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Proffitt T, Menzies V. Relationship of symptoms associated with ICU-survivorship: An integrative literature review. Intensive Crit Care Nurs 2019; 53:60-67. [PMID: 30878537 DOI: 10.1016/j.iccn.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/23/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of adults who survive a critical illness involving admission to an intensive care unit is increasing. These survivors have an increased risk of developing impairments in cognition, physical function and psychological health. OBJECTIVE This integrative literature review examined the literature for studies exploring the relationships among two or more of the variables of interest, i.e. cognitive, physical, and psychological symptoms (depressive, anxiety, or posttraumatic stress) in intensive care unit survivors post-hospital discharge. METHODS A literature search was conducted using PubMed, CINHAL and PsycINFO databases. FINDINGS While all 13 studies included in the review explored some aspect of a relationship among the variables of interest, none explored associations among all three variables. Five studies explored physical function and psychological symptoms, four studies explored cognitive impairment and psychological symptoms and five studies explored the association among different psychological symptoms. Inconsistencies were found in the study designs, follow-up time frames, patient populations and measures used. CONCLUSIONS Further research using well-designed methodologies and standardized instruments is warranted. Gaining a better understanding of the relationships among these impairments has the potential to contribute to the development of screening guidelines, preventative strategies, and treatments.
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Affiliation(s)
- Tracye Proffitt
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Box 980567, Richmond, VA 23298-0567, United States.
| | - Victoria Menzies
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Box 980567, Richmond, VA 23298-0567, United States
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202
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Elliott R, Yarad E, Webb S, Cheung K, Bass F, Hammond N, Elliott D. Cognitive impairment in intensive care unit patients: A pilot mixed-methods feasibility study exploring incidence and experiences for recovering patients. Aust Crit Care 2019; 32:131-138. [DOI: 10.1016/j.aucc.2018.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/13/2018] [Accepted: 01/14/2018] [Indexed: 12/20/2022] Open
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203
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[Hematological-oncological intensive care patients : Treatment without borders]. Med Klin Intensivmed Notfmed 2019; 114:214-221. [PMID: 30725269 DOI: 10.1007/s00063-019-0532-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 01/07/2023]
Abstract
The number of treatment options and success of treating patients with cancer have both significantly increased in recent years. However, many of these patients require intensive care due to comorbidities, treatment-associated complications, or severe infections. At the same time, the boundaries between what is feasible and sensible are difficult to draw. Over the past few years, awareness of the problems these cancer patients may have in the intensive care unit has increased and discussions have begun. This article intends to offer a discussion basis and also possible solution strategies.
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Valent F, Sermann G, De Monte A. One-year post-ICU discharge survival among patients receiving long-term intensive care in the University Hospital of Udine, Italy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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205
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Abstract
Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential solutions include the development of common definitions for intensive care unit (ICU), intensivist, and intensive care to create a universal ICU organization framework; development of educational programs for capacity building of health care professionals working in resource-limited settings; global prioritization of epidemiologic and clinical research in resource-limited settings to conduct timely and ethical studies in response to emerging threats; adaptation of international guidelines to promote implementation of evidence-based care; and strengthening of health systems that integrates these interventions. This manuscript reviews the field of global critical care, barriers to safe high-quality care, and potential solutions to existing challenges. We also suggest a roadmap for improving the treatment of critically ill patients in resource-limited settings.
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206
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Clarissa C, Salisbury L, Rodgers S, Kean S. Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities. J Intensive Care 2019; 7:3. [PMID: 30680218 PMCID: PMC6337811 DOI: 10.1186/s40560-018-0355-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022] Open
Abstract
Background Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature. Methods Whittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies. Results Seventy-six studies were included from which four major themes were inferred: (1) non-standardised definition, (2) contextual factors, (3) negotiated process and (4) collaboration between patients and staff. The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients’ characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation. Conclusions This review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.
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Affiliation(s)
- Catherine Clarissa
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Lisa Salisbury
- 2Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU UK
| | - Sheila Rodgers
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Susanne Kean
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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Kompotiatis P, Wiley BM, Jentzer JC, Kashani KB. Echocardiographic parameters of patients in the intensive care unit undergoing continuous renal replacement therapy. PLoS One 2019; 14:e0209994. [PMID: 30633756 PMCID: PMC6329514 DOI: 10.1371/journal.pone.0209994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/16/2018] [Indexed: 12/29/2022] Open
Abstