcome (adjusted Hazard ratio = 1.22, 95%-CI 1.19-1.26), after adjustment for confounders. The survival trend was similar among patients who survived the hospitalization. CONCLUSION In this retrospective multicentre study, frailty was associated with poorer one-year survival in patients admitted to Australian ICUs following an IHCA.
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Affiliation(s)
- Ryo Ueno
- Intensive Care Medicine, Eastern Health, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia.
| | - Mallikarjuna Ponnapa Reddy
- Intensive Care Medicine, Peninsula Health, Victoria, Australia; Intensive Care Medicine, Calvary Hospital Health, Canberra, Australia
| | - Daryl Jones
- Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia; Intensive Care Medicine, Austin Health, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia; Intensive Care Medicine, Alfred Health, Victoria, Australia; Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation, Victoria, Australia
| | - Ashwin Subramaniam
- Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia; Intensive Care Medicine, Peninsula Health, Victoria, Australia; Intensive Care Medicine, Monash Health, Victoria, Australia; Monash University, Peninsula Clinical School, Victoria, Australia
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Kobara S, Yamamoto R, Rad MG, Grunwell JR, Hikota N, Uzawa Y, Hayashi Y, Coopersmith CM, Kamaleswaran R. Association between comorbidities at ICU admission and post-Sepsis physical impairment: A retrospective cohort study. J Crit Care 2024; 83:154833. [PMID: 38776846 DOI: 10.1016/j.jcrc.2024.154833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Few studies have measured the association between pre-existing comorbidities and post-sepsis physical impairment. The study aimed to estimate the risk of physical impairment at hospital discharge among sepsis patients, adjusting for pre-existing physical impairment prior to ICU admission and in-hospital mortality. MATERIALS AND METHODS We analyzed all consecutive adult patients admitted to an ICU in a tertiary community hospital, Kameda Medical Center, with sepsis diagnosis from September 2014 to October 2020. Inverse probability attrition weighting using machine learning was employed to estimate the risk of physical impairment at hospital discharge for sepsis patients with and without pre-existing comorbidities at ICU admission. This estimation was adjusted for baseline covariates, pre-ICU physical impairment, and in-hospital mortality. RESULTS Of 889 sepsis patients analyzed, 668 [75.1%] had at least one comorbidity and 221 [24.9%] had no comorbidities at ICU admission. Upon adjusting for baseline covariates, pre-ICU physical impairment, and in-hospital mortality, pre-existing comorbidities were not associated with an elevated risk of physical impairment at hospital discharge (RR: 1.02, 95% CI: 0.92, 1.14). CONCLUSIONS Pre-existing comorbidities prior to ICU admission were not associated with an increased risk of physical impairment at hospital discharge among sepsis patients after adjusting for baseline covariates and in-hospital mortality.
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Affiliation(s)
- Seibi Kobara
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Intensive Care, Kameda Medical Center, Chiba, Japan
| | - Milad G Rad
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jocelyn R Grunwell
- Department of Pediatrics, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, GA, USA
| | - Nao Hikota
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yoshihiro Uzawa
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yoshiro Hayashi
- Department of Intensive Care, Kameda Medical Center, Chiba, Japan
| | - Craig M Coopersmith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA; Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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18
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Hamadeh S, Lambert GW, Willetts G, Garvey L. Pain management of adult sedated and ventilated patients in the intensive care units: A survey with free text responses. Intensive Crit Care Nurs 2024; 84:103770. [PMID: 39032213 DOI: 10.1016/j.iccn.2024.103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Pain management of sedated and ventilated patients in intensive care units lacks consistency. OBJECTIVES To investigate nurses' training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses' perspectives. METHODS A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to. OUTCOME MEASURES Demographics, training, governance, clinical practice, knowledge, and attitudes. RESULTS/FINDINGS 108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor's preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses' knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between "knowledge scores" and "years of ICU experience" and weak negative relationship r = [-0.119], p = [0.260] between "knowledge scores" and "hours of clinical practice" was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: "Pain assessment, where is it?" And "Priorities of critical illness." CONCLUSION The study uncovered pain management situation and examined nurses' demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management. IMPLICATIONS FOR CLINICAL PRACTICE Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses' role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.
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Affiliation(s)
- Samira Hamadeh
- Institute of Health and Wellbeing, Federation University, Australia. https://federation.edu.au/
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia. https://twitter.com/glamb30004
| | - Georgina Willetts
- Institute of Health and Wellbeing, Federation University, Australia. https://twitter.com/GeorgiWilletts
| | - Loretta Garvey
- Assessment Transformation, Federation University, Australia. https://twitter.com/LorettaGarvey
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Rousseau AF, Fontana M, Georis S, Lambermont B, Cavalleri J, Pirotte M, Tronconi G, Paquay M, Misset B. Implementation of a routine post-shift debriefing program in ICU aiming at quality-of-care improvement: A primary analysis of feasibility and impacts. Intensive Crit Care Nurs 2024; 84:103752. [PMID: 38896963 DOI: 10.1016/j.iccn.2024.103752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES This report describes the implementation of a clinical debriefing (CD) program in intensive care units (ICU) and analyses its feasibility and its impact on staff well-being. DESIGN Observational study. SETTING From April to September 2023, post-shift CDs were run once a week in 2 out of 7 units in our department, using an adapted version of the DISCOVER-PHASE tool. CD sessions were performed face-to-face with volunteer members of the multidisciplinary ICU team. MAIN OUTCOME MEASURES After 6 months, a survey assessing the satisfaction of the debriefed teams was conducted. The impact of CD on staff well-being was assessed using three validated questionnaires (Maslach Burnout Inventory, Ways of Coping Checklist, Professional Quality of Life Scale) administered in the 7 units before and after the CD period. RESULTS A total of 44 CDs were performed, lasting 15 (4-35) min. There were 6 (1-9) attendees per CD, mainly nurses (64.6%). Discussions focused mainly on basic problems related to dysfunctional material, communication and organization inside the team. The two debriefed teams were satisfied of the program and gave 9, 8 and 8 out of 10 on a visual analogical scale for the climate of confidence of the DC, their organisation, and their ability to improve working conditions and quality of care, respectively. Subscores at the three questionnaires assessing staff well-being before and after the CD period were similar, whether teams experienced CD or not. CONCLUSIONS Implementing of post-shift debriefings in our ICU was feasible and well accepted. More prolonged programs are probably needed to demonstrate benefits on staff well-being. IMPLICATIONS FOR CLINICAL PRACTICE This report offers elements that other teams can use to successfully conduct post-shift debriefings and to plan future research on longer-term programs.
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Affiliation(s)
- Anne-Françoise Rousseau
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium; Research Unit for a Life-Course Perspective on Health & Education-RUCHE, University of Liège, Liège, Belgium.
| | - Michael Fontana
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Stéphanie Georis
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Bernard Lambermont
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Jonathan Cavalleri
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Marc Pirotte
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Gaëlle Tronconi
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Méryl Paquay
- Centre for Medical Simulation, University of Liège, Belgium; Emergency Department, University Hospital of Liège, University of Liège, Belgium
| | - Benoit Misset
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
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20
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Iqbal K, Banga A, Arif TB, Rathore SS, Bhurwal A, Naqvi SKB, Mehdi M, Kumar P, Salklan MM, Iqbal A, Ahmed J, Sharma N, Lal A, Kashyap R, Bansal V, Domecq JP. Anticoagulant use before COVID-19 diagnosis prevent COVID-19 associated acute venous thromboembolism or not: A systematic review and meta-analysis. World J Methodol 2024; 14:92983. [DOI: 10.5662/wjm.v14.i3.92983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. There is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 disease.
AIM To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 patients.
METHODS A Literature search was performed on LitCovid PubMed, WHO, and Scopus databases from inception (December 2019) till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with COVID-19. The primary outcome was the risk of thromboembolic events in COVID-19 patients taking anticoagulants. Secondary outcomes included COVID-19 disease severity, in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection, and mortality. The random effects models were used to calculate crude and adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs).
RESULTS Forty-six observational studies met our inclusion criteria. The unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk [n = 43851, 9 studies, odds ratio (OR)= 0.67 (0.22, 2.07); P = 0.49; I2 = 95%]. The association between prior anticoagulation and disease severity was non-significant [n = 186782; 22 studies, OR = 1.08 (0.78, 1.49); P = 0.64; I2 = 89%]. However, pre-hospital anticoagulation significantly increased all-cause mortality risk [n = 207292; 35 studies, OR = 1.72 (1.37, 2.17); P < 0.00001; I2 = 93%]. Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk [aOR = 0.87 (0.42, 1.80); P = 0.71], mortality [aOR = 0.94 (0.84, 1.05); P = 0.31], and disease severity [aOR = 0.96 (0.72, 1.26); P = 0.76].
CONCLUSION Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events, improved survival, and lower disease severity in COVID-19 patients.
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Affiliation(s)
- Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Akshat Banga
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
| | - Taha Bin Arif
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur 342003, Rajasthan, India
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | | | - Muhammad Mehdi
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Pankaj Kumar
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Mitali Madhu Salklan
- Department of Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Ayman Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Nikhil Sharma
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Rahul Kashyap
- Department of Research, Wellspan Health, York, PA 17403, United States
| | - Vikas Bansal
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Juan Pablo Domecq
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
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21
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Ruck JM, Bush EL. Use of Extracorporeal Membrane Oxygenation for Patients with Coronavirus Disease 2019 Infection. Adv Surg 2024; 58:249-273. [PMID: 39089781 PMCID: PMC11294677 DOI: 10.1016/j.yasu.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic was a cataclysmic event that infected over 772 million and killed over 6.9 million people worldwide. The pandemic pushed hospitals and society to their limits and resulted in incredibly severe respiratory disease in millions of people. This severe respiratory disease often necessitated maximum medical therapy, including the use of extracorporeal membrane oxygenation. While our understanding of COVID-19 and its treatment continue to evolve, we review the current evidence to guide the care of patients with severe COVID-19 infection.
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Affiliation(s)
- Jessica M Ruck
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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22
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Bromley SE, Shakery K, Vora P, Atabaki A, Reimer T, McDermott L, Hajizadeh N. Understanding Causes of Death in Patients With Acute Respiratory Distress Syndrome: A Narrative Review. Crit Care Explor 2024; 6:e1147. [PMID: 39172623 PMCID: PMC11343544 DOI: 10.1097/cce.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES To provide a comprehensive summary of the published data on cause of death in patients with acute respiratory distress syndrome (ARDS). DATA SOURCES PubMed (January 2015 to April 2024), bibliographies of relevant articles, and ARDS Network and Prevention & Early Treatment of Acute Lung Injury (PETAL) network websites. STUDY SELECTION Observational studies and clinical trials that reported on cause of death in greater than or equal to 30 patients with ARDS, not obtained from death certificates. Animal studies, case reports, review articles, study protocols, and studies in pediatrics were excluded. DATA EXTRACTION Causes of death among ARDS patients who died were extracted and tabulated along with other pertinent study characteristics. DATA SYNTHESIS We identified 15 observational studies (nine non-COVID ARDS, five COVID-related ARDS; one both) and five clinical trials (all non-COVID ARDS). Mutually exclusive prespecified categories were used for recording the cause of death in only eight studies although studies differed in the categories included and their definitions. When multiple organ failure was a predetermined category, it was the most common cause of death recorded (~50% of deaths), followed by respiratory causes with proportions varying from 16% to 42% depending on nomenclature (e.g., refractory hypoxemia, pulmonary causes) and definitions. However, the largest observational study in non-COVID ARDS (964 deaths), did not include multiple organ failure as a predetermined category, and found that pulmonary failure (42%) and cardiac failure (37%) were the most common causes of death. In COVID-related ARDS observational studies, pulmonary reasons were the most reported cause of death (up to 88%). CONCLUSIONS Few studies have reported cause of death in patients with ARDS. In those that do, cause of death categories and definitions used are heterogeneous. Further research is needed to see whether a more rigorous and unified approach to assigning and reporting cause of death in ARDS would help identify more relevant endpoints for the assessment of targeted treatments in clinical trials.
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Affiliation(s)
| | | | - Pareen Vora
- Integrated Evidence Generation, Bayer AG, Berlin, Germany
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23
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Coggins SA, Carr LH, Harris MC, Srinivasan L. Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition and Severity Assessment. J Pediatr 2024; 272:114117. [PMID: 38815749 DOI: 10.1016/j.jpeds.2024.114117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/15/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To analyze relationships between provider-documented signs prompting sepsis evaluations, assessments of illness severity, and late-onset infection (LOI). STUDY DESIGN Retrospective cohort study of all infants receiving a sepsis huddle in conjunction with a LOI evaluation. Participants were ≥3 days old and admitted to a level IV neonatal intensive care unit (NICU) from September 2018 through May 2021. Data were extracted from standardized sepsis huddle notes in the electronic health record, including clinical signs prompting LOI evaluations, illness severity assessments (from least to most severe: green, yellow, and red), and management plans. To analyze relationships of sepsis huddle characteristics with the detection of culture-confirmed LOI (bacteremia, urinary tract infection, or meningitis), we utilized diagnostic test statistics, area under the receiver-operator characteristic analyses, and multivariable logistic regression. RESULTS We identified 1209 eligible sepsis huddles among 604 infants. There were 111 culture-confirmed LOI episodes (9% of all huddles). Twelve clinical signs of infection poorly distinguished infants with and without LOI, with sensitivity for each ranging from 2% to 36% and area under the receiver-operator characteristic ranging 0.49-0.53. Multivariable logistic regression identified increasing odds of infection with higher perceived illness severity at the time of sepsis huddle, adjusted for gestational age and receipt of intensive care supports. CONCLUSIONS Clinical signs prompting sepsis huddles were nonspecific and not predictive of concurrent LOI. Higher perceived illness severity was associated with presence of infection, despite some misclassification based on objective criteria. In level IV NICUs, antimicrobial stewardship through development of criteria for antibiotic noninitiation may be challenging, as presenting signs of LOI are similar among infants with and without confirmed infection.
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Affiliation(s)
- Sarah A Coggins
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Leah H Carr
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mary Catherine Harris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Lakshmi Srinivasan
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
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24
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Gundersen S, Blikstad-Løkkevik S, Brenna G, Steindal SA, Kvande ME. Critical care nurses' assessment of writing diaries for adult patients in the intensive care unit - A qualitative study. Aust Crit Care 2024; 37:680-685. [PMID: 38627115 DOI: 10.1016/j.aucc.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Patients describe surreal experiences, hallucinations, loss of control, fear, pain, and other discomforts during their stay in intensive care units. Diaries written by critical care nurses can help patients fill-in memory gaps, gain an understanding of their illness after returning home, and enhance recovery. However, critical care nurses have difficulty deciding which patients in the intensive care unit should receive diaries and how to conduct and prioritise this nursing intervention. OBJECTIVES The objective of this study was to explore critical care nurses' assessments regarding starting and writing diaries for adult patients in the intensive care unit. METHODS A qualitative study with an exploratory descriptive design was utilised. Interviews were conducted with 14 critical care nurses from four hospitals. The data were analysed using systematic text condensation and were reported according to the consolidated criteria for reporting qualitative research checklist. FINDINGS Three categories emerged: patients' disease trajectories and prognoses, tailoring the content and language and balancing time, and resources to create diaries that benefit patients. CONCLUSIONS Whilst critical care nurses' assessments of the need for diaries are based on patients' disease trajectories and prognoses, patients' conditions can shift rapidly, which makes these assessments challenging. To ensure diary quality, the language and content should be personal and address the individual patient. The time and resources required for diaries are weighed against the benefits to patients. Contributions from colleagues and a common recognition in the intensive care unit of the value of the diaries influence nurses' judgements and are essential for successful diary practices.
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Affiliation(s)
- Silje Gundersen
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Department of Medicine, Oslo University Hospital, Oslo, Norway.
| | - Siri Blikstad-Løkkevik
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Emergency Department, Oslo University Hospital, Oslo, Norway.
| | - Guro Brenna
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Emergency Department, Oslo University Hospital, Oslo, Norway.
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Monica Evelyn Kvande
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Department of Anaesthesiology and Surgery, University Hospital of North Norway, Tromsø, Norway.
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25
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Byrd TF, Phelan TA, Ingraham NE, Langworthy BW, Bhasin A, Kc A, Melton-Meaux GB, Tignanelli CJ. Beyond Unplanned ICU Transfers: Linking a Revised Definition of Deterioration to Patient Outcomes. Crit Care Med 2024; 52:e439-e449. [PMID: 38832836 DOI: 10.1097/ccm.0000000000006333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To develop an electronic descriptor of clinical deterioration for hospitalized patients that predicts short-term mortality and identifies patient deterioration earlier than current standard definitions. DESIGN A retrospective study using exploratory record review, quantitative analysis, and regression analyses. SETTING Twelve-hospital community-academic health system. PATIENTS All adult patients with an acute hospital encounter between January 1, 2018, and December 31, 2022. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Clinical trigger events were selected and used to create a revised electronic definition of deterioration, encompassing signals of respiratory failure, bleeding, and hypotension occurring in proximity to ICU transfer. Patients meeting the revised definition were 12.5 times more likely to die within 7 days (adjusted odds ratio 12.5; 95% CI, 8.9-17.4) and had a 95.3% longer length of stay (95% CI, 88.6-102.3%) compared with those who were transferred to the ICU or died regardless of meeting the revised definition. Among the 1812 patients who met the revised definition of deterioration before ICU transfer (52.4%), the median detection time was 157.0 min earlier (interquartile range 64.0-363.5 min). CONCLUSIONS The revised definition of deterioration establishes an electronic descriptor of clinical deterioration that is strongly associated with short-term mortality and length of stay and identifies deterioration over 2.5 hours earlier than ICU transfer. Incorporating the revised definition of deterioration into the training and validation of early warning system algorithms may enhance their timeliness and clinical accuracy.
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Affiliation(s)
- Thomas F Byrd
- Division of Hospital Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
| | | | - Nicholas E Ingraham
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
- Division of Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Benjamin W Langworthy
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Ajay Bhasin
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abhinab Kc
- University of Minnesota Medical School, Minneapolis, MN
| | - Genevieve B Melton-Meaux
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Christopher J Tignanelli
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
- Division of Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN
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26
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Girault C, Artaud-Macari E, Jolly G, Carpentier D, Cuvelier A, Béduneau G. [High-flow nasal oxygen therapy and hypercapnic acute respiratory failure]. Rev Mal Respir 2024; 41:498-507. [PMID: 38926023 DOI: 10.1016/j.rmr.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Humidified high-flow nasal oxygen therapy (HFNO) has, in recent years, come to assume a key role in the management of hypoxemic acute respiratory failure (ARF). While non-invasive ventilation (NIV) currently represents the first-line ventilatory strategy in patients exhibiting hypercapnic ARF, the operating principles and physiological effects of HFNO could be interesting and useful in the initial management of hypercapnic ARF and/or after extubation, particularly in acute exacerbations of chronic obstructive pulmonary disease. Under these conditions, HFNO could be used either alone continuously or in combination with NIV during breaks in spontaneous breathing, depending on the severity and etiology of the underlying hypercapnic ARF.
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Affiliation(s)
- C Girault
- Service de médecine intensive et réanimation, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France.
| | - E Artaud-Macari
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
| | - G Jolly
- Service de médecine intensive et réanimation, CHU-hôpitaux de Rouen, 76000 Rouen, France
| | - D Carpentier
- Service de médecine intensive et réanimation, CHU-hôpitaux de Rouen, 76000 Rouen, France
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
| | - G Béduneau
- Service de médecine intensive et réanimation, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
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27
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In de Braekt A, Coolen CM, Maaskant JM, de Man-van Ginkel JM, Eskes AM, Jongerden IP. Views of family members on using video calls during the hospital admission of a patient: A qualitative study. J Adv Nurs 2024; 80:3757-3766. [PMID: 38243625 DOI: 10.1111/jan.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Utilization of video calls on hospital wards to facilitate involvement of and communication with family members is still limited. A deeper understanding of the needs and expectations of family members regarding video calls on hospital wards is necessary, to identify potential barriers and facilitate video calls in practice. AIM The aim of this study was to explore the views, expectations and needs of a patient's family members regarding the use of video calls between family members, patients and healthcare professionals, during the patient's hospital admission. METHODS A qualitative study was carried out. Semi-structured interviews with family members of patients admitted to two hospitals were conducted between February and May 2022. Family members of patients admitted to the surgical, internal medicine and gynaecological wards were recruited. RESULTS Twelve family members of patients participated. Family members stated that they perceive video calls as a supplemental option and prefer live visits during hospital admission. They expected video calls to initiate additional moments of contact with healthcare professionals, e.g. to join in medical rounds. When deploying video calls, family members mentioned that adequate instruction and technical support by nurses should be available. CONCLUSION Family members considered video calls valuable when visiting is not possible or to participate in medical rounds or other contacts with healthcare professionals outside of visiting hours. IMPLICATIONS Family members need to be supported in options and use of video calls on hospital wards. Additional knowledge about actual participation in care through video calls is needed as well as the effect on patient, family and healthcare professional outcomes. IMPACT Using video calls on hospital wards can provide family members with flexible alternatives for contact and promote family involvement. REPORTING METHOD COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Family members of patients admitted to hospital have contributed by sharing their perspectives in interviews. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Family members perceive additional value from the use of video calls on hospital wards. For family, use of video calls needs to be facilitated with clear instruction materials and support. TRIAL AND PROTOCOL REGISTRATION Amsterdam UMC Medical Ethics Review Committee (ref number W21_508 # 21.560).
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Affiliation(s)
- Anna In de Braekt
- Nursing Science, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Celeste M Coolen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Department of Pediatrics, University Medical Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke M de Man-van Ginkel
- Nursing Science, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Nursing Science, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Digital Health, Amsterdam, The Netherlands
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, Quality and Organization of Care, Amsterdam, The Netherlands
- Expertise Center for Palliative Care, Amsterdam, The Netherlands
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28
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Shahid A, Lovelock S, Cussen J, Stelfox HT, Marshall AP. The many hats of a researcher in the intensive care unit - Moving towards integrating researchers into intensive care unit care teams. Aust Crit Care 2024; 37:667-668. [PMID: 39068068 DOI: 10.1016/j.aucc.2024.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Affiliation(s)
- Anmol Shahid
- Cumming School of Medicine, University of Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada
| | | | | | - Henry Thomas Stelfox
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Alberta Health Services, Alberta, Canada
| | - Andrea P Marshall
- Gold Coast Health and Griffith University, Queensland, Australia; Griffith University School of Nursing and Midwifery, Brisbane, Australia
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29
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Sheikh F, Chechulina V, Garber G, Hendrick K, Kissoon N, Proulx L, Russell K, Fox-Robichaud AE, Schwartz L, Barrett KA. Reducing the burden of preventable deaths from sepsis in Canada: A need for a national sepsis action plan. Healthc Manage Forum 2024; 37:366-370. [PMID: 38597370 PMCID: PMC11348619 DOI: 10.1177/08404704241240956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Sepsis is a global health threat with significant morbidity and mortality. Despite clinical practice guidelines and developed health systems, sepsis is often unrecognized or misdiagnosed, leading to preventable harm. In Canada, sepsis is responsible for 1 in 20 deaths and is a significant driver of health system costs. Despite being a signatory to the World Health Organization's Resolution WHA 70.7, adopted in 2017, Canada has not lived up to its commitment. Many existing sepsis policies were developed in response to a specific tragedy, and there is no national sepsis action plan. In this article, we describe the burden of sepsis, provide examples of existing, context-specific, reactionary sepsis policies, and urge a coordinated, proactive Canadian sepsis action plan to reduce the burden of sepsis.
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Affiliation(s)
| | | | - Gary Garber
- Canadian Medical Protective Association, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn Hendrick
- Sepsis Canada Patient Advisory Council, Hamilton, Ontario, Canada
| | - Niranjan Kissoon
- BC Children’s Hospital, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- Sepsis Canada Patient Advisory Council, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | - Kristine Russell
- Sepsis Canada Patient Advisory Council, Hamilton, Ontario, Canada
- University of Calgary, Calgary, Alberta, Canada
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Balucani C, Canner JK, Tonna JE, Dalton H, Bianchi R, Al-Kawaz MNG, Choi CW, Etchill E, Kim BS, Whitman GJ, Cho SM. Sex-Related Differences in Utilization and Outcomes of Extracorporeal Cardio-Pulmonary Resuscitation for Refractory Cardiac Arrest. ASAIO J 2024; 70:750-757. [PMID: 38588589 DOI: 10.1097/mat.0000000000002210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Sparse data exist on sex-related differences in extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest (rCA). We explored the role of sex on the utilization and outcomes of ECPR for rCA by retrospective analysis of the Extracorporeal Life Support Organization (ELSO) International Registry. The primary outcome was in-hospital mortality. Exploratory outcomes were discharge disposition and occurrence of any specific extracorporeal membrane oxygenation (ECMO) complications. From 1992 to 2020, a total of 7,460 adults with ECPR were identified: 30.5% women; 69.5% men; 55.9% Whites, 23.7% Asians, 8.9% Blacks, and 3.8% Hispanics. Women's age was 50.4 ± 16.9 years (mean ± standard deviation) and men's 54.7 ± 14.1 ( p < 0.001). Ischemic heart disease occurred in 14.6% women vs. 18.5% men ( p < 0.001). Overall, 28.5% survived at discharge, 30% women vs. 27.8% men ( p = 0.138). In the adjusted analysis, sex was not associated with in-hospital mortality (odds ratio [OR] = 0.93 [confidence interval {CI} = 0.80-1.08]; p = 0.374). Female sex was associated with decreased odds of neurologic, cardiovascular, and renal complications. Despite being younger and having fewer complications during ECMO, women had in-hospital mortality similar to men. Whether these findings are driven by biologic factors or disparities in health care warrants further investigation.
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Affiliation(s)
- Clotilde Balucani
- From the Neurocritical Care Division, Department of Neurology, New York University Langone/Bellevue Hospital, New York, New York
| | - Joseph K Canner
- Division of Cardiac Surgery, Cardiovascular Surgical Intensive Care, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Heidi Dalton
- Division of Critical Care Medicine, Department of Pediatrics, INOVA Heart and Vascular Institute, Inova Fairfax Medical Institute, Falls Church, Virginia
| | - Riccardo Bianchi
- Department of Physiology and Pharmacology, College of Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
| | - Mais N G Al-Kawaz
- Department of Neurology, Neurosurgery, and Radiology, University of Kentucky HealthCare, Lexington, Kentucky
| | - Chun Woo Choi
- Department of Cardiothoracic Surgery, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey
| | - Eric Etchill
- Department of Cardiothoracic Surgery, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey
| | - Bo Soo Kim
- Department of Cardiothoracic Surgery, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey
| | - Glenn J Whitman
- Department of Cardiothoracic Surgery, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey
| | - Sung-Min Cho
- Department of Cardiothoracic Surgery, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey
- Division of Neuroscience Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesia & Critical Care, The Johns Hopkins University, Baltimore, Maryland
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Otani H, Yokomichi N, Imai K, Toyota S, Yamauchi T, Miwa S, Yuasa M, Okamoto S, Kogure T, Inoue S, Morita T. A Novel Objective Measure for Terminal Delirium: Activity Scores Measured by a Sheet-Type Sensor. J Pain Symptom Manage 2024; 68:246-254. [PMID: 38810949 DOI: 10.1016/j.jpainsymman.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
CONTEXT Delirium is a significant concern in end-of-life care. Continuous monitoring of agitation levels using objective methods may have advantages over existing measurement scales. OBJECTIVES To examine whether an objective measure of activity scores measured using a sheet-type non-wearable sensor (Nemuri SCAN [NSCAN]) was correlated with agitation levels measured using the modified Richmond Agitation-Sedation Scale (RASS) in terminally ill patients with cancer. METHODS We conducted a single-center, prospective, observational study in a palliative care unit using the NSCAN to measure activity scores and the RASS to assess agitation levels. RASS scores were prospectively measured by ward nurses blinded to the NSCAN variables. A database was created to pair the RASS scores and activity scores at night on the same day. RESULTS During the observation period, 1209 patients were hospitalized, and 3028 pairs of assessments of 971 patients were analyzed. The NSCAN activity scores significantly increased with increasing RASS scores (Jonckheere-Terpstra test, p < 0.001). The mean values of the activity scores for each RASS score were RASS -5, 28.9; RASS -4, 36.4; RASS -3, 41.7; RASS -2, 57.4; RASS -1, 58.8; RASS 0, 62.6; RASS 1, 79.6; RASS 2, 106.5; and RASS 3, 118.7. CONCLUSION The NSCAN activity significantly correlated with modified RASS agitation scores. Real-time NSCAN data on agitation may aid timely interventions for optimal symptom control. To improve outcomes for patients suffering from terminal delirium, more research on monitoring tools is warranted.
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Affiliation(s)
- Hiroyuki Otani
- Department of Palliative and Supportive Care(H.O.), St. Mary's Hospital, Kurume City, Fukuoka 830-8543, Japan; Department of Palliative Care Team and Palliative and Supportive Care(H.O.), National Hospital Organization Kyushu Cancer Center, Mitami-ku, Fukuoka 811-1395, Japan.
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division(N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka 433-8558, Japan
| | - Kengo Imai
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Saori Toyota
- Paramount Bed Sleep Research Laboratory(S.T., T.K.), PARAMOUNT BED CO., Tokyo 136-8670, Japan
| | - Toshihiro Yamauchi
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Satoru Miwa
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Misuzu Yuasa
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Soichiro Okamoto
- Uguisu home clinic(S.O.), Hamamatsu City, Shizuoka Prefecture 430-0856
| | - Takamasa Kogure
- Paramount Bed Sleep Research Laboratory(S.T., T.K.), PARAMOUNT BED CO., Tokyo 136-8670, Japan
| | - Satoshi Inoue
- Clinical Laboratory Department(S.I.), Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka 433-8558, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division(N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka 433-8558, Japan; Research Association for Community Health(T.M.), Hamamatsu city, Shizuoka 434-0046, Japan
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Beurton A, Kooistra EJ, De Jong A, Schiffl H, Jourdain M, Garcia B, Vimpère D, Jaber S, Pickkers P, Papazian L. Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review. Curr Obes Rep 2024; 13:545-563. [PMID: 38573465 DOI: 10.1007/s13679-024-00562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear. RECENT FINDINGS The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.
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Affiliation(s)
- Alexandra Beurton
- Department of Intensive Care, Hôpital Tenon, APHP, Paris, France.
- UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.
| | - Emma J Kooistra
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Helmut Schiffl
- Division of Nephrology, Department of Internal Medicine IV, University Hospital LMU Munich, Munich, Germany
| | - Mercedes Jourdain
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Bruno Garcia
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Damien Vimpère
- Anesthesia and Critical Care Department, Hôpital Necker, APHP, Paris, France
| | - Samir Jaber
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Laurent Papazian
- Intensive Care Unit, Centre Hospitalier de Bastia, Bastia, Corsica, France
- Aix-Marseille University, Marseille, France
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Sanchez-Pinto LN, Del Pilar Arias López M, Scott H, Gibbons K, Moor M, Watson RS, Wiens MO, Schlapbach LJ, Bennett TD. Digital solutions in paediatric sepsis: current state, challenges, and opportunities to improve care around the world. Lancet Digit Health 2024; 6:e651-e661. [PMID: 39138095 DOI: 10.1016/s2589-7500(24)00141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/17/2024] [Accepted: 06/14/2024] [Indexed: 08/15/2024]
Abstract
The digitisation of health care is offering the promise of transforming the management of paediatric sepsis, which is a major source of morbidity and mortality in children worldwide. Digital technology is already making an impact in paediatric sepsis, but is almost exclusively benefiting patients in high-resource health-care settings. However, digital tools can be highly scalable and cost-effective, and-with the right planning-have the potential to reduce global health disparities. Novel digital solutions, from wearable devices and mobile apps, to electronic health record-embedded decision support tools, have an unprecedented opportunity to transform paediatric sepsis research and care. In this Series paper, we describe the current state of digital solutions in paediatric sepsis around the world, the advances in digital technology that are enabling the development of novel applications, and the potential effect of advances in artificial intelligence in paediatric sepsis research and clinical care.
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Affiliation(s)
- L Nelson Sanchez-Pinto
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | | | - Halden Scott
- Department of Pediatrics, University of Colorado-Denver and Children's Hospital Colorado, Aurora, CO, USA
| | - Kristen Gibbons
- Children's Intensive Care Research Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Moor
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - R Scott Watson
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Matthew O Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; World Alliance for Lung and Intensive Care Medicine in Uganda, Kampala, Uganda
| | - Luregn J Schlapbach
- Children's Intensive Care Research Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia; Department of Intensive Care and Neonatology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tellen D Bennett
- Department of Pediatrics, University of Colorado-Denver and Children's Hospital Colorado, Aurora, CO, USA
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Erbay Dalli Ö, Akça Doğan D, Bayram R, Pehlivan S, Yildiz H. Practices of the ABCDEF care bundle in intensive care units as reported by nurses: A cross-sectional study from Turkey. Nurs Crit Care 2024; 29:974-986. [PMID: 37581265 DOI: 10.1111/nicc.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Recent critical care guidelines recommended the evidence-based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs. AIM To assess the current practices of the ABCDEF care bundle as reported by ICU nurses. STUDY DESIGN A cross-sectional study using a web-based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members. RESULTS A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non-ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits. CONCLUSIONS While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation. RELEVANCE TO CLINICAL PRACTICE Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs.
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Affiliation(s)
- Öznur Erbay Dalli
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Derya Akça Doğan
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Rıdvan Bayram
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Seda Pehlivan
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Hicran Yildiz
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
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Madhok J, O'Donnell C, Jin J, Owyang CG, Weimer JM, Pashun RA, Shudo Y, McNulty J, Chadwick B, Ruoss SJ, Rao VK, Zehnder JL, Hsu JL. Impact of C-reactive Protein on Anticoagulation Monitoring in Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2024; 38:1885-1896. [PMID: 38960805 DOI: 10.1053/j.jvca.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To evaluate the impact of inflammation on anticoagulation monitoring for patients supported with extracorporeal membrane oxygenation (ECMO). DESIGN Prospective single-center cohort study. SETTING University-affiliated tertiary care academic medical center. PARTICIPANTS Adult venovenous and venoarterial ECMO patients anticoagulated with heparin/ MEASUREMENTS AND MAIN RESULTS: C-Reactive protein (CRP) was used as a surrogate for overall inflammation. The relationship between CRP and the partial thromboplastin time (PTT, seconds) was evaluated using a CRP-insensitive PTT assay (PTT-CRP) in addition to measurement using a routine PTT assay. Data from 30 patients anticoagulated with heparin over 371 ECMO days was included. CRP levels (mg/dL) were significantly elevated (median, 17.2; interquartile range [IQR], 9.2-26.1) and 93% of patients had a CRP of ≥5. The median PTT (median 58.9; IQR, 46.9-73.3) was prolonged by 11.3 seconds compared with simultaneously measured PTT-CRP (median, 47.6; IQR, 40.1-55.5; p < 0.001). The difference between PTT and PTT-CRP generally increased with CRP elevation from 2.7 for a CRP of <5.0 to 13.0 for a CRP between 5 and 10, 17.7 for a CRP between 10 and 15, and 15.1 for a CRP of >15 (p < 0.001). In a subgroup of patients, heparin was transitioned to argatroban, and a similar effect was observed (median PTT, 62.1 seconds [IQR, 53.0-78.5 seconds] vs median PTT-CRP, 47.6 seconds [IQR, 41.3-57.7 seconds]; p < 0.001). CONCLUSIONS Elevations in CRP are common during ECMO and can falsely prolong PTT measured by commonly used assays. The discrepancy due to CRP-interference is important clinically given narrow PTT targets and may contribute to hematological complications.
