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Albulushi A, Tawfek A, Al Lawatia H. Evaluating the efficacy and safety of temporary mechanical circulatory support devices in acute cardiogenic shock: A subgroup-specific systematic review. Curr Probl Cardiol 2024; 49:102619. [PMID: 38723794 DOI: 10.1016/j.cpcardiol.2024.102619] [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: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This systematic review aims to assess the comparative effectiveness and safety of temporary mechanical circulatory support (MCS) devices in various subgroups of patients with acute cardiogenic shock, providing insights for personalized clinical decision-making. METHODS We conducted a comprehensive search across major databases to identify studies that reported on the use of temporary MCS devices like TandemHeart, Impella, and VA-ECMO in acute cardiogenic shock. Special attention was given to subgroup analyses based on etiologies of shock, patient demographics, and comorbid conditions. RESULTS Our analysis revealed that while devices like TandemHeart and Impella offer significant hemodynamic support, their effectiveness and safety profiles vary across different patient subgroups. VA-ECMO demonstrated the highest flow rates and potential for mortality benefits but requires careful management due to associated risks. The lack of randomized controlled trials in specific patient subgroups highlights a gap in the current literature, underscoring the need for targeted research. CONCLUSION The review underscores the necessity of a personalized approach in selecting temporary MCS devices for patients with acute cardiogenic shock, guided by specific patient characteristics and clinical scenarios. Future research should focus on addressing the identified evidence gaps through well-designed studies that provide robust subgroup-specific data, enabling clinicians to optimize treatment strategies and improve patient outcomes in this critical care context.
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Affiliation(s)
- Arif Albulushi
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
| | - Ahmed Tawfek
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Hatim Al Lawatia
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
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Tanaka K, Meguro A, Hara Y, Endo L, Izawa A, Muraoka S, Kaneko A, Somekawa K, Hirata M, Otsu Y, Matsumoto H, Nagasawa R, Kubo S, Murohashi K, Aoki A, Fujii H, Watanabe K, Horita N, Kato H, Kobayashi N, Takeuchi I, Nakajima A, Inoko H, Mizuki N, Kaneko T. HLA-DQA1*01:03 and DQB1*06:01 are risk factors for severe COVID-19 pneumonia. HLA 2024; 104:e15609. [PMID: 39041300 DOI: 10.1111/tan.15609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
The clinical spectrum of COVID-19 includes a wide range of manifestations, from mild symptoms to severe pneumonia. HLA system plays a pivotal role in immune responses to infectious diseases. The purpose of our study was to investigate the association between HLA and COVID-19 severity in a Japanese population. The study included 209 Japanese COVID-19 patients aged ≥20 years. Saliva samples were collected and used to determine the HLA genotype by HLA imputation through genome-wide association analyses. The association between HLA genotype and COVID-19 severity was then evaluated. The allele frequency was compared between patients with respiratory failure (severe group: 91 cases) and those without respiratory failure (non-severe group: 118 cases), categorising the data into three time periods: pre-Omicron epidemic period, Omicron epidemic period, and total period of this study (from January 2021 to May 2023). In comparing the severe and non-severe groups, the frequencies of the HLA-DQA1*01:03 (35.1% vs. 10.5%, odds ratio [OR] = 4.57, corrected p [pc] = 0.041) and -DQB1*06:01 (32.4% vs. 7.9%, OR = 5.54, pc = 0.030) alleles were significantly higher in the severe group during the pre-Omicron epidemic period. During the Omicron epidemic period, HLA-DQB1*06 (32.4% vs. 7.9%, OR = 5.54, pc = 0.030) was significantly higher in the severe group. During total period of this study, HLA-DQA1*01:03 (30.2% vs. 14.4%, OR = 2.57, corrected pc = 0.0013) and -DQB1*06:01 (44.5% vs. 26.7%, OR = 2.20, pc = 0.013) alleles were significantly higher in the severe group. HLA-DQB1*06:01 and -DQA1*01:03 were in strong linkage disequilibrium with each other (r2 = 0.91) during total period of this study, indicating that these two alleles form a haplotype. The frequency of the HLA-DQA1*01:03-DQB1*06:01 in the severe group was significantly higher than in the non-severe group during pre-Omicron epidemic period (32.4% vs. 7.9%, OR = 5.59, pc = 0.00072), and total period of this study (28.6% vs. 13.1%, OR = 2.63, pc = 0.0013). During Omicron epidemic period, the haplotype did not demonstrate statistical significance, although the odds ratio indicated a value greater 1. Frequencies of the HLA-DQA1*01:03 and -DQB1*06:01 alleles were significantly higher in severe COVID-19 patients, suggesting that these alleles are risk factors for severe COVID-19 pneumonia in the Japanese population.
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Affiliation(s)
- Katsushi Tanaka
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Lisa Endo
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ami Izawa
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Suguru Muraoka
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ayami Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kohei Somekawa
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Momo Hirata
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukiko Otsu
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromi Matsumoto
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryo Nagasawa
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sosuke Kubo
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kota Murohashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ayako Aoki
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroaki Fujii
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keisuke Watanabe
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Nobuaki Kobayashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hidetoshi Inoko
- Department of Molecular Life Science, Division of Basic Medical Science and Molecular Medicine, School of Medicine, Tokai University, Isehara, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Dweck B, Pane M, Nguyen V, Sharma S, Monhollen A, Malireddy S, Whiteley A. Clinical and economic implications of false-positive heparin-induced thrombocytopenia immunoassays: utility of the 4T score. Blood Coagul Fibrinolysis 2024; 35:265-270. [PMID: 38874904 DOI: 10.1097/mbc.0000000000001314] [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: 06/15/2024]
Abstract
Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition induced by platelet-activating IgG antibodies that recognize PF4/heparin complexes. Diagnosis of HIT relies on enzyme immunologic assays (EIAs) and functional assays [serotonin release assay (SRA)]. Our institution uses a latex immunoturbidimetric assay (LIA), which has shown a positive-predictive value (PPV) of 55.6%, and a negative-predictive value (NPV) of 99.7%. The low PPV of EIAs/LIAs, in combination with the clinical delay in obtaining results of a SRA, commonly leads to a false-positive diagnosis of HIT and inappropriate treatment. We performed a single-institution retrospective study at a large tertiary center to assess patient management decisions and economic costs following a false-positive HIT (LIA) test. This study found an 89.5% incidence of false-positive HIT (LIA) tests. 97.4% of patients underwent anticoagulation changes. 69.6% of patients were switched to argatroban. Of patients with a false-positive HIT immunoassay (LIA), 42 (40.7%) patients were on a prophylactic dose of anticoagulation at the time of HIT (LIA) positivity, of which 22 (52.4%) were switched to full anticoagulation with either argatroban or fondaparinux. Of the 22 patients switched to full anticoagulation, 15 (68%) had low-probability 4T scores. Seven (8.8%) of patients had bleeding events after HIT (LIA) positivity. All seven patients were switched to argatroban from a full-dose heparin anticoagulation. Five of the seven patients were considered major bleeds. Utilization of argatroban incurred substantial costs, estimated at approximately $73 000 for false-positive HIT cases. False-positive HIT (LIA) tests contribute to unwarranted anticoagulation changes, increased bleeding risks, and substantial healthcare costs. Incorporating the 4T score into diagnostic algorithms may help mitigate these risks by guiding appropriate clinical decisions. Future research should focus on refining diagnostic approaches and standardizing management strategies to improve patient outcomes and cost-effectiveness in HIT diagnosis and management.
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154
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Dettlaff K, Anglart G, Gruszczyńska A, Jelińska A. Compatibility studies of selected multichamber bag parenteral nutrition with fluconazole. Nutrition 2024; 123:112417. [PMID: 38593672 DOI: 10.1016/j.nut.2024.112417] [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: 01/18/2024] [Revised: 02/23/2024] [Accepted: 03/02/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Fluconazole (FLZ) is a drug widely used in the treatment of fungal infections including the treatment of immunocompromised patients, HIV-infected patients, and cancer patients. Critically ill patients often require the administration of drugs with parenteral nutrition (PN). The safety of this combination should be defined before the drug and PN are administered in one infusion line. This study aimed to determine the compatibility of FLZ with six selected multichamber bag parenteral nutrition. METHODS FLZ solution for infusion was combined with PNs in appropriate proportions, considering most clinical situations resulting from different possible administration rates of the preparations. Samples were visually assessed, and pH, osmolality, turbidity, particle size (dynamic light scattering and light obscuration methods), and zeta potential were measured. These measurements were made immediately after combining the solutions and after 4 h of storage at 23 ± 1°C. RESULTS FLZ combined with PNs did not cause changes observed visually. The turbidity of the samples was <0.4 NTU. The average particle size of the lipid emulsion was below 300 nm, and the PFAT5 parameter was ≤0.02%. The absolute value of the zeta potential of the PN + FLZ samples was higher for 5 out of 6 PN than the corresponding value for PN immediately after activation. Changes in pH and osmolality during 4 h of sample observations were within acceptable limits. CONCLUSION Compatibility of the FLZ with six multichamber bag PN was confirmed. Hence, those preparations can be administered to patients in one infusion line using the Y-site.
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Affiliation(s)
- Katarzyna Dettlaff
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, Poznań, Poland.
| | - Gabriela Anglart
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, Poznań, Poland
| | - Agnieszka Gruszczyńska
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, Poznań, Poland
| | - Anna Jelińska
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, Poznań, Poland
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155
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Tume LN, Simons C, Latten L, Huang C, Comfort P, Compton V, Wagh A, Veale A, Valla FV. Association between protein intake and muscle wasting in critically ill children: A prospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:615-623. [PMID: 38554130 DOI: 10.1002/jpen.2627] [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: 09/11/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Survival from pediatric critical illness in high-income countries is high, and the focus now must be on optimizing the recovery of survivors. Muscle mass wasting during critical illness is problematic, so identifying factors that may reduce this is important. Therefore, the aim of this study was to examine the relationship between quadricep muscle mass wasting (assessed by ultrasound), with protein and energy intake during and after pediatric critical illness. METHODS A prospective cohort study in a mixed cardiac and general pediatric intensive care unit in England, United Kingdom. Serial ultrasound measurements were undertaken at day 1, 3, 5, 7, and 10. RESULTS Thirty-four children (median age 6.65 [0.47-57.5] months) were included, and all showed a reduction in quadricep muscle thickness during critical care admission, with a mean muscle wasting of 7.75%. The 11 children followed-up had all recovered their baseline muscle thickness by 3 months after intensive care discharge. This muscle mass wasting was not related to protein (P = 0.53, ρ = 0.019) (95% CI: -0.011 to 0.049) or energy intake (P = 0.138, ρ = 0.375 95% CI: -0.144 to 0.732) by 72 h after admission, nor with severity of illness, highest C-reactive protein, or exposure to intravenous steroids. Children exposed to neuromuscular blocking drugs exhibited 7.2% (95% CI: -0.13% to 14.54%) worse muscle mass wasting, but this was not statistically significant (P = 0.063). CONCLUSION Our study did not find any association between protein or energy intake at 72 h and quadricep muscle mass wasting.
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Affiliation(s)
- Lyvonne N Tume
- Faculty of Health, Special Care & Medicine, Edge Hill University, Ormskirk, UK
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christopher Simons
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lynne Latten
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Chao Huang
- Institute for Clinical and Applied Health Research and Hull York Medical School, University of Hull, Hull, UK
| | - Paul Comfort
- Directorate of Psychology and Sport, University of Salford, Salford, Greater Manchester, UK
| | - Vanessa Compton
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anand Wagh
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Archie Veale
- Patient and Public Engagement Expert, Carlisle, UK
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156
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Barrera Sánchez M, Royo Villa C, Ruiz de Gopegui Miguelena P, Gutiérrez Ibañes P, Carrillo López A. Factors associated with vasoplegic shock in the postoperative period of cardiac surgery and influence on morbidity and mortality of the use of arginine vasopressin as rescue therapy. Med Intensiva 2024; 48:392-402. [PMID: 38697904 DOI: 10.1016/j.medine.2024.04.003] [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] [Received: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Analyzing associated factors with vasoplegic shock in the postoperative period of Cardiac Surgery. Analyzing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine. DESIGN Cohort, prospective and observational study. SETTING Main hospital Postoperative Cardiac ICU. PATIENTS Patients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022. INTERVENTIONS Record of presurgical, perioperative and ICU discharge clinical variables. MAIN VARIABLES OF INTEREST chronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality. RESULTS 773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse Euroscore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality. CONCLUSIONS Postcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with VSP is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.
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157
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Peñuelas O, Lomelí M, Del Campo-Albendea L, Toledo SI, Arellano A, Chavarría U, Marín MC, Rosas K, Galván Merlos MA, Mercado R, García-Lerma HR, Monares E, González D, Pérez J, Esteban-Fernández A, Muriel A, Frutos-Vivar F, Esteban A. Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico. Med Intensiva 2024; 48:377-385. [PMID: 38582715 DOI: 10.1016/j.medine.2024.03.002] [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: 10/29/2023] [Accepted: 02/19/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge. DESIGN An observational, prospective and multicenter, nation-wide study. SETTING Eight adult ICU across eight academic acute care hospitals in Mexico. PATIENTS All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty. RESULTS 196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40-9.81, P = .008). CONCLUSIONS Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.
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Affiliation(s)
- Oscar Peñuelas
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain.
| | | | - Laura Del Campo-Albendea
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | | | | | | | | | | | | | | | | | | | - Juan Pérez
- Hospital H+ Los Cabos, Baja California Sur, México
| | | | - Alfonso Muriel
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Fernando Frutos-Vivar
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
| | - Andrés Esteban
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
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158
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Argento F, Donato M, Villalba D, Sarubbio MG, Giménez A, Ciapponi A, Augustovski F. Mortalidad, Secuelas Clínicas y Calidad de Vida Luego del Alta de Unidades de Cuidados Intensivos en Pacientes con COVID-19: Estudio Multicéntrico Descriptivo en Argentina. Value Health Reg Issues 2024; 42:100989. [PMID: 38728912 DOI: 10.1016/j.vhri.2024.100989] [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: 06/27/2023] [Revised: 01/11/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Patients with COVID-19 who require hospitalization in an intensive care unit, in addition to being at risk of presenting premature death, have higher rates of complications. This study aimed to describe mortality, rehospitalizations, quality of life, and symptoms related to postintensive care syndrome (PICS) and prolonged COVID-19 in patients with COVID-19 discharged from the intensive care unit in hospitals in Argentina. METHODS A cross-sectional study was conducted in 4 centers in the Autonomous City and province of Buenos Aires as of December 2022. The variables of interest were mortality after discharge, rehospitalization, health-related quality of life, post-COVID-19-related symptoms, cognitive status, and PICS. Data collection was by telephone interview between 6 and 18 months after discharge. RESULTS A total of 124 patients/families were contacted. Mortality was 7.3% (95% CI: 3.87-13.22) at 14.46 months of follow-up after discharge. Patients reported a reduction of the EQ-5D-3L visual analog scale of 13.8 points, reaching a mean of 78.05 (95% CI: 73.7-82.4) at the time of the interview. Notably, 54.4% of patients (95% CI: 41.5-66.6) reported cognitive impairment and 66.7% (95% CI: 53.7-77.5) developed PICS, whereas 37.5% (95% CI: 26-50.9) had no symptoms of prolonged COVID-19. CONCLUSION The results showed a significant impact on the outcomes studied, consistent with international evidence.
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Affiliation(s)
| | - Manuel Donato
- Comisión Nacional de Evaluación de Tecnologías Sanitarias y Excelencia Clínica (CONETEC). Ministerio de Salud de la Nación Argentina
| | - Dario Villalba
- Hospital municipal "Santiago Fornos" de la ciudad de Chivilcoy
| | | | - Anabella Giménez
- Hospital General de Agudos "Dr. Juan A. Fernández" de la Ciudad Autónoma de Buenos Aires
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS); CIESP, CONICET
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159
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Mir-Tabar A, Pardo-Herrera L, Goñi-Blanco A, Martínez-Rodríguez MT, Goñi-Viguria R. Patient satisfaction with nursing care in an Intensive Care Unit measured through the Nursing Intensive-Care Satisfaction Scale (NICSS). ENFERMERIA INTENSIVA 2024; 35:201-212. [PMID: 38523052 DOI: 10.1016/j.enfie.2023.10.004] [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: 06/15/2023] [Accepted: 10/04/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patient satisfaction in relation with nursing care has become a key determinant of the quality of hospital care. OBJECTIVES To evaluate patient satisfaction in relation with nursing care in a critical care context; to determine the correlation between critical patient satisfaction and sociodemographic and clinical variables and to describe patient perceptions with nursing care. METHODS A descriptive, prospective, correlational study which includes the analysis of some open questions in the intensive care unit (ICU) of a tertiary level university hospital. The degree of satisfaction of all patients discharged from de ICU was evaluated. It was used the validated Spanish version of Nursing Intensive-Care Satisfaction-Scale (NICSS). There were also collected sociodemographic and clinical data and 3 open questions were asked. It was used the inferential and descriptive statistics considering statistically significant p<.05. Open questions were examined using a language context analysis. The approval of the hospital ethical committee was obtained. RESULTS 111 patients agreed to participate, with a mean age of 64.18 years (CI 95% 61.36-66.88) and with a medium level of satisfaction of 5.83 (CI 95% 5.78-5.88) being 6 the maximum score. Women, older patients and those who reflect a higher degree of recovery, are those who reported greater satisfaction. Three main themes emerged from the analysis of the open-ended questions of the surveys: nurse patient relationship, professional practice environment and ICU nature. CONCLUSION Patient satisfaction in relation with nursing care was elevated. Age, sex and degree of recovery significantly influenced their perception. Nurse patient relationship and the professional practice environment were aspects highlighted by patients. The professional model incorporated by the institution may encouraged these results.
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Affiliation(s)
- A Mir-Tabar
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - L Pardo-Herrera
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - A Goñi-Blanco
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - M T Martínez-Rodríguez
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - R Goñi-Viguria
- Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
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160
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Taboada M, Estany-Gestal A, Rial M, Cariñena A, Martínez A, Selas S, Eiras M, Veiras S, Ferreiroa E, Cardalda B, López C, Calvo A, Fernández J, Álvarez J, Alcántara JM, Seoane-Pillado T. Impact of Universal Use of the McGrath Videolaryngoscope as a Device for All Intubations in the Cardiac Operating Room. A Prospective Before-After VIDEOLAR-CAR Study. J Cardiothorac Vasc Anesth 2024; 38:1499-1505. [PMID: 38580479 DOI: 10.1053/j.jvca.2024.03.016] [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: 01/13/2024] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Tracheal intubation in cardiac surgery patients has a higher incidence of difficult laryngoscopic views compared with patients undergoing other types of surgery. The authors hypothesized that using the McGrath Mac videolaryngoscope as the first intubation option for cardiac surgery patients improves the percentage of patients with "easy intubation" compared with using a direct Macintosh laryngoscope. DESIGN A prospective, observational, before-after study. SETTING At a tertiary-care hospital. PARTICIPANTS One thousand one hundred nine patients undergoing cardiac surgery. INTERVENTION Consecutive patients undergoing cardiac surgery were intubated using, as the first option, a Macintosh laryngoscope (preinterventional phase) or a McGrath Mac videolaryngoscope (interventional phase). MEASUREMENTS AND MAIN RESULTS The main objective was to assess whether the use of the McGrath videolaryngoscope, as the first intubation option, improves the percentage of patients with "easy intubation," defined as successful intubation on the first attempt, modified Cormack-Lehane grades of I or IIa, and the absence of the need for adjuvant airway devices. A total of 1,109 patients were included, 801 in the noninterventional phase and 308 in the interventional phase. The incidence of "easy intubation" was 93% in the interventional phase versus 78% in the noninterventional phase (p < 0.001). First-success-rate intubation was higher in the interventional phase (304/308; 98.7%) compared with the noninterventional phase (754/801, 94.1%; p = 0.005). Intubation in the interventional phase showed decreases in the incidence of difficult laryngoscopy (12/308 [3.9%] v 157/801 [19.6%]; p < 0.001), as well as moderate or difficult intubation (5/308 [1.6%] v 57/801 [7.1%]; p < 0.001). CONCLUSIONS The use of the McGrath videolaryngoscope as the first intubation option for tracheal intubation in cardiac surgery improves the percentage of patients with "easy" intubation," increasing glottic view and first-success-rate intubation and decreasing the incidence of moderate or difficult intubation.
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Affiliation(s)
- Manuel Taboada
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.
| | - Ana Estany-Gestal
- Research Methodology Unit. Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | - María Rial
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Agustín Cariñena
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Adrián Martínez
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Salomé Selas
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - María Eiras
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Sonia Veiras
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Esteban Ferreiroa
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Borja Cardalda
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Carmen López
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Andrea Calvo
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Jorge Fernández
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Julián Álvarez
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Jorge Miguel Alcántara
- Research Methodology Unit. Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | - Teresa Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
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Deshwal PR, Tiwari P. Investigating the Variability among Indicators for Quantifying Antimicrobial Use in the Intensive Care Units: Analysis of Real-world Evidence. Indian J Crit Care Med 2024; 28:662-676. [PMID: 38994266 PMCID: PMC11234130 DOI: 10.5005/jp-journals-10071-24745] [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: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 07/13/2024] Open
Abstract
This study investigated variability among four indicators for quantifying antimicrobial use in intensive care units (ICUs): defined daily doses (DDD), prescribed daily doses (PDD), duration of therapy (DOT), and length of therapy (LOT) and recommended the most clinically relevant approach. Retrospective data from patients who had received at least one antimicrobial was analyzed. Patients whose records were incomplete or expired were excluded. Duration of therapy (24433/1000 PDs) and LOTs (12832/1000 PDs) underestimated the overall consumption of antimicrobials compared with DDD of 28391/1000 PDs. Whereas PDD (46699/1000 PDs) overestimated it. Comparison analysis detected % differences of 13.94, 23.92, and 54.80% between DDD and DOT, DDD and PDD, and DDD and LOT, indicators respectively. Linear regression revealed stronger (r 2 = 0.86), moderate (r 2 = 0.50), and moderate (r 2 =0.60) correlation between DDD and DOT, DDD and PDD and DDD and LOT indicators respectively. According to findings, combining DOT and DDD is a more practical method to quantify antimicrobial consumption in hospital ICUs. How to cite this article Deshwal PR, Tiwari P. Investigating the Variability among Indicators for Quantifying Antimicrobial Use in the Intensive Care Units: Analysis of Real-world Evidence. Indian J Crit Care Med 2024;28(7):662-676.
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Affiliation(s)
- Prity R Deshwal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
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162
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Alcántara Carmona S, Del Saz A, Contreras S, Riera J, Blandino A. Volatile sedation practices in patients with severe acute respiratory distress syndrome under VV-ECMO support. Intensive Care Med 2024; 50:1161-1163. [PMID: 38753268 DOI: 10.1007/s00134-024-07479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Sara Alcántara Carmona
- Intensive Care Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Ana Del Saz
- Intensive Care Department, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Murcia, Spain
| | - Sofía Contreras
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Riera
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- SODIR, Vall d'Hebron Research Institute, Barcelona, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Aaron Blandino
- Intensive Care Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Reddy PRV, Cherukuri M, Eshwara VK, Kudru CU, Prabhu RVK. Diagnostic Potential of Serum Interleukin-6 in Predicting Bacteremia in Adult Patients with Sepsis: A Prospective Observational Study. Indian J Crit Care Med 2024; 28:637-644. [PMID: 38994269 PMCID: PMC11234134 DOI: 10.5005/jp-journals-10071-24754] [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: 04/14/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024] Open
Abstract
Background This study aimed to assess the potential of serum interleukin-6 (IL-6) as a diagnostic marker in predicting bacteremia and to determine its association with severity and outcome among sepsis patients. Materials and methods A prospective observational study was conducted, comprising a cohort of 118 patients admitted to the ICU with suspected sepsis from January 2019 to April 2020. Results Among the 108 patients analyzed, 60 (55.6%) were bacteremic and 48 (44.4%) were nonbacteremic. Of 60 patients with bacteremia, 13 (21.6%) had sepsis and 47 (78.3%) had septic shock. In predicting bacteremia, the area under the curve (AUC) for IL-6 was 0.512 [95% CI, 0.400-0.623]. The AUC for IL-6 in differentiating sepsis from septic shock was 0.724 [95% CI, 0.625-0.823]. The sensitivity and specificity for predicting bacteremia for IL-6 were 66% and 67%, respectively (p < 0.001). Multivariate analysis revealed that C-reactive protein (CRP) (p = 0.04) and APACHE II score (p = 0.025) were significant predictors of bacteremia, whereas lactate (p = 0.04), and APACHE II score (p < 0.001) were significant predictors of sepsis severity. Patients with elevated levels of procalcitonin PCT (p = 0.024), APACHE II (p = 0.003), and SOFA (p = 0.002) scores had significantly higher mortality rates. Conclusion C-reactive protein and APACHE II score, lactate and APACHE II score, and PCT, SOFA, and APACHE II scores performed better in predicting bacteremia, sepsis severity, and clinical outcome, respectively compared with IL-6. How to cite this article Reddy PRV, Cherukuri M, Eshwara VK, Kudru CU, Prabhu RVK. Diagnostic Potential of Serum Interleukin-6 in Predicting Bacteremia in Adult Patients with Sepsis: A Prospective Observational Study. Indian J Crit Care Med 2024;28(7):637-644.
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Affiliation(s)
- Penna RV Reddy
- Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mounika Cherukuri
- Faculty of General Medicine, Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vandana K Eshwara
- Faculty of Microbiology, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chandrashekar Udyavara Kudru
- Faculty of General Medicine, Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - RV Krishnananda Prabhu
- Faculty of Biochemistry, Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Gravante F, Trotta F, Latina S, Simeone S, Alvaro R, Vellone E, Pucciarelli G. Quality of life in ICU survivors and their relatives with post-intensive care syndrome: A systematic review. Nurs Crit Care 2024; 29:807-823. [PMID: 38622971 DOI: 10.1111/nicc.13077] [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: 06/02/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status. AIM This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post-intensive care syndrome (PICS-F) and to report anxiety, depression and Post-Traumatic Stress Disorders (PTSD) in studies investigating PICS. STUDY DESIGN A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123). RESULTS We included 19 studies of PICS and PICS-F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post-traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain-related symptoms and sleep disorders were problems encountered by ICU relatives with PICS-F. CONCLUSION PICS and PICS-F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS-F on QoL. RELEVANCE TO CLINICAL PRACTICE PICS and PICS-F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission.
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Affiliation(s)
- Francesco Gravante
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Latina
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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165
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Morán Gallego FJ, Sanchez Casado M, López de Toro Martin Consuegra I, Marina Martinez L, Alvarez Fernandez J, Sánchez Carretero MJ. Evaluation of the last 2 decades in the characteristics of presentation, management and prognosis of serious spontaneous intracerebral hemorrhage in a third level hospital. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:169-176. [PMID: 38295901 DOI: 10.1016/j.neucie.2023.11.001] [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: 04/06/2023] [Accepted: 11/12/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To analyze the change in the characteristics of presentation, evolution and treatment in the ICU, as well as the functional evolution at 12 months of spontaneous intracranial hemorrhages (ICHs) treated in an ICU reference center. PATIENT AND METHODS Descriptive, retrospective study in a Neurocritical Reference Hospital. All admissions of patients with HICE during three periods are studied: 1999-2001 (I), 2015-2016 (II) and 2020-2021 (III). Evolution in the three periods of demographic variables, baseline characteristics of the patients, clinical variables and characteristics of bleeding, evolutionary data in the ICU are studied. At one year we assessed the GOS scale (Glasgow Outcome Score) according to whether they had a poor (GOS 1-3) or good (GOS 4-5) prognosis. RESULTS 300 admitted patients, distributed in periods: I: 28.7%, II: 36.3% and III: 35%. 56.7% were males aged 66 (55.5-74) years; ICH score 2 (1-3). The ICU stay was 5 (2-14) days with a mortality of 36.8%. GOS 1-3 a year in 67.3% and GOS 4-5 in 32.7%. Comparing the three periods, we observed a higher prevalence in women, and the presence of cardiovascular factors; no changes in etiology; in relation to the location, it increases cerebellar hemorrhage and in the brainstem. Although the severity was greater, the stay in the ICU, the use of invasive mechanical ventilation and tracheostomy were lower. Open surgery has decreased its use by 50%. Mortality continues to be high, stagnating in the ICU at 35% and entails a high degree of disability one year after assessment. CONCLUSIONS Severe ICH is a complex pathology that has changed some characteristics in the last two decades, with more severe patients, with more cardiovascular history and a greater predominance of brainstem and cerebellar hemorrhage. Despite the increase in severity, better parameters during the ICU stay, with open surgery used 50% less. Mortality remains stagnant at 35% with high disability per year.
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166
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Belatti A, Bertarini F, Pombo V, Mazzuoccolo L, Ferrario D. Follicular unit grafting in chronic ulcers: a valuable technique for integrated management. An Bras Dermatol 2024; 99:568-577. [PMID: 38521704 PMCID: PMC11220926 DOI: 10.1016/j.abd.2023.08.012] [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: 06/02/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 03/25/2024] Open
Abstract
Chronic ulcers significantly affect the quality of life of patients and impose a high cost on the healthcare system. The therapeutic management should be comprehensive, taking into consideration the etiological diagnosis of the wound and the characteristics of the wound bed when deciding on a therapeutic proposal appropriate to the healing phase, correcting factors that delay healing. During the epithelialization phase, repair techniques with grafts are recommended to shorten re-epithelialization time, improve the quality of scar tissue, and achieve adequate pain management. Currently, due to the reported benefits of skin appendages, the technique of follicular unit auto-grafting obtained with a scalp punch is among the chosen strategies for wound repair. This is a minimally invasive, outpatient practice, whose technique has advantages over the donor site, patients recovery and well-being.
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Affiliation(s)
- Anahi Belatti
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Florencia Bertarini
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Virginia Pombo
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Mazzuoccolo
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Damian Ferrario
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Luceño Ros MÁ, Álvarez Fernández MC, Morbelli JA, de la Calle Lorenzo JV, Suárez Pereiro MJ, Espinel Díez J, Quiñones Castro R. Acute pancreatitis secondary to migration and impaction of an intragastric balloon. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:385-386. [PMID: 37882160 DOI: 10.17235/reed.2023.9532/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Obesity represents a significant global health problem, and reducing its alarmingly high incidence is an urgent challenge. The intragastric balloon is a safe and effective device for weight loss; therefore, it is widely used. Although the frequency of serious complications resulting from its use is low, it is not exempt from them. We would like to present a case of a severe but infrequent complication secondary to this device, with the aim of highlighting the most appropriate procedure in such cases and emphasizing the importance of awareness regarding it.