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Affiliation(s)
- Jai Madhok
- Department of Anesthesiology, Perioperative, and Pain Medicine. Division of Adult Cardiothoracic Anesthesiology, Stanford University School of Medicine, Stanford, CA.
| | - Christian O'Donnell
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jing Jin
- Stanford Special Coagulation Laboratory, Stanford Health Care, Stanford, CA
| | - Clark G Owyang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Jonathan M Weimer
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Raymond A Pashun
- Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, New York, NY
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA
| | - John McNulty
- Cardiovascular Perfusion, Stanford Health Care, Stanford, CA
| | - Blaine Chadwick
- Cardiovascular Perfusion, Stanford Health Care, Stanford, CA
| | - Stephen J Ruoss
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative, and Pain Medicine. Division of Adult Cardiothoracic Anesthesiology, Stanford University School of Medicine, Stanford, CA
| | - James L Zehnder
- Department of Pathology and Laboratory Medicine, Stanford University School of Medicine, Stanford, CA
| | - Joe L Hsu
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
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Galli F, Bartolini D, Ronco C. Oxidative stress, defective proteostasis and immunometabolic complications in critically ill patients. Eur J Clin Invest 2024; 54:e14229. [PMID: 38676423 DOI: 10.1111/eci.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/31/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Oxidative stress (OS) develops in critically ill patients as a metabolic consequence of the immunoinflammatory and degenerative processes of the tissues. These induce increased and/or dysregulated fluxes of reactive species enhancing their pro-oxidant activity and toxicity. At the same time, OS sustains its own inflammatory and immunometabolic pathogenesis, leading to a pervasive and vitious cycle of events that contribute to defective immunity, organ dysfunction and poor prognosis. Protein damage is a key player of these OS effects; it generates increased levels of protein oxidation products and misfolded proteins in both the cellular and extracellular environment, and contributes to forms DAMPs and other proteinaceous material to be removed by endocytosis and proteostasis processes of different cell types, as endothelial cells, tissue resident monocytes-macrophages and peripheral immune cells. An excess of OS and protein damage in critical illness can overwhelm such cellular processes ultimately interfering with systemic proteostasis, and consequently with innate immunity and cell death pathways of the tissues thus sustaining organ dysfunction mechanisms. Extracorporeal therapies based on biocompatible/bioactive membranes and new adsorption techniques may hold some potential in reducing the impact of OS on the defective proteostasis of patients with critical illness. These can help neutralizing reactive and toxic species, also removing solutes in a wide spectrum of molecular weights thus improving proteostasis and its immunometabolic corelates. Pharmacological therapy is also moving steps forward which could help to enhance the efficacy of extracorporeal treatments. This narrative review article explores the aspects behind the origin and pathogenic role of OS in intensive care and critically ill patients, with a focus on protein damage as a cause of impaired systemic proteostasis and immune dysfunction in critical illness.
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Affiliation(s)
- Francesco Galli
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Desirée Bartolini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Claudio Ronco
- Department of Medicine, International Renal Research Institute of Vicenza, University of Padova, San Bortolo Hospital Vicenza, Vicenza, Italy
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Haeberer M, Mengel M, Fan R, Toquero-Asensio M, Martin-Toribio A, Liu Q, He Y, Uppal S, Rojo-Rello S, Domínguez-Gil M, Hernán-García C, Fernández-Espinilla V, Liang C, Begier E, Castrodeza Sanz J, Eiros JM, Sanz-Muñoz I. RSV Risk Profile in Hospitalized Adults and Comparison with Influenza and COVID-19 Controls in Valladolid, Spain, 2010-2022. Infect Dis Ther 2024; 13:1983-1999. [PMID: 39033476 PMCID: PMC11343947 DOI: 10.1007/s40121-024-01021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION We aimed to describe the risk profile of respiratory syncytial virus (RSV) infections among adults ≥ 60 years in Valladolid from January 2010 to August 2022, and to compare them with influenza and COVID-19 controls. METHODS This was a retrospective cohort study of all laboratory-confirmed RSV infections identified in centralized microbiology database during a 12-year period. We analyzed risk factors for RSV hospitalization and severity (length of stay, intensive care unit admission, in-hospital death or readmission < 30 days) and compared severity between RSV patients vs. influenza and COVID-19 controls using multivariable logistic regression models. RESULTS We included 706 RSV patients (635 inpatients and 71 outpatients), and 598 influenza and 60 COVID-19 hospitalized controls with comparable sociodemographic profile. Among RSV patients, 96 (15%) had a subtype identified: 56% A, 42% B, and 2% A + B. Eighty-one percent of RSV patients had cardiovascular conditions, 65% endocrine/metabolic, 46% chronic lung, and 43% immunocompromising conditions. Thirty-six percent were coinfected (vs. 21% influenza and 20% COVID-19; p = < .0001 and 0.01). Ninety-two percent had signs of lower respiratory infection (vs. 85% influenza and 72% COVID-19, p = < .0001) and 27% cardiovascular signs (vs. 20% influenza and 8% COVID-19, p = 0.0031 and 0.0009). Laboratory parameters of anemia, inflammation, and hypoxemia were highest in RSV. Among RSV, being a previous smoker (adjusted OR 2.81 [95% CI 1.01, 7.82]), coinfection (4.34 [2.02, 9.34]), and having cardiovascular (3.79 [2.17, 6.62]), neurologic (2.20 [1.09, 4.46]), or chronic lung (1.93 [1.11, 3.38]) diseases were risks for hospitalization. Being resident in care institutions (1.68 [1.09, 2.61]) or having a coinfection (1.91[1.36, 2.69]) were risks for higher severity, while RSV subtype was not associated with severity. Whereas RSV and influenza patients did not show differences in severity, RSV patients had 68% (38-84%) lower odds of experiencing any severe outcome compared to COVID-19. CONCLUSIONS RSV especially affects those with comorbidities, coinfections, and living in care institutions. RSV vaccination could have an important public health impact in this population.
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Affiliation(s)
- Mariana Haeberer
- Pfizer SLU, Av Europa 20B, 28108, Madrid, Spain.
- Pfizer Inc, Collegeville, USA.
| | | | | | - Marina Toquero-Asensio
- National Influenza Centre, Valladolid, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León, ICSCYL, Soria, Spain
| | | | | | | | | | - Silvia Rojo-Rello
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Domínguez-Gil
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina Hernán-García
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Javier Castrodeza Sanz
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José M Eiros
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ivan Sanz-Muñoz
- Instituto de Estudios de Ciencias de la Salud de Castilla y León, ICSCYL, Soria, Spain
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Gesser AF, Campos ML, Artismo RS, Karloh M, Matte DL. Impact of COVID-19 critical illness on functional status, fatigue symptoms, and health-related quality of life one-year after hospital discharge: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:4086-4097. [PMID: 37818936 DOI: 10.1080/09638288.2023.2266365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To estimate the prevalence and severity of impairments in functional status, fatigue, and health-related quality of life (HRQoL) among critical COVID-19 survivors one-year after hospital discharge. METHODS A systematic review was conducted following PRISMA statement and registered in PROSPERO (CRD42021258356), with searches in eight databases. Observational studies were selected. The prevalence meta-analysis of abnormalities was performed using random-effects models. Risk of bias was evaluated using the National Heart, Lung, and Blood Institute tool. RESULTS Twenty studies were included, with data collected between 12 and 13.5 months after hospital discharge and a total of 1828 participants. Of these, 71% were men, and 77.7% were intubated in the intensive care unit (ICU). Impairments and sequelae were identified in varying prevalence and degrees, with greater impact on functional capacity and physical components of fatigue and HRQoL. The prevalence of abnormalities of 32.3% [95% CI 23.9; 41.9] found in the meta-analysis is substantially high. Most studies were classified as having fair and poor quality. CONCLUSION Critical COVID-19 survivors experience impairments in functional status, fatigue, and HRQoL to varying degrees one-year after hospital discharge, particularly among patients who stayed in the ICU and on MV for a prolonged period.