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168
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González-Castro A, Ferrero-Franco R, Blanco Huelga C. Challenges in the use of intravenous albumin in critically ill patients: Reflections and future perspectives. Med Intensiva 2024; 48:429-430. [PMID: 38735809 DOI: 10.1016/j.medine.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 05/14/2024]
Affiliation(s)
| | | | - Carmen Blanco Huelga
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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169
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Aponte MT, Cerviño Camino S, Ramírez-Martín R, Rico Nieto A. [Infections related to vascular catheters: Case report]. Rev Esp Geriatr Gerontol 2024; 59:101491. [PMID: 38579367 DOI: 10.1016/j.regg.2024.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Affiliation(s)
| | | | - Raquel Ramírez-Martín
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - Alicia Rico Nieto
- Unidad de Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, España
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170
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Konsberg Y, Åneman A, Olsen F, Hessulf F, Nellgård B, Hård Af Segerstad M, Dalla K. Progressive changes in pulmonary gas exchange during invasive respiratory support for COVID-19 associated acute respiratory failure: A retrospective study of the association with 90-day mortality. Acta Anaesthesiol Scand 2024; 68:803-811. [PMID: 38563250 DOI: 10.1111/aas.14415] [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: 09/17/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Ratio of arterial pressure of oxygen and fraction of inspired oxygen (P/F ratio) together with the fractional dead space (Vd/Vt) provides a global assessment of pulmonary gas exchange. The aim of this study was to assess the potential value of these variables to prognosticate 90-day survival in patients with COVID-19 associated ARDS admitted to the Intensive Care Unit (ICU) for invasive ventilatory support. METHODS In this single-center observational, retrospective study, P/F ratios and Vd/Vt were assessed up to 4 weeks after ICU-admission. Measurements from the first 2 weeks were used to evaluate the predictive value of P/F ratio and Vd/Vt for 90-day mortality and reported by the adjusted hazard ratio (HR) and 95% confidence intervals [95%CI] by Cox proportional hazard regression. RESULTS Almost 20,000 blood gases in 130 patients were analyzed. The overall 90-day mortality was 30% and using the data from the first ICU week, the HR was 0.85 [0.77-0.94] for every 10 mmHg increase in P/F ratio and 1.61 [1.20-2.16] for every 0.1 increase in Vd/Vt. In the second week, the HR for 90-day mortality was 0.82 [0.75-0.89] for every 10 mmHg increase in P/F ratio and 1.97 [1.42-2.73] for every 0.1 increase in Vd/Vt. CONCLUSION The progressive changes in P/F ratio and Vd/Vt in the first 2 weeks of invasive ventilatory support for COVID-19 ARDS were significant predictors for 90-day mortality.
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Affiliation(s)
- Ylva Konsberg
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Anders Åneman
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Intensive Care Unit, Liverpool Hospital, Southwestern Sydney Local Health District, Australia
- South Western Clinical School, University of New South Wales, Australia
- Ingham Institute for Applied Medical Science, Sydney, Australia
| | - Fredrik Olsen
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska, Sweden
| | - Fredrik Hessulf
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Mathias Hård Af Segerstad
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
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Correia I, Fernandes S, Bernardino M, Gonçalves Pereira J. Infection on Frail Patients in the Intensive Care Unit: Insights From the PalMuSIC Study. Cureus 2024; 16:e63897. [PMID: 39099977 PMCID: PMC11298117 DOI: 10.7759/cureus.63897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Along with population aging, frailty is also increasingly common in the intensive care unit (ICU). However, the impact of frailty on the infection incidence, the risk of multidrug-resistant (MDR) microorganisms, and the potential benefits of broad-spectrum antibiotics are still poorly studied. METHODS This is a multicentric, prospective, observational study collecting data for 15 consecutive days of all consecutive adult patients admitted in each participating ICU. Exclusion criteria included admission for less than 24 hours or failure to obtain informed consent. The Clinical Frailty Score (CFS) was calculated both by the doctor and by the nurse in charge, and the patient's next of kin. Patients were considered frail if the mean of the three measured scores was ≥5. This is a post hoc analysis of the PALliative MUlticenter Study in Intensive Care (PalMuSIC) study. The Hospital de Vila Franca de Xira Ethics Committee approved the study (approval number: 63). RESULTS A total of 335 patients from 23 Portuguese ICUs were included. Frailty was diagnosed in 20.9%. More than 60% of the patients had a diagnosis of infection during their ICU stay, either present on admission or hospital-acquired. This included 25 (35.7%) frail and 75 (28.3%) non-frail (p=0.23) patients diagnosed with infection. In 34 patients, MDR microorganisms were isolated, which were more common in frail patients (odds ratio (OR): 2.65, 95% confidence interval (CI): 1.3-5.6, p=0.018). Carbapenems were started in 37 (18.1%) patients, but after adjusting for frailty and severity, no clear mortality benefit of this strategy was noted (odds ratio for ICU mortality: 1.61, 95% confidence interval: 0.49-5.31, p=0.43; odds ratio for hospital mortality: 1.61, 95% confidence interval: 0.61-4.21, p=0.33). CONCLUSION Frail patients had similar rates of infection to non-frail patients but were more prone to have MDR microorganisms as causative pathogens. The use of empirical therapy with large-spectrum antibiotics should be based on microbiological risk factors and not simply on the host characteristics.
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Affiliation(s)
- Iuri Correia
- Internal Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
- Palliative Medicine Unit, Hospital CUF Tejo, Lisbon, PRT
| | - Susana Fernandes
- Intensive Care Department, Hospital de Santa Maria, Lisbon, PRT
- Intensive Care University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PRT
| | - Mariana Bernardino
- Intensive Care University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PRT
| | - João Gonçalves Pereira
- Intensive Care Unit Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
- Intensive Care University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PRT
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Havaldar AA, Selvam S. Nutritional Prescription in ICU Patients: Does it Matter? Indian J Crit Care Med 2024; 28:657-661. [PMID: 38994260 PMCID: PMC11234123 DOI: 10.5005/jp-journals-10071-24755] [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: 04/21/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Background The nutritional status of the patients before critical illness and nutrition support given during the critical illness play an important role in the recovery. We aimed to evaluate the nutritional prescription and its effect on ICU mortality. Materials and methods This was a prospective observational study conducted after institutional ethical committee approval (IEC 94/2018, CTRI/2018/06/014625) in a case-mixed (medical and surgical) ICU. Patients admitted to the ICU were enrolled within 24 hours of admission. The amount of calories and proteins prescribed and received by the patients was collected for 7 days. The primary outcome was ICU mortality. Results A total of 100 patients were included. The mean age was 48.63 (16.25) years, and 62% were males. The acute physiology and chronic health evaluation (APACHE II), sequential organ failure assessment (SOFA), and modified Nutric (mNUTRIC) scores were comparable between the two groups. The ICU mortality was 30%. The calorie and protein deficits were comparable between survivors and non-survivors. Among the secondary outcomes, a significant time effect (p = 0.013) and interaction effect (p = 0.004) were noted for maximum glucose levels. The glucose variability calculated by coefficient of variation (CV) was significantly higher in non-survivors than survivors (p = 0.031). Conclusion The calorie and protein deficits did not affect ICU mortality. The maximum glucose variability and CV were significant parameters associated with ICU mortality. How to cite this article Havaldar AA, Selvam S. Nutritional Prescription in ICU Patients: Does it Matter? Indian J Crit Care Med 2024;28(7):657-661.
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Affiliation(s)
- Amarja Ashok Havaldar
- Department of Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Sumithra Selvam
- Department of Biostatistics, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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173
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Sinha S. Interleukin-6 in Sepsis-Promising but Yet to Be Proven. Indian J Crit Care Med 2024; 28:629-631. [PMID: 38994265 PMCID: PMC11234135 DOI: 10.5005/jp-journals-10071-24758] [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] [Indexed: 07/13/2024] Open
Abstract
How to cite this article: Sinha S. Interleukin-6 in Sepsis-Promising but Yet to Be Proven. Indian J Crit Care Med 2024;28(7):629-631.
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Affiliation(s)
- Saswati Sinha
- Department of Critical Care, Manipal Hospital Dhakuria, Kolkata, West Bengal, India
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174
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Asim M, El-Menyar A, Abdelrahman H, Consunji R, Siddiqui T, Kanbar A, Taha I, Rizoli S, Al-Thani H. Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center. J Intensive Care Med 2024; 39:672-682. [PMID: 38193211 DOI: 10.1177/08850666231225607] [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: 01/10/2024]
Abstract
Background: We aimed to analyze in-hospital timing and risk factors for mortality in a level 1 trauma center. Methods: This is a retrospective analysis of all trauma-related mortality between 2013 and 2018. Patients were divided and analyzed based on the time of mortality (early (≤48 h) vs late (>48 h)), and within different age groups. Multivariate regression analysis was performed to predict in-hospital mortality. Results: 8624 trauma admissions and 677 trauma-related deaths occurred (47.7% at the scene and 52.3% in-hospital). Among in-hospital mortality, the majority were males, with a mean age of 35.8 ± 17.2 years. Most deaths occurred within 3-7 days (35%), followed by 33% after 1 week, 20% on the first day, and 12% on the second day of admission. Patients with early mortality were more likely to have a lower Glasgow coma scale, a higher shock index, a higher chest and abdominal abbreviated injury score, and frequently required exploratory laparotomy and massive blood transfusion (P < .005). The injury severity scores and proportions of head injuries were higher in the late mortality group than in the early group. The severity of injuries, blood transfusion, in-hospital complications, and length of intensive care unit stay were comparable among the age groups, whereas mortality was higher in the age group of 19 to 44. The higher proportions of early and late in-hospital deaths were evident in the age group of 24 to 29. In multivariate analysis, the shock index (OR 2.26; 95%CI 1.04-4.925; P = .04) was an independent predictor of early death, whereas head injury was a predictor of late death (OR 4.54; 95%CI 1.92-11.11; P = .001). Conclusion: One-third of trauma-related mortalities occur early after injury. The initial shock index appears to be a reliable hemodynamic indicator for predicting early mortality. Therefore, timely hemostatic resuscitation and appropriate interventions for bleeding control may prevent early mortality.
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Affiliation(s)
- Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
- Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | - Rafael Consunji
- Hamad Injury Prevention Program, Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Tariq Siddiqui
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Ahad Kanbar
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Ibrahim Taha
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
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175
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Kelly M, Donovan RL, Dailiana ZH, Pape HC, Chana-Rodríguez F, Pari C, Ponsen KJ, Cattaneo S, Belluati A, Contini A, Gómez-Vallejo J, Casallo-Cerezo M, Willinge GJ, van Veen RN, Gosling JC, Papadakis SA, Iliopoulos E. Rehabilitation after musculoskeletal injury: European perspective. OTA Int 2024; 7:e330. [PMID: 39114372 PMCID: PMC11301633 DOI: 10.1097/oi9.0000000000000330] [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: 12/15/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 08/10/2024]
Abstract
Trauma is one of the main causes of death in younger people and ongoing disability worldwide. In Europe, while there is generally good organization of trauma reception and acute treatment, rehabilitation from major musculoskeletal injuries is less well defined and provided. This article documents the diverse approaches to rehabilitation after major injury in 6 European nations. The recognition of need is universal, but achieving a robust rehabilitation strategy is more elusive across the varying health care systems. Switzerland has the most robust service in the insured population. In the other countries, particularly where there is a reliance on public institutes, this provision is at best patchy. In the Netherlands, innovative patient-empowering strategies have gained traction with notable success, and in the United Kingdom, a recent randomized trial also showed this approach to be reproducible and robust. Overall, there is a clear need for learning across the national systems and implementation of a minimum set of standards.