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Affiliation(s)
- Ana Flávia Gesser
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Mariana Lanzoni Campos
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Regiana Santos Artismo
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Manuela Karloh
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Darlan Laurício Matte
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
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Zhong Z, Wang X, Guo J, Li X, Han Y. Comparison of Clinical Characteristics and Outcomes in Intensive Care Units Between Patients with Coronavirus Disease 2019 (COVID-19) and Patients with Influenza: A Systematic Review and Meta-Analysis. J Intensive Care Med 2024; 39:840-852. [PMID: 38404127 DOI: 10.1177/08850666241232888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Severe infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or influenza virus can cause patients to be admitted to intensive care units (ICUs). It is necessary to understand the differences in clinical characteristics and outcomes between these two types of critically ill patients. METHODS We searched Embase, PubMed, and Web of Science for articles and performed a meta-analysis using Stata 14.0 with a random-effects model. This paper was written in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Thirty-five articles involving 131,692 ICU patients with coronavirus disease 2019 (COVID-19) and 30,286 ICU patients with influenza were included in our meta-analysis. Compared with influenza patients, COVID-19 patients were more likely to be male (odds ratio (OR) = 1.75, 95% CI: 1.54-1.99) and older (standardized mean difference (SMD) = 0.16, 95% CI: 0.03-0.29). In terms of laboratory test results, COVID-19 patients had higher lymphocyte (SMD = 0.38, 95% CI: 0.17-0.59) and platelet counts (SMD = 0.52, 95% CI: 0.29-0.75) but lower creatinine (SMD = -0.29, 95% CI: -0.55-0.03) and procalcitonin levels (SMD = -0.78, 95% CI: -1.11-0.46). Diabetes (SMD = 1.27, 95% CI: 1.08-1.48) and hypertension (SMD = 1.30, 95% CI: 1.05-1.60) were more prevalent in COVID-19 patients, while influenza patients were more likely to have cancer (OR = 0.52, 95% CI: 0.44-0.62), cirrhosis (OR = 0.52, 95% CI: 0.44-0.62), immunodepression (OR = 0.38, 95% CI: 0.25-0.58), and chronic pulmonary diseases (OR = 0.35, 95% CI: 0.24-0.52). We also found that patients with COVID-19 had longer ICU stays (SMD = 0.20, 95% CI: 0.05-0.34), were more likely to develop acute respiratory distress syndrome (OR = 4.90, 95% CI: 2.77-8.64), and had higher mortality (OR = 1.35, 95% CI: 1.17-1.55). CONCLUSIONS There are some differences in the basic characteristics, comorbidities, laboratory test results and complications between ICU patients with COVID-19 and ICU patients with influenza. Critically ill patients with COVID-19 often require more medical resources and have worse clinical outcomes. PROSPERO Registration Number: CRD42023452238.
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Affiliation(s)
- Zhuan Zhong
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Xin Wang
- Infection Management Department of Hospital, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Jia Guo
- Department of Respiratory, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Xingzhao Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Yingying Han
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130000, China
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Luckner KM, Seckel MA. Understanding the Evolving Pathophysiology of Coronavirus Disease 2019 and Adult Nursing Management. Crit Care Nurs Clin North Am 2024; 36:295-321. [PMID: 39069352 DOI: 10.1016/j.cnc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Coronavirus disease 2019 (COVID-19) was first identified in December 2019 and quickly became a global pandemic. The understanding of the pathophysiology, treatment, and management of the disease has evolved since the beginning of the pandemic in 2020. COVID-19 can be complicated by immune system dysfunction, lung injury with hypoxemia, acute kidney injury, and coagulopathy. The treatment and management of COVID-19 is based on the severity of illness, ranging from asymptomatic to severe and often life-threatening disease. The 3 main recommended medication classes include antivirals, immunomodulators, and anticoagulants. Other supportive therapies include ensuring adequate oxygenation, mechanical ventilation, and prone positioning.
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Alrawashdeh M, Klompas M, Rhee C. The Impact of Common Variations in Sequential Organ Failure Assessment Score Calculation on Sepsis Measurement Using Sepsis-3 Criteria: A Retrospective Analysis Using Electronic Health Record Data. Crit Care Med 2024; 52:1380-1390. [PMID: 38780372 DOI: 10.1097/ccm.0000000000006338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To assess the impact of different methods of calculating Sequential Organ Failure Assessment (SOFA) scores using electronic health record data on the incidence, outcomes, agreement, and predictive validity of Sepsis-3 criteria. DESIGN Retrospective observational study. SETTING Five Massachusetts hospitals. PATIENTS Hospitalized adults, 2015 to 2022. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We defined sepsis as a suspected infection (culture obtained and antibiotic administered) with a concurrent increase in SOFA score by greater than or equal to 2 points (Sepsis-3 criteria). Our reference SOFA implementation strategy imputed normal values for missing data, used Pa o2 /F io2 ratios for respiratory scores, and assumed normal baseline SOFA scores for community-onset sepsis. We then implemented SOFA scores using different missing data imputation strategies (averaging worst values from preceding and following days vs. carrying forward nonmissing values), imputing respiratory scores using Sp o2 /F io2 ratios, and incorporating comorbidities and prehospital laboratory data into baseline SOFA scores. Among 1,064,459 hospitalizations, 297,512 (27.9%) had suspected infection and 141,052 (13.3%) had sepsis with an in-hospital mortality rate of 10.3% using the reference SOFA method. The percentage of patients missing SOFA components for at least 1 day in the infection window was highest for Pa o2 /F io2 ratios (98.6%), followed by Sp o2 /F io2 ratios (73.5%), bilirubin (68.5%), and Glasgow Coma Scale scores (57.2%). Different missing data imputation strategies yielded near-perfect agreement in identifying sepsis (kappa 0.99). However, using Sp o2 /F io2 imputations yielded higher sepsis incidence (18.3%), lower mortality (8.1%), and slightly lower predictive validity for mortality (area under the receiver operating curves [AUROC] 0.76 vs. 0.78). For community-onset sepsis, incorporating comorbidities and historical laboratory data into baseline SOFA score estimates yielded lower sepsis incidence (6.9% vs. 11.6%), higher mortality (13.4% vs. 9.6%), and higher predictive validity (AUROC 0.79 vs. 0.75) relative to the reference SOFA implementation. CONCLUSIONS Common variations in calculating respiratory and baseline SOFA scores, but not in handling missing data, lead to substantial differences in observed incidence, mortality, agreement, and predictive validity of Sepsis-3 criteria.
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Affiliation(s)
- Mohammad Alrawashdeh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Sürmeli M, Boy Y, Pazarli AC. Postintensive care syndrome: Development and psychometric validation of a knowledge test. J Eval Clin Pract 2024; 30:1059-1065. [PMID: 38798159 DOI: 10.1111/jep.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/27/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Postintensive care syndrome (PICS) is a combination of short-, medium- and long-term morbidities that occur in patients discharged from the Intensive care unit (ICU). ICU professionals have a crucial role in managing and understanding the PICS. This study aimed to develop the PICS Knowledge Test (PICS-KT), which measures ICU professionals' awareness and knowledge levels regarding PICS, and to determine its validity and reliability. METHODS The databases were searched in detail, scientific research related to PICS was analyzed, and the draft scale was created accordingly. A total of 117 doctors and nurses who had been working in the ICU for at least 6 months were included in the study. For the validity and reliability analysis of the test, content validity ratio, item difficulty index, item discrimination index values and Cronbach α were examined. RESULTS The Cronbach's α reliability coefficient for the 46-item PICS-KT is 0.93, indicating high reliability. Scores range from 0 to 46, with 32 or higher considered successful, suggesting adequate knowledge of PICS among ICU professionals. Scores of 14 or less indicate minimal knowledge. Those with scores between 14 and 32 possess some knowledge but need improvement. PICS-KT assesses knowledge in four main areas: general information, risk factors/causes, symptoms and findings and interventions. ICU professionals show high awareness of interventions for preventing and treating PICS, as indicated by a high mean score in the interventions subdimension. CONCLUSION The PICS-KT is crucial in assessing healthcare professionals' understanding of the various short-, medium- and long-term morbidities associated with PICS. The study ensures that the test is a robust and dependable instrument for evaluating ICU professionals' knowledge about PICS.