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176
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Moumneh MB, Jamil Y, Kalra K, Ijaz N, Campbell G, Kochar A, Nanna MG, van Diepen S, Damluji AA. Frailty in the cardiac intensive care unit: assessment and impact. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:506-514. [PMID: 38525951 PMCID: PMC11214587 DOI: 10.1093/ehjacc/zuae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
Frailty, a clinical syndrome of increased vulnerability, due to diminished cognitive, physical, and physiological reserves is a growing concern in the cardiac intensive care unit (CICU). It contributes to morbidity, mortality, and complications and often exerts a bidirectional association with cardiovascular disease. Although it predominately affects older adults, frailty can also be observed in younger patients <65 years of age, with approximately 30% of those admitted in CICU are frail. Acute cardiovascular illness can also impair physical and cognitive functioning among survivors and these survivors often suffer from frailty and functional declines post-CICU discharge. Patients with frailty in the CICU often have higher comorbidity burden, and they are less likely to receive optimal therapy for their acute cardiovascular conditions. Given the significance of this geriatric syndrome, this review will focus on assessment, clinical outcomes, and interventions, in an attempt to establish appropriate assessment, management, and resource utilization in frail patients during and after CICU admission.
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Affiliation(s)
- Mohamad B Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Yasser Jamil
- Department of Medicine, Yale School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
| | - Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Naila Ijaz
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Greta Campbell
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Ajar Kochar
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Michael G Nanna
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
| | - Sean van Diepen
- Division of Critical Care, University of Alberta, 116 St. and 85 Ave, Edmonton, AB T6G 2R3, CA
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
- Division of Critical Care, University of Alberta, 116 St. and 85 Ave, Edmonton, AB T6G 2R3, CA
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
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177
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Padín JF, Pérez-Ortiz JM, Redondo-Calvo FJ. Aprotinin (II): Inhalational Administration for the Treatment of COVID-19 and Other Viral Conditions. Int J Mol Sci 2024; 25:7209. [PMID: 39000315 PMCID: PMC11241800 DOI: 10.3390/ijms25137209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Aprotinin is a broad-spectrum inhibitor of human proteases that has been approved for the treatment of bleeding in single coronary artery bypass surgery because of its potent antifibrinolytic actions. Following the outbreak of the COVID-19 pandemic, there was an urgent need to find new antiviral drugs. Aprotinin is a good candidate for therapeutic repositioning as a broad-spectrum antiviral drug and for treating the symptomatic processes that characterise viral respiratory diseases, including COVID-19. This is due to its strong pharmacological ability to inhibit a plethora of host proteases used by respiratory viruses in their infective mechanisms. The proteases allow the cleavage and conformational change of proteins that make up their viral capsid, and thus enable them to anchor themselves by recognition of their target in the epithelial cell. In addition, the activation of these proteases initiates the inflammatory process that triggers the infection. The attraction of the drug is not only its pharmacodynamic characteristics but also the possibility of administration by the inhalation route, avoiding unwanted systemic effects. This, together with the low cost of treatment (≈2 Euro/dose), makes it a good candidate to reach countries with lower economic means. In this article, we will discuss the pharmacodynamic, pharmacokinetic, and toxicological characteristics of aprotinin administered by the inhalation route; analyse the main advances in our knowledge of this medication; and the future directions that should be taken in research in order to reposition this medication in therapeutics.
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Affiliation(s)
- Juan-Fernando Padín
- Department of Medical Sciences, School of Medicine at Ciudad Real, University of Castilla-La Mancha, 13971 Ciudad Real, Spain
| | - José Manuel Pérez-Ortiz
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, 28692 Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, 28015 Madrid, Spain
| | - Francisco Javier Redondo-Calvo
- Department of Medical Sciences, School of Medicine at Ciudad Real, University of Castilla-La Mancha, 13971 Ciudad Real, Spain
- Department of Anaesthesiology and Critical Care Medicine, University General Hospital, 13005 Ciudad Real, Spain
- Translational Research Unit, University General Hospital and Research Institute of Castilla-La Mancha (IDISCAM), 13005 Ciudad Real, Spain
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178
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Morales-Rodríguez AM, Morales-Rodríguez FM. Effectiveness of a Mindfulness-Based Intervention Program to Improve Communication and Stress Coping Skills in University Students. Eur J Investig Health Psychol Educ 2024; 14:1927-1939. [PMID: 39056643 PMCID: PMC11275262 DOI: 10.3390/ejihpe14070128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Investigating the contribution of mindfulness training to psychological well-being and quality of life in the university setting is of interest. The objective of the study is to present a comparative analysis of the scores in the variables of self-efficacy, resilience, coping strategies, and communication skills before and after the application of an intervention program based on mindfulness. An ex post facto cross-sectional design and a convenience sample of participants were adopted. The participants were students belonging to Education Sciences who benefited from the activities of the program. Instruments were administered to assess mindfulness, self-efficacy, resilience, coping strategies, and communication skills. The correlations of the mindfulness variable with the other psychoeducational variables evaluated were also analyzed. The results indicate an increase in the scores in the selected variables of mindfulness, resilience, communication skills, and some of the coping strategies considered productive or functional such as problem solving, self-criticism, emotional expression, desiderative thinking, social support, and cognitive restructuring. Statistically significant correlations were also observed between the variable mindfulness and those of perceived self-efficacy, resilience, coping strategies, and communication skills. The development of mindfulness training programs in the university setting is necessary to contribute to the improvement of more adaptive coping skills and the promotion of resilience.
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179
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Arrigoni R, Ballini A, Jirillo E, Santacroce L. Current View on Major Natural Compounds Endowed with Antibacterial and Antiviral Effects. Antibiotics (Basel) 2024; 13:603. [PMID: 39061285 PMCID: PMC11274329 DOI: 10.3390/antibiotics13070603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Nowadays, infectious diseases of bacterial and viral origins represent a serious medical problem worldwide. In fact, the development of antibiotic resistance is responsible for the emergence of bacterial strains that are refractory even to new classes of antibiotics. Furthermore, the recent COVID-19 pandemic suggests that new viruses can emerge and spread all over the world. The increase in infectious diseases depends on multiple factors, including malnutrition, massive migration of population from developing to industrialized areas, and alteration of the human microbiota. Alternative treatments to conventional antibiotics and antiviral drugs have intensively been explored. In this regard, plants and marine organisms represent an immense source of products, such as polyphenols, alkaloids, lanthipeptides, and terpenoids, which possess antibacterial and antiviral activities. Their main mechanisms of action involve modifications of bacterial cell membranes, with the formation of pores, the release of cellular content, and the inhibition of bacterial adherence to host cells, as well as of the efflux pump. Natural antivirals can interfere with viral replication and spreading, protecting the host with the enhanced production of interferon. Of note, these antivirals are not free of side effects, and their administration to humans needs more research in terms of safety. Preclinical research with natural antibacterial and antiviral compounds confirms their effects against bacteria and viruses, but there are still only a few clinical trials. Therefore, their full exploitation and more intensive clinical studies represent the next steps to be pursued in this area of medicine.
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Affiliation(s)
- Roberto Arrigoni
- CNR Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies (IBIOM), 70124 Bari, Italy
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Emilio Jirillo
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Luigi Santacroce
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
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180
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Min JY, Hyung SW, Jeon JP, Chung MY, Kim CJ, Kim YH. A stepwise lung recruitment maneuver using I-gel can improve respiratory parameters: A prospective observational study. Medicine (Baltimore) 2024; 103:e38718. [PMID: 38941413 DOI: 10.1097/md.0000000000038718] [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] [Indexed: 06/30/2024] Open
Abstract
I-gel has been used in various clinical situations. The study investigated alterations in respiratory parameters following a stepwise lung recruitment maneuver (LRM) using the i-gel. The research involved 60 patients classified as American Society of Anesthesiologists class I-II, aged 30 to 75 years, undergoing elective urologic surgery. Various respiratory parameters, including lung compliance, airway resistance, leak volume, airway pressure, and oxygen reserve index, were recorded at different time points: before LRM, immediately after LRM, and at 5, 15, and 30 minutes after LRM, as well as at the end of the surgery. The primary outcome was to assess an improvement in lung compliance. Dynamic lung compliance (mean ± SD) was significantly increased from 49.2 ± 1.8 to 70.15 ± 3.2 mL/cmH2O (P < .05) after LRM. Static lung compliance (mean ± SD) was increased considerably from 52.4 ± 1.7 to 65.0 ± 2.5 mL/cmH2O (P < .05) after the LRM. Both parameters maintained a statistically significant increased status for a certain period compared to baseline despite a decreased degree of increment. Airway resistance (mean ± SD) was significantly reduced after the LRM from 12.05 ± 0.56 to 10.41 ± 0.64 L/cmH2O/s (P < .05). Stepwise LRM using i-gel may improve lung compliance and airway resistance. Repeated procedures could lead to prolonged improvements in respiratory parameters.
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Affiliation(s)
- Ji Young Min
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Woo Hyung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Pyo Jeon
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee Young Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National Hospital, College of Medicine, The Chungnam National University of Korea, Daejeon, Republic of Korea
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181
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Kim WY, Jung SY, Kim JY, Chae G, Kim J, Joh JS, Park TY, Baek AR, Jegal Y, Chung CR, Lee J, Cho YJ, Park JH, Hwang JH, Song JW. ECMO is associated with decreased hospital mortality in COVID-19 ARDS. Sci Rep 2024; 14:14835. [PMID: 38937516 PMCID: PMC11211457 DOI: 10.1038/s41598-024-64949-x] [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: 01/08/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
This study determined whether compared to conventional mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) is associated with decreased hospital mortality or fibrotic changes in patients with COVID-19 acute respiratory distress syndrome. A cohort of 72 patients treated with ECMO and 390 with conventional MV were analyzed (February 2020-December 2021). A target trial was emulated comparing the treatment strategies of initiating ECMO vs no ECMO within 7 days of MV in patients with a PaO2/FiO2 < 80 or a PaCO2 ≥ 60 mmHg. A total of 222 patients met the eligibility criteria for the emulated trial, among whom 42 initiated ECMO. ECMO was associated with a lower risk of hospital mortality (hazard ratio [HR], 0.56; 95% confidence interval [CI] 0.36-0.96). The risk was lower in patients who were younger (age < 70 years), had less comorbidities (Charlson comorbidity index < 2), underwent prone positioning before ECMO, and had driving pressures ≥ 15 cmH2O at inclusion. Furthermore, ECMO was associated with a lower risk of fibrotic changes (HR, 0.30; 95% CI 0.11-0.70). However, the finding was limited due to relatively small number of patients and differences in observability between the ECMO and conventional MV groups.
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Affiliation(s)
- Won-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong-Yeon Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Ganghee Chae
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Borame Medical Center, Seoul, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yangjin Jegal
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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182
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López Gómez JJ, Díaz Marín C, Castillo-García T, Larrad-Sainz A, Gastaldo-Simeón R, Juarros-Martínez S, Leunda-Eizmendi L, Civera Andrés M, Matía Martín P. [Medical nutrition therapy in amyotrophic lateral sclerosis - Do we act or react? A case report and multidisciplinary review]. NUTR HOSP 2024; 41:712-723. [PMID: 38726604 DOI: 10.20960/nh.05189] [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: 06/28/2024] Open
Abstract
Introduction Background: amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a progressive course. The current prevalence is between 3 and 6 cases/100,000. Malnutrition is closely related to patient prognosis in ALS. The implications of this conditions have been that we should recommend patient care in a multidisciplinary unit. Case report: the case presented shows the evolution of a patient with ALS. The patient was referred to different clinical departments after neurological evaluation and her nutritional, functional and respiratory status were assessed. There was no nutritional deterioration at diagnosis; however, intake was below energy-protein requirements. The clinical evolution of the patient showed a decrease in muscle mass with preservation of weight and fat mass. "Aggressive" measures to control nutritional status such as gastrostomy were rejected in the initial stages of the disease, but had to be carried out after development of dysphagia and associated malnutrition. This situation of progressive morphofunctional deterioration and the development of disease-related complications made essential the participation of different health services and professionals in its control. Dicussion: the management of ALS in a multidisciplinary manner allows to improve the course of the disease and the quality of life of both the patients and their families. Patient follow-up is based on the adjustment and management of complications. The basis of the relationship with these patients includes maintaining an adequate communication with them and their families, and ensuring joint decision-making about their condition.
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Affiliation(s)
- Juan José López Gómez
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid. Centro de Investigación Endocrinología y Nutrición. Universidad de Valladolid
| | | | | | - Angélica Larrad-Sainz
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC)
| | | | | | | | - Miguel Civera Andrés
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valencia
| | - Pilar Matía Martín
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Facultad de Medicina. Universidad Complutense de Madrid. Instituto de Investigación Sanitaria San Carlos (IdISSC)
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183
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Milona M, Olszowski T, Uzar I, Safranow K, Janiszewska-Olszowska J, Szmidt-Kądys M, Rola H, Sikora M, Chlubek D, Adler G. TLR2 and TLR4 Polymorphisms Are Not Associated with Dental Caries in Polish Children. Int J Mol Sci 2024; 25:6985. [PMID: 39000094 PMCID: PMC11241597 DOI: 10.3390/ijms25136985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
The aim of the present study was to analyze the association of the TLR2 (Toll-like receptor 2 gene) 2258G>A (rs5743708), TLR4 (Toll-like receptor 4 gene) 896A>G (rs4986790), and TLR4 1196C>T (rs4986791) polymorphisms with dental caries in Polish children. The participants, 261 15-year-old children, were divided into two groups: 82 cases (i.e., children with DMFT (Decayed, Missing, and Filled Teeth) index >5, having either moderate or high caries experience, assigned as the "higher" caries experience group) and 179 controls (i.e., children with DMFT ≤ 5, having either low or very low caries experience, assigned as the "lower" caries experience group). Genomic DNA was isolated from buccal swabs, and genotyping was determined by means of real-time PCR (polymerase chain reaction). There were no significant differences in the genotype or allele distributions in all tested SNPs (single nucleotide polymorphisms) between children with "higher" caries experience and those with "lower" caries experience. TLR4 haplotype frequencies did not differ significantly between cases and controls. In an additional analysis with another case definition applied (subjects with DMFT ≥ 1 were assigned as "cases", whereas children with DMFT = 0 were assigned as "controls"), no significant differences in the TLR2 and TLR4 genotype, allele frequencies, and TLR4 haplotype frequencies were found between the case and the control groups. The results of the present study broaden our knowledge on the potential genetic factors that might affect caries risk and suggest that TLR2 rs5743708 and TLR4 rs4986790 and rs4986791 SNPs are not associated with dental caries susceptibility in Polish children.
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Affiliation(s)
- Marta Milona
- Department of Hygiene and Epidemiology, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.M.); (T.O.)
| | - Tomasz Olszowski
- Department of Hygiene and Epidemiology, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.M.); (T.O.)
| | - Izabela Uzar
- Department of General Pharmacology and Pharmacoeconomics, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland;
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (K.S.); (M.S.)
| | - Joanna Janiszewska-Olszowska
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Monika Szmidt-Kądys
- Department of Conservative Dentistry with Endodontics, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Hubert Rola
- MIL-MED Healthcare Center, Ruta 8, 72-300 Gryfice, Poland;
| | - Maciej Sikora
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (K.S.); (M.S.)
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (K.S.); (M.S.)
| | - Grażyna Adler
- Department of Studies in Anthropogenetics and Biogerontology, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland;
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184
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Zhang Y, Dou Y, Yin Z, Gao M, Wu B, Zhang Q. Initiation of adaptive feeding within 24 h after burn injury improves nutritional therapy for severely burned patients. Front Nutr 2024; 11:1342682. [PMID: 38988856 PMCID: PMC11233793 DOI: 10.3389/fnut.2024.1342682] [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: 11/22/2023] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction and objective Nutritional therapy is a crucial component of treatment for severely burned patients. Although overly aggressive enteral nutrition immediately after burn injury has potential risks, nutritional disruption after a severe burn can also increase infection risk and delay wound healing. For approximately six decades, the Ruijin Hospital Burn Center has used two distinct approaches for patients during the early period after burn injury: complete fasting or adaptive feeding. Notably, adaptive feeding more closely resembles enteral nutrition. In this retrospective study, we analyzed factors influencing the selection of either modality, as well as the benefits of adaptive feeding. We sought to promote adaptive feeding as a precursor to initiating enteral nutrition. Patients and methods This retrospective study analyzed medical data from adult patients with extensive burns between January 2009 and December 2020. All patients had been admitted to the burn department within 24 h after injury and had a burned area comprising >30% of total body surface area. Patients were divided into two groups: adaptive feeding and fasting. We examined the total burned area, full-thickness burned area, burn type, inhalation injury, start time of adaptive feeding, and start time of enteral nutrition. Outcome measures were 28-day mortality and hospital mortality. Results Univariate analysis revealed significant differences in burn type, percent of total body surface area (TBSA), full-thickness burned area, and inhalation injury between the adaptive feeding and fasting groups (all p < 0.05). Linear regression analysis showed that full-thickness burned area and inhalation injury were the main factors influencing the start time of adaptive feeding in patients with severe burns (p < 0.05). After propensity score matching analysis, the results showed that the start time of enteral nutrition was significantly earlier in the adaptive feeding group (p < 0.01). However, overall mortality, 28-day mortality, and length of hospital stay did not significantly improve in the adaptive feeding group. The incidence of intolerance after enteral nutrition therapy did not significantly differ between groups. Conclusion The results of the study showed that larger full-thickness burned areas and concomitant inhalation injury were the primary factors considered by physicians when selecting complete fasting for severely burned patients. Moreover, the results indicate that adaptive feeding improves nutritional therapy for severely burned patients by shortening the time between injury and initiation of enteral nutrition. Complete fasting due to concerns about extensive burned area and inhalation injuries does not reduce the incidence of enteral nutrition intolerance; instead, it delays the initiation of enteral nutrition.
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Affiliation(s)
- Yin Zhang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Dou
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongqi Yin
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Gao
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beiwen Wu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Zhang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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185
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López-Gobernado M, Pérez-Rubio A, Villalba Gil D, Hernández Bartolomé J, Eiros JM. [Vaccine prophylaxis to prevent acute respiratory infections in the healthcare environment]. Semergen 2024; 50:102288. [PMID: 38936096 DOI: 10.1016/j.semerg.2024.102288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 06/29/2024]
Affiliation(s)
- M López-Gobernado
- Servicio de Estudios, Documentación y Estadística. Consejería de Sanidad Junta de Castilla y León, Valladolid, España.
| | | | - D Villalba Gil
- Servicio de Estudios, Documentación y Estadística. Consejería de Sanidad Junta de Castilla y León, Valladolid, España; Complejo Asistencial de Ávila, Ávila, España; Hospital Clínico Universitario de Valladolid, Valladolid, España; Servicio Prevención de Riesgos Laborales. Área de Salud Valladolid-Este, Valladolid, España; Servicio de Microbiología. Hospital Río Hortega de Valladolid, Valladolid, España
| | - J Hernández Bartolomé
- Servicio de Estudios, Documentación y Estadística. Consejería de Sanidad Junta de Castilla y León, Valladolid, España; Complejo Asistencial de Ávila, Ávila, España; Hospital Clínico Universitario de Valladolid, Valladolid, España; Servicio Prevención de Riesgos Laborales. Área de Salud Valladolid-Este, Valladolid, España; Servicio de Microbiología. Hospital Río Hortega de Valladolid, Valladolid, España
| | - J M Eiros
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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186
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Chen Q, Zhou W, Cheng Y, Wang G, San Z, Guo L, Liu L, Zhao C, Sun N. Four novel Acinetobacter lwoffii strains isolated from the milk of cows in China with subclinical mastitis. BMC Vet Res 2024; 20:274. [PMID: 38918815 PMCID: PMC11201367 DOI: 10.1186/s12917-024-04119-3] [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: 03/08/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Acinetobacter lwoffii (A. lwoffii) is a Gram-negative bacteria common in the environment, and it is the normal flora in human respiratory and digestive tracts. The bacteria is a zoonotic and opportunistic pathogen that causes various infections, including nosocomial infections. The aim of this study was to identify A. lwoffii strains isolated from bovine milk with subclinical mastitis in China and get a better understanding of its antimicrobial susceptibility and resistance profile. This is the first study to analyze the drug resistance spectrum and corresponding mechanisms of A. lwoffii isolated in raw milk. RESULTS Four A. lwoffii strains were isolated by PCR method. Genetic evolution analysis using the neighbor-joining method showed that the four strains had a high homology with Acinetobacter lwoffii. The strains were resistant to several antibiotics and carried 17 drug-resistance genes across them. Specifically, among 23 antibiotics, the strains were completely susceptible to 6 antibiotics, including doxycycline, erythromycin, polymyxin, clindamycin, imipenem, and meropenem. In addition, the strains showed variable resistance patterns. A total of 17 resistance genes, including plasmid-mediated resistance genes, were detected across the four strains. These genes mediated resistance to 5 classes of antimicrobials, including beta-lactam, aminoglycosides, fluoroquinolones, tetracycline, sulfonamides, and chloramphenicol. CONCLUSION These findings indicated that multi-drug resistant Acinetobacter lwoffii strains exist in raw milk of bovine with subclinical mastitis. Acinetobacter lwoffii are widespread in natural environmental samples, including water, soil, bathtub, soap box, skin, pharynx, conjunctiva, saliva, gastrointestinal tract, and vaginal secretions. The strains carry resistance genes in mobile genetic elements to enhance the spread of these genes. Therefore, more attention should be paid to epidemiological surveillance and drug resistant A. lwoffii.