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Affiliation(s)
- Mahmut Sürmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Yasemin Boy
- Department of Nursing, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Ahmet Cemal Pazarli
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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Padmanabhan P, Roberts LH, Chancellor MB, Peters KM, Zwaans BMM. Prospective follow-up of overactive bladder symptoms in patients with prior SARS-CoV-2 infection. Neurourol Urodyn 2024; 43:1514-1522. [PMID: 38828830 DOI: 10.1002/nau.25509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE SARS-CoV-2 infection can result in genitourinary symptoms, such as frequency, urgency, nocturia, and pain/pressure. In this study, we followed the progression of overactive bladder (OAB) symptoms in patients that reported new or worsening OAB symptoms after coronavirus disease-19 (COVID-19) diagnosis. MATERIALS AND METHODS Individuals from a COVID-19 serology study were invited to participate in a follow-up study. Respondents were divided into three groups based on prior COVID-19 testing. Patients scored symptoms retrospectively before the pandemic, at study onset, and prospectively during 12-month follow-up. Genitourinary symptoms were assessed using international consultation on incontinence questionaire for OAB (ICIQ-OAB). Change in ICIQ-OAB scores from baseline were calculated. The minimal important difference of one on ICIQ-OAB is considered a significant change. RESULTS 26.0% of participants previously had positive COVID polymerase chain reaction (PCR) test (PCR+), 5.6% a positive serology test only (Ser+), and 65.5% were COVID naïve (COVID-). 23.8% of participants reported a significant increase in ICIQ-OAB score at study onset compared to prepandemic. ICIQ-OAB scores were similar at prepandemic but significantly higher at study start (p < 0.001) in PCR+ group. During follow-up, change in ICIQ-OAB scores from baseline remained unchanged for COVID- group, but gradually reduced for PCR+, reaching similar levels as COVID- group by 12 months. By 12 months, 71.4% of PCR+, 42.9% of Ser+, and 68.8% of COVID- participants still reported significant increase in ICIQ-OAB scores. CONCLUSIONS Most COVID-19 patients experienced return of symptoms to baseline, indicative of the potential resolution of COVID-associated cystitis. A subset of cases did not, raising questions about the underlying factors contributing to this outcome. Additional research is needed to assess long COVID on urological health.
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Affiliation(s)
- Priya Padmanabhan
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Ly Hoang Roberts
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Chancellor
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kenneth M Peters
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Bernadette M M Zwaans
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Esteves AM, Buchfellner MC, Holmes BM, Berndsen JA, Roginski MA. Impact of a Divided Phenobarbital Load and Taper Compared With Lorazepam Symptom Triggered Therapy in Hospitalized Patients. Ann Pharmacother 2024; 58:896-905. [PMID: 38258797 DOI: 10.1177/10600280231222294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Benzodiazepines are the preferred treatment for alcohol withdrawal. Phenobarbital is an alternative in the setting of prescriber expertise or benzodiazepine contraindication. OBJECTIVE To evaluate the efficacy and safety of a phenobarbital dosing strategy aimed at treating a spectrum of alcohol withdrawal symptoms across various patient populations. METHODS Retrospective review of patients admitted with concerns of alcohol withdrawal between May 2018 and November 2022. Patients were separated into a before-after cohort of lorazepam or phenobarbital. The primary outcome was hospital length of stay (LOS). Secondary outcomes were intensive care unit (ICU) LOS, escalation of respiratory support, increased level of care (LOC), and incidence of delirium tremens and/or seizures. RESULTS Two hundred and seventy-seven patients received lorazepam and 198 received phenobarbital. Hospital LOS was longer in the phenobarbital cohort compared with the lorazepam cohort (6.9 vs 9.3 days). There was no difference in ICU LOS. Level of care increases were fewer in the phenobarbital cohort (4 events vs 19 events). There were higher rates of non-invasive respiratory interventions in the lorazepam cohort and higher rates of mechanical ventilation in the phenobarbital cohort. Utilization of phenobarbital was attributed to a reduction in delirium tremens and seizures. CONCLUSION AND RELEVANCE This study is novel because of the broad application of a phenobarbital order set across multiple levels of care and patient admission diagnoses. A risk targeted split load intravenous phenobarbital order set can safely be administered to patients with fewer escalations of care, seizures, delirium tremens, and respiratory care escalation.
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Affiliation(s)
- Alyson M Esteves
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Matthew C Buchfellner
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Brooke M Holmes
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Joseph A Berndsen
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Matthew A Roginski
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
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Nasser A, de Zwart BJ, Stewart DJ, Zielke AM, Blazek K, Heywood AE, Craig AT. Risk factors predicting the need for intensive care unit admission within forty-eight hours of emergency department presentation: A case-control study. Aust Crit Care 2024; 37:686-693. [PMID: 38584063 DOI: 10.1016/j.aucc.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Patients admitted from the emergency department to the wards, who progress to a critically unwell state, may require expeditious admission to the intensive care unit. It can be argued that earlier recognition of such patients, to facilitate prompt transfer to intensive care, could be linked to more favourable clinical outcomes. Nevertheless, this can be clinically challenging, and there are currently no established evidence-based methods for predicting the need for intensive care in the future. OBJECTIVES We aimed to analyse the emergency department data to describe the characteristics of patients who required an intensive care admission within 48 h of presentation. Secondly, we planned to test the feasibility of using this data to identify the associated risk factors for developing a predictive model. METHODS We designed a retrospective case-control study. Cases were patients admitted to intensive care within 48 h of their emergency department presentation. Controls were patients who did not need an intensive care admission. Groups were matched based on age, gender, admission calendar month, and diagnosis. To identify the associated variables, we used a conditional logistic regression model. RESULTS Compared to controls, cases were more likely to be obese, and smokers and had a higher prevalence of cardiovascular (39 [35.1%] vs 20 [18%], p = 0.004) and respiratory diagnoses (45 [40.5%] vs 25 [22.5%], p = 0.004). They received more medical emergency team reviews (53 [47.8%] vs 24 [21.6%], p < 0.001), and more patients had an acute resuscitation plan (31 [27.9%] vs 15 [13.5%], p = 0.008). The predictive model showed that having acute resuscitation plans, cardiovascular and respiratory diagnoses, and receiving medical emergency team reviews were strongly associated with having an intensive care admission within 48 h of presentation. CONCLUSIONS Our study used emergency department data to provide a detailed description of patients who had an intensive care unit admission within 48 h of their presentation. It demonstrated the feasibility of using such data to identify the associated risk factors to develop a predictive model.
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Affiliation(s)
- Ahmad Nasser
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - Blake J de Zwart
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - David J Stewart
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia; School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
| | - Anne M Zielke
- Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Katrina Blazek
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Adam T Craig
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
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Ushio N, Yamakawa K, Mochizuki K, Hisamune R, Umemura Y, Takasu A. Efficacy of unfractionated heparin in patients with moderate sepsis-induced coagulopathy: An observational study. Thromb Res 2024; 241:109095. [PMID: 39024902 DOI: 10.1016/j.thromres.2024.109095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/22/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION The 2021 Surviving Sepsis Campaign guidelines recommend low-molecular-weight heparin for the prevention of venous thromboembolism in sepsis. However, observational studies suggest that anticoagulants as a whole may benefit severely ill sepsis patients with coagulopathy, but the optimal targets of unfractionated heparin remain unclear. This study investigated which sepsis patients could most benefit from unfractionated heparin. MATERIALS AND METHODS In this retrospective observational study, we identified adult sepsis patients requiring urgent hospitalization from 2006 to 2019 using a large-scale Japanese medical database. Patients were divided into two groups: those receiving unfractionated heparin within 72 h of admission and those who did not. We compared in-hospital mortality, major bleeding complications, and thromboembolic events between these groups using a multivariate logistic regression model adjusted for patient and treatment variables. Additionally, we assessed the association between heparin administration and in-hospital mortality across various subgroups. RESULTS Among 30,342 sepsis patients, 2520 received early heparin administration, and 27,822 did not. Multivariate logistic regression revealed a significant association between heparin and reduced in-hospital mortality (adjusted OR: 0.735, 95 % CI: 0.596-0.903) but no significant association with major bleeding and thromboembolic risk (adjusted OR: 1.137, 1.243; 95 % CI: 0.926-1.391, 0.853-1.788, respectively). Subgroup analyses suggested significant survival benefits associated with heparin only in the sepsis patients with moderate coagulopathy and sepsis-induced coagulopathy scores of 3 or 4 (adjusted OR: 0.452, 0.625; 95 % CI: 0.265-0.751, 0.410-0.940, respectively). CONCLUSIONS Early heparin administration upon admission is associated with lower in-hospital mortality, especially in moderate sepsis-induced coagulopathy, and no significant increase in complications.
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Affiliation(s)
- Noritaka Ushio
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Ryo Hisamune
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
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Peng K, Hu L, Huang X, He Y, Wu X, Li H, Zhang W, Zhu H, Wang Z, Chen C. Innovative Percutaneous 3-Stitch Suture Technique for Site Closure in Venoarterial Extracorporeal Membrane Oxygenation Decannulation Without Direct Artery Repair: A Case Series. ASAIO J 2024; 70:787-794. [PMID: 38587868 PMCID: PMC11356694 DOI: 10.1097/mat.0000000000002198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
No previous studies have reported the use of a percutaneous suture technique performed by bedside intensivists for site closure during decannulation without direct artery repair in venoarterial extracorporeal membrane oxygenation (VA-ECMO) cases. Thus, the objective of this study was to evaluate the safety and effectiveness of this alternative approach. This retrospective study included 26 consecutive patients who underwent percutaneous VA-ECMO decannulation at Maoming People's Hospital. Bedside percutaneous suture technique performed by intensivists facilitated cannula site closure. Primary outcome was successful closure without additional interventions. Secondary outcomes included procedural time, surgical conversion rate, complications (bleeding, vascular/wound complications, neuropathy, lymphocele), procedure-related death. Follow-up ultrasound were conducted within 6 months after discharge. All patients achieved successful site hemostasis with a median procedural time of 28 minutes. Procedure-related complications included minor bleeding (7.7%), acute lower limb ischemia (15.4%), venous thrombus (11.5%), minor arterial stenosis (7.7%), wound infection (4.2%), delayed healing (15.4%), and wound secondary suturing (6.3%). No procedure-related deaths occurred. Follow-up vascular ultrasound revealed two cases (7.7%) of minor arterial stenosis. The perivascular suture technique may offer intensivists a safe and effective alternative method for access site closure without direct artery suture during ECMO decannulation.