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Affiliation(s)
- Qiang Chen
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China
| | - Wensi Zhou
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China
| | - Yuening Cheng
- Key Laboratory of Special Animal Epidemic Disease, Ministry of Agriculture, Institute of Special Economic Animals and Plants, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Guisheng Wang
- Shandong Provincial Center for Animal Disease Control and Prevention, Jinan, China
| | - Zhihao San
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China
| | - Li Guo
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China
| | - Liming Liu
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China
| | - Cuiqing Zhao
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China
| | - Na Sun
- College of Animal Science and Technology, Jilin Agricultural Science and Technology University, Jilin, China.
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Rabanal Llevot JM, Ramos Goicoechea F, Díaz de Téran JC, Bermejo Zubelzu JF. Knowledge about the chain of survival after out-of-hospital cardiac arrest among the citizens of a Spanish region. Med Clin (Barc) 2024:S0025-7753(24)00308-7. [PMID: 38926037 DOI: 10.1016/j.medcli.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024]
Affiliation(s)
- José Manuel Rabanal Llevot
- Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Formación de Cruz-Roja, Santander, España.
| | - Francisco Ramos Goicoechea
- Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Formación de Cruz-Roja, Santander, España
| | - Juan Carlos Díaz de Téran
- Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Formación de Cruz-Roja, Santander, España
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188
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Cuenca Fito E, González Castro A, Gómez Acebo I. Reasons for refusal of admission to the ICU in oncological population and their association with 6-month mortality. Med Intensiva 2024:S2173-5727(24)00136-X. [PMID: 38918161 DOI: 10.1016/j.medine.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- Elena Cuenca Fito
- Servicio de Medicina Intensiva Hospital Universitario de Ourense, Spain.
| | | | - Inés Gómez Acebo
- Departamento Ciencias médicas y quirúrgicas de la Universidad de Cantabria, Spain
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Alves P, Bååth C, Manuel T, Almeida S, Källman U. Pressure ulcers during the COVID-19 pandemic in intensive care:A multicenter cohort study. J Tissue Viability 2024:S0965-206X(24)00082-2. [PMID: 38937249 DOI: 10.1016/j.jtv.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
AIM The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. MATERIALS AND METHODS Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. RESULTS The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. CONCLUSION When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.
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Affiliation(s)
- Paulo Alves
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal.
| | - Carina Bååth
- Karlstad University, Department of Health Sciences, Karlstad, Sweden; Østfold University College, Faculty of Health, Welfare and Organization, Fredrikstad, Norway
| | - Tânia Manuel
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal
| | - Sofia Almeida
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal
| | - Ulrika Källman
- Research Unit, FoUI Department, Södra Älvsborgs Hospital, Borås, Sweden; University of Gothenburg, Faculty of Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
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190
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Hernández-Zambrano SM, Carrillo-Algarra AJ, Manotas-Solano OE, Ibáñez-Gamboa SE, Mejia-Mendez LM, Martínez-Montoya OH, Fernández-Alcántara M, Hueso-Montoro C. Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review. ENFERMERIA INTENSIVA 2024:S2529-9840(23)00069-1. [PMID: 38910066 DOI: 10.1016/j.enfie.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/24/2023] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.
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Affiliation(s)
- S M Hernández-Zambrano
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia.
| | - A J Carrillo-Algarra
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O E Manotas-Solano
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - S E Ibáñez-Gamboa
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - L M Mejia-Mendez
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O H Martínez-Montoya
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | | | - C Hueso-Montoro
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Jaén, Spain
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191
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Rodríguez-Calvo-de-Mora M, Giménez-Almenara-Amo J, Mataix-Albert B, Arias-Alcalá M, García-Montesinos-Gutiérrez J, Rocha-de-Lossada C, Villalba-Montoro R, Díaz-Gallardo MS, Cuende N, Álvarez-Márquez A. Andalusian Public Eye-Banks: a decade of continuous improvement. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024:S2173-5794(24)00111-7. [PMID: 38909891 DOI: 10.1016/j.oftale.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/05/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES To show donation data, number of keratoplasties and the changes in transplant indications and techniques that occurred in Andalusia in the period from 2013 to 2022. MATERIALS AND METHODS The present work is a retrospective and descriptive study that included all keratoplasties performed between January 2013 and December 2022 in Andalusia, as well as the evolution of the cornea donation and transplant activity of the public and private hospitals pertaining to the waiting list management system of the Public Health System of Andalusia. Transplants performed in private centers with corneas from outside Andalusia were excluded. RESULTS Cornea donation activity in Andalusia in the decade 2013-2022 has experienced a growth of more than 126%, while overall transplant activity has increased by 157% in public hospitals. Penetrating keratoplasty has decreased from 83% in 2013 to 43% in 2022, while lamellar techniques have increased from 17% to 57% in this same period. Since 2018, more lamellar transplants are performed than penetrating transplants. Regarding indications, endothelial conditions already represent the first cause of transplantation. In 2022 alone, the public Andalusian Eye Banks evaluated 1,054 corneas and prepared 281 endothelial grafts. CONCLUSION In the decade from 2013 to 2022 in Andalusia there has been an increase in donation activity and the number of keratoplasties. The public Eye Banks implementation in this period has played a key role in the widespread adoption of lamellar keratoplasty techniques and has enabled the transition to perform a greater number of lamellar keratoplasties compared to penetrating keratoplasty.
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Affiliation(s)
- M Rodríguez-Calvo-de-Mora
- Qvision, Departmento Oftalmología, VITHAS Almería Hospital, Almería, Spain; Unidad de Córnea y Superficie Ocular, Departamento Oftalmología, VITHAS Málaga. Málaga, Spain; Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain.
| | - J Giménez-Almenara-Amo
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain; Unidad de Córnea y Cirugía Refractiva, Clínica Baviera Córdoba, Córdoba, Spain
| | - B Mataix-Albert
- Unidad de Córnea y Superficie Ocular, Hospital Universitario Virgen Macarena, Sevilla, Spain; Unidad de Córnea y Superficie Ocular, Hospital Quirón Ave María, Sevilla, Spain
| | - M Arias-Alcalá
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - J García-Montesinos-Gutiérrez
- Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Unidad de Córnea y Superficie Ocular, Miranza Málaga, Málaga, Spain; HM Hospitales Málaga, Málaga, Spain
| | - C Rocha-de-Lossada
- Qvision, Departmento Oftalmología, VITHAS Almería Hospital, Almería, Spain; Unidad de Córnea y Superficie Ocular, Departamento Oftalmología, VITHAS Málaga. Málaga, Spain; Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Universidad de Sevilla, Departamento de Cirugía, Área de Oftalmología, Sevilla, Spain
| | | | | | - N Cuende
- Coordinación Autonómica de Trasplantes de Andalucía, Spain
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Carini FC, Munshi L, Novitzky-Basso I, Dozois G, Heredia C, Damouras S, Ferreyro BL, Mehta S. Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study. Med Intensiva 2024:S2173-5727(24)00141-3. [PMID: 38906793 DOI: 10.1016/j.medine.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM). DESIGN Retrospective cohort study (2014-2022). SETTING Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center. PATIENTS Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy. INTERVENTIONS None. MAIN VARIABLES OF INTEREST We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU. RESULTS We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76-0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary. CONCLUSIONS In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%. CLINICAL TRIAL REGISTRATION NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).
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Affiliation(s)
- Federico C Carini
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Laveena Munshi
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Igor Novitzky-Basso
- Princess Margaret Cancer Centre, Department of Medical Oncology; University Health Network, Toronto, Ontario, Canada
| | - Graham Dozois
- Princess Margaret Cancer Centre, Department of Medical Oncology; University Health Network, Toronto, Ontario, Canada
| | - Camila Heredia
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sotirios Damouras
- Department of Computer & Mathematical Sciences, University of Toronto Scarborough, Ontario, Canada
| | - Bruno L Ferreyro
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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193
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Blasco Mariño R, Argudo E, Soteras Martinez I. Before and after the first extracorporeal cardiopulmonary resuscitation due to accidental hypothermia in Spain. Med Intensiva 2024:S2173-5727(24)00165-6. [PMID: 38906789 DOI: 10.1016/j.medine.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Robert Blasco Mariño
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Facultad de Medicina, Departamento de Ciencias Médicas. Universidad de Girona, Girona, Spain
| | - Eduard Argudo
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Grupo de Investigación en Shock, Disfunción Orgánica y Reanimación (SODIR), Vall d'Hebron Institut de Recerca, Barcelona, Spain.
| | - Iñigo Soteras Martinez
- Sistema d'Emergències Mèdiques (SEM), Spain; Servicio de Urgencias, Hospital Transfrontarer de la Cerdanya, Girona, Spain
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194
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Sun PF, Wang CJ, Du Y, Zhan YQ, Shen PP, Ding YH. Development and validation of a nomogram to predict risk of septic cardiomyopathy in the intensive care unit. Sci Rep 2024; 14:14114. [PMID: 38898142 PMCID: PMC11187202 DOI: 10.1038/s41598-024-64965-x] [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: 12/21/2023] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
The aim of this study was to develop a simple but effective nomogram to predict risk of septic cardiomyopathy (SCM) in the intensive care unit (ICU). We analyzed data from patients who were first admitted to the ICU for sepsis between 2008 and 2019 in the MIMIC-IV database, with no history of heart disease, and divided them into a training cohort and an internal validation cohort at a 7:3 ratio. SCM is defined as sepsis diagnosed in the absence of other cardiac diseases, with echocardiographic evidence of left (or right) ventricular systolic or diastolic dysfunction and a left ventricular ejection fraction (LVEF) of less than 50%. Variables were selected from the training cohort using the Least Absolute Shrinkage and Selection Operator (LASSO) regression to develop an early predictive model for septic cardiomyopathy. A nomogram was constructed using logistic regression analysis and its receiver operating characteristic (ROC) and calibration were evaluated in two cohorts. A total of 1562 patients participated in this study, with 1094 in the training cohort and 468 in the internal validation cohort. SCM occurred in 13.4% (147 individuals) in the training cohort, 16.0% (75 individuals) in the internal validation cohort. After adjusting for various confounding factors, we constructed a nomogram that includes SAPS II, Troponin T, CK-MB index, white blood cell count, and presence of atrial fibrillation. The area under the curve (AUC) for the training cohort was 0.804 (95% CI 0.764-0.844), and the Hosmer-Lemeshow test showed good calibration of the nomogram (P = 0.288). Our nomogram also exhibited good discriminative ability and calibration in the internal validation cohort. Our nomogram demonstrated good potential in identifying patients at increased risk of SCM in the ICU.