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Affiliation(s)
- Kaiyi Peng
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Linhui Hu
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
- The Center of Scientific Research, Maoming People’s Hospital, Maoming, China
| | - Xiangwei Huang
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Yuemei He
- The Center of Scientific Research, Maoming People’s Hospital, Maoming, China
| | - Xinxin Wu
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Huihua Li
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Wentao Zhang
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Hengling Zhu
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Zheng Wang
- From the Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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Raavi L, Isha S, Jonna S, Craver EC, Nataraja H, Jenkins A, Hanson AJ, Venkataraman AB, Balasubramanian P, Tekin A, Bansal V, Caples SM, Khan SA, Jain NK, LaNou AT, Kashyap R, Cartin-Ceba R, Patel BM, Milian RD, Venegas CP, Shapiro AB, Bhattacharyya A, Chaudhary S, Kiley SP, Erben YM, Quinones QJ, Patel NM, Guru PK, Franco PM, Roy A, Sanghavi DK. Association of antibiotics with the outcomes in COVID-19 pneumonia patients with elevated PCT levels. Respir Med 2024; 231:107697. [PMID: 38857810 DOI: 10.1016/j.rmed.2024.107697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To assess antibiotics impact on outcomes in COVID-19 pneumonia patients with varying procalcitonin (PCT) levels. METHODS This retrospective cohort study included 3665 COVID-19 pneumonia patients hospitalized at five Mayo Clinic sites (March 2020 to June 2022). PCT levels were measured at admission. Patients' antibiotics use and outcomes were collected via the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Patients were stratified into high and low PCT groups based on the first available PCT result. The distinction between high and low PCT was demarcated at both 0.25 ng/ml and 0.50 ng/ml. RESULTS Our cohort consisted of 3665 patients admitted with COVID-19 pneumonia. The population was predominantly male, Caucasian and non-Hispanic. With the PCT cut-off of 0.25 ng/ml, 2375 (64.8 %) patients had a PCT level <0.25 ng/mL, and 1290 (35.2 %) had PCT ≥0.25 ng/ml. While when the PCT cut off of 0.50 ng/ml was used we observed 2934 (80.05 %) patients with a PCT <0.50 ng/ml while 731(19.94 %) patients had a PCT ≥0.50 ng/ml. Patients with higher PCT levels exhibited significantly higher rates of bacterial infections (0.25 ng/ml cut-off: 4.2 % vs 7.9 %; 0.50 ng/ml cut-off: 4.6 % vs 9.2 %). Antibiotics were used in 66.0 % of the cohort. Regardless of the PCT cutoffs, the antibiotics group showed increased hospital length of stay (LOS), intensive care unit (ICU) admission rate, and mortality. However, early de-escalation (<24 h) of antibiotics correlated with reduced hospital LOS, ICU LOS, and mortality. These results were consistent even after adjusting for confounders. CONCLUSION Our study shows a substantial number of COVID-19 pneumonia patients received antibiotics despite a low incidence of bacterial infections. Therefore, antibiotics use in COVID pneumonia patients with PCT <0.5 in the absence of clinical evidence of bacterial infection has no beneficial effect.
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Affiliation(s)
- Lekhya Raavi
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Shahin Isha
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Sadhana Jonna
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Emily C Craver
- Department of Quantitative Health Sciences, Mayo Clinic in Florida, USA
| | | | - Anna Jenkins
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Abby J Hanson
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | | | | | - Aysun Tekin
- Department of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vikas Bansal
- Department of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean M Caples
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System in Mankato, USA
| | - Nitesh K Jain
- Department of Critical Care Medicine, Mayo Clinic Health System in Mankato, USA
| | - Abigail T LaNou
- Emergency Medicine and Critical Care, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Rahul Kashyap
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic Rochester, Minnesota, USA
| | | | - Bhavesh M Patel
- Department of Critical Care Medicine, Mayo Clinic, Arizona, USA
| | | | - Carla P Venegas
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Anna B Shapiro
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | | | - Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Sean P Kiley
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Young M Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Neal M Patel
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic in Florida, USA
| | | | - Archana Roy
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Watson RS, Carrol ED, Carter MJ, Kissoon N, Ranjit S, Schlapbach LJ. The burden and contemporary epidemiology of sepsis in children. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:670-681. [PMID: 39142741 DOI: 10.1016/s2352-4642(24)00140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 08/16/2024]
Abstract
Sepsis is a dysregulated host response to infection that leads to life-threatening organ dysfunction. Half of the 50 million people affected by sepsis globally every year are neonates and children younger than 19 years. This burden on the paediatric population translates into a disproportionate impact on global child health in terms of years of life lost, morbidity, and lost opportunities for children to reach their developmental potential. This Series on paediatric sepsis presents the current state of diagnosis and treatment of sepsis in children, and maps the challenges in alleviating the burden on children, their families, and society. Drawing on diverse experience and multidisciplinary expertise, we offer a roadmap to improving outcomes for children with sepsis. This first paper of the Series is a narrative review of the burden of paediatric sepsis from low-income to high-income settings. Advances towards improved operationalisation of paediatric sepsis across all age groups have facilitated more standardised assessment of the Global Burden of Disease estimates of the impact of sepsis on child health, and these estimates are expected to gain further precision with the roll out of the new Phoenix criteria for sepsis. Sepsis remains one of the leading causes of childhood morbidity and mortality, with immense direct and indirect societal costs. Although substantial regional differences persist in relation to incidence, microbiological epidemiology, and outcomes, these cannot be explained by differences in income level alone. Recent insights into post-discharge sequelae after paediatric sepsis, ranging from late mortality and persistent neurodevelopmental impairment to reduced health-related quality of life, show how common post-sepsis syndrome is in children. Targeting sepsis as a key contributor to poor health outcomes in children is therefore an essential component of efforts to meet the Sustainable Development Goals.
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Affiliation(s)
- R Scott Watson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Enitan D Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Michael J Carter
- Centre for Human Genetics, University of Oxford, Oxford, UK; Paediatric Intensive Care unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Niranjan Kissoon
- Global Child Health Department of Pediatrics and Emergency Medicine, British Columbia Women and Children's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | | | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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Neeland IJ, Linge J, Birkenfeld AL. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obes Metab 2024; 26 Suppl 4:16-27. [PMID: 38937282 DOI: 10.1111/dom.15728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
Weight loss induced by glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucagon-like peptide-1 receptor (GLP-1R)/glucose-dependent insulinotropic polypeptide receptor agonists is coming closer to the magnitudes achieved with surgery. However, with greater weight loss there is concern about potential side effects on muscle quantity (mass), health and function. There is heterogeneity in the reported effects of GLP-1-based therapies on lean mass changes in clinical trials: in some studies, reductions in lean mass range between 40% and 60% as a proportion of total weight lost, while other studies show lean mass reductions of approximately 15% or less of total weight lost. There are several potential reasons underlying this heterogeneity, including population, drug-specific/molecular, and comorbidity effects. Furthermore, changes in lean mass may not always reflect changes in muscle mass as the former measure includes not only muscle but also organs, bone, fluids, and water in fat tissue. Based on contemporary evidence with the addition of magnetic resonance imaging-based studies, skeletal muscle changes with GLP-1RA treatments appear to be adaptive: reductions in muscle volume seem to be commensurate with what is expected given ageing, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function. Nevertheless, factors such as older age and severity of disease may influence the selection of appropriate candidates for these therapies due to risk of sarcopenia. To further improve muscle health during weight loss, several pharmacological treatments to maintain or improve muscle mass designed in combination with GLP-1-based therapies are under development. Future research on GLP-1-based and other therapies designed for weight loss should focus on more accurate and meaningful assessments of muscle mass, composition, as well as function, mobility or strength, to better define their impact on muscle health for the substantial number of patients who will likely be taking these medications well into the future.
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Affiliation(s)
- Ian J Neeland
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jennifer Linge
- AMRA Medical AB, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Diabetology, Endocrinology, and Nephrology, University Clinic Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Diabetes, Life Sciences & Medicine Cardiovascular Medicine & Sciences, Kings College London, London, UK
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