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Affiliation(s)
- Peng-Fei Sun
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Cheng-Jian Wang
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Ying Du
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yu-Qin Zhan
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Pan-Pan Shen
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Ya-Hui Ding
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
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195
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Fuentes E, Jacob J, Del Castillo JG, Montero-Pérez FJ, Alquezar-Arbé A, García-Lamberechts EJ, Aguiló S, Fernández-Alonso C, Burillo-Putze G, Piñera P, Llauger L, Vázquez-Rey V, Carrasco-Fernández E, Juárez R, Blanco-Hoffman MJ, de Las Nieves Rodríguez E, Rios-Gallardo R, Berenguer-Diez MA, Guiu S, López-Laguna N, Delgado-Sardina V, Diego-Robledo FJ, Ezponda P, Martínez-Lorenzo A, Ortega-Liarte JV, García-Rupérez I, Borne-Jerez S, Gil-Rodrigo A, Llorens P, Miró Ò. Use of resources in elderly patients consulting the emergency department: analysis of the Emergency Department and Elder Needs Cohort (EDEN-21). Intern Emerg Med 2024:10.1007/s11739-024-03638-z. [PMID: 38896167 DOI: 10.1007/s11739-024-03638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/08/2024] [Indexed: 06/21/2024]
Abstract
The elderly population frequently consults the emergency department (ED). This population could have greater use of EDs and hospital health resources. The EDEN cohort of patients aged 65 years or older visiting the ED allowed this association to be investigated. To analyse the association between healthcare resource use and the characteristics of patients over 65 years of age who consult hospital EDs. We performed an analysis of the EDEN cohort, a retrospective, analytical, and multipurpose registry that includes patients over 65 years of age who consulted in 52 Spanish EDs. The impact of age, sex, and characteristics of ageing on the following outcomes was studied: need for hospital admission (primary outcome) and need for observation, stay in the ED > 12 h, prolonged hospital stay > 7 days, need for intensive care unit (ICU) and return to the ED at 30 days related to the index visit (secondary outcomes). The association was analysed by calculating the adjusted odds ratios (aOR) and their 95% confidence intervals (CI), using a logistic regression model. A total of 25,557 patients with a mean age of 78.3 years were analysed, 45% were males. Of note was the presence of comorbidity, a Charlson index ≥ 3 (33%), and polypharmacy (66%). Observation in the ED was required by 26%, 25.4% were admitted to the hospital, and 0.9% were admitted to the ICU. The ED stay was > 12 h in 12.5% and hospital stay > 7 days in 13.5% of cases. There was a progressive increase in healthcare resource use based on age, with an aOR for the need for observation of 2.189 (95% CI 2.038-2.352), ED stay > 12 h 2.136 (95% CI 1.942-2.349) and hospital admission 2.579 (95% CI 2.399-2.772) in the group ≥ 85 years old. Most of the characteristics inherent to ageing (cognitive impairment, falls in the previous 6 months, polypharmacy, functional dependence, and comorbidity) were associated with significant increases in the use of healthcare resources, except for ICU admission, which was less in all the variables studied. Age and the characteristics inherent to ageing are associated with greater use of structural healthcare resources.
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Affiliation(s)
- Elena Fuentes
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | | | | | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | | | - Pascual Piñera
- Servicio de Urgencias, Hospital Reina Sofía, Murcia, Spain
| | - Lluís Llauger
- Servicio de Urgencias, Hospital de Vic, Barcelona, Spain
| | | | | | - Ricardo Juárez
- Servicio de Urgencias, Hospital Nuestra Señora del Prado de Talavera de La Reina, Toledo, Spain
| | | | | | | | | | - Sandra Guiu
- Servicio de Urgencias, Hospital Universitario Son Espases, Illes Balears, Spain
| | | | | | | | - Patxi Ezponda
- Servicio de Urgencias, Hospital de Zumarraga, Gipuzkoa, Spain
| | | | | | | | | | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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196
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O'Hara JE, Graham RJ. Pediatric pulmonology year in review-Pediatric pulmonary critical care. Pediatr Pulmonol 2024. [PMID: 38888167 DOI: 10.1002/ppul.27116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
Pediatric pulmonary critical care literature has continued to grow in recent years. Our aim in this review is to narrowly focus on publications providing clinically-relevant advances in pediatric pulmonary critical care in 2023.
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Affiliation(s)
- Jill E O'Hara
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Robert J Graham
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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197
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Moïsi L, Mino JC, Guidet B, Vallet H. Frailty assessment in critically ill older adults: a narrative review. Ann Intensive Care 2024; 14:93. [PMID: 38888743 PMCID: PMC11189387 DOI: 10.1186/s13613-024-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.
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Affiliation(s)
- L Moïsi
- Department of Geriatrics, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012, Paris, France.
- UVSQ, INSERM, Centre de Recherche en Epidémiologie Et Santé Des Populations, UMR 1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France.
- Département d'éthique, Faculté de Médecine, Sorbonne Université, Paris, France.
- Service de Gériatrie Aigue, Hopital St Antoine, 184 rue du Fbg St Antoine, 75012, Paris, France.
| | - J-C Mino
- UVSQ, INSERM, Centre de Recherche en Epidémiologie Et Santé Des Populations, UMR 1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
- Département d'éthique, Faculté de Médecine, Sorbonne Université, Paris, France
| | - B Guidet
- Service de Réanimation Médicale, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
- INSERM, UMRS 1136, Institute Pierre Louis d'Épidémiologie Et de Santé Publique, 75013, Paris, France
| | - H Vallet
- Department of Geriatrics, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012, Paris, France
- UMRS 1135, Centre d'immunologie Et de Maladies Infectieuses (CIMI), Institut National de La Santé Et de La Recherche Médicale (INSERM), Paris, France
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198
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Pérez-Torres D, Martín-Luengo AI, Cuenca-Rubio C, Berezo-García JÁ, Díaz-Rodríguez C, Canas-Pérez I, Fernández-Rodríguez ML, Colmenero-Calleja C, Sánchez-Ballesteros J, Blanco-Schweizer P, Ticona-Espinoza TG, Piqueras-Pérez JM. Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study. Med Intensiva 2024:S2173-5727(24)00139-5. [PMID: 38897897 DOI: 10.1016/j.medine.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU). DESIGN Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups. SETTING Four-bed BU, in a referral University Hospital in Spain. PATIENTS All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded. INTERVENTION SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU. MAIN VARIABLE OF INTEREST Incidence of HAIs during the stay in the BU. SECONDARY OUTCOMES incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints. RESULTS We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21-3.82) and 1.13 (0.54-1.73), respectively (p=0.029). CONCLUSIONS SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.
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Affiliation(s)
- David Pérez-Torres
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Programa de Optimización del Uso de Antimicrobianos (PROA), Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain.
| | - Ana Isabel Martín-Luengo
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cristina Cuenca-Rubio
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José Ángel Berezo-García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cristina Díaz-Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Isabel Canas-Pérez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - María Lorena Fernández-Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cristina Colmenero-Calleja
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Jesús Sánchez-Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo Blanco-Schweizer
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Thalia Gloria Ticona-Espinoza
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José María Piqueras-Pérez
- Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Servicio de Cirugía Plástica, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
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199
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Cerezuela MM, Becerril Moreno F, Amor García MÁ, Bastida Fernández C, Aquerreta González I, Cobo Sacristán S, Egüés Lugea A, Albanell Fernández M, Doménech Moral L, Fernández Polo A, Betancor García T, Ortiz Pérez S, Domingo Chiva E. National record and analysis of pharmaceutical interventions in critical care units: PHARMACRITIC study. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00088-6. [PMID: 38890066 DOI: 10.1016/j.farma.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To design a homogeneous methodology for the registration and analysis of pharmaceutical interventions performed in Spanish critical adults' care units. METHOD Observational, prospective and multicenter study. In the first stage, a national registry of pharmaceutical interventions will be agreed upon and subsequently all the pharmaceutical interventions performed on adult patients admitted to Spanish CCUs during eight weeks will be recorded. Variables related to the type of CCU, the drug involved in the intervention, type of intervention (indication, effectiveness, safety), recommendation made by the pharmacist and the degree of acceptance will be evaluated. Risk and incidence will be calculated for each of the medication errors detected. The χ2-squared test or Fisher exact test will be used for categorical variables and Mann-Whitney U or Kruskal-Wallis test for continuous variables. All tests will be performed with a significance level α = 0.05 and confidence intervals with confidence 1- α. DISCUSSION The results obtained from this project will make it possible to obtain a homogeneous classification of the pharmaceutical interventions performed in CCU, a national record and an evaluation of the weak points with the aim of developing strategies for improvement in the pharmaceutical care of the critically ill patient.
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Affiliation(s)
| | | | | | | | | | | | - Amaia Egüés Lugea
- Servicio de Farmacia, Complejo Hospitalario de Navarra, Pamplona, España
| | | | | | | | - Tatiana Betancor García
- Servicio de Farmacia, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España
| | - Sara Ortiz Pérez
- Servicio de Farmacia, Hospital Universitario 12 de Octubre, Madrid, España
| | - Esther Domingo Chiva
- Servicio de Farmacia, Gerencia de Atención Integrada de Albacete, Albacete, España.
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Travers R, Gagliardi G, Ramseyer M. Delirium management in perioperative geriatric services: a narrative review of non-pharmaceutical strategies. Front Psychiatry 2024; 15:1394583. [PMID: 38952635 PMCID: PMC11215170 DOI: 10.3389/fpsyt.2024.1394583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Delirium, a common complication in elderly surgical patients, poses significant challenges in perioperative care. Perioperative geriatric services (PGS) aim at managing comorbidities, postoperative complications, and initiating early recovery of mobility to enhance elderly patients' prognosis in the perioperative period. Studies have shown that patients with preoperative cognitive disorders are at a significantly increased risk of postoperative delirium. While postoperative delirium affects up to 70% of people over 60 and 90% of people with neurodegenerative diseases, it remains underdiagnosed in many cases. Postoperative delirium can lead to functional decline, prolonged hospitalization, increased healthcare costs, cognitive impairment, and psychological malaise. This article briefly summarizes the literature on delirium, its risk factors, and its non-pharmaceutical management strategies within the perioperative period. It highlights the importance of integrating cognitive and psychological assessments into perioperative care protocols to provide baseline data, improve patient outcomes, reduce hospital stays, and minimize complications associated with delirium. By embracing evidence-based delirium management protocols, healthcare professionals can better identify and manage delirium, ultimately improving the quality of care for elderly surgical patients, which would also benefit healthcare staff and healthcare institutions.
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Affiliation(s)
- Rozenn Travers
- Service de Court Séjour Gériatrique, Pôle Médecines Fortes Consultations, Centre Hospitalier Universitaire d’Orléans, Orléans, France
| | - Geoffroy Gagliardi
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Maximilian Ramseyer
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
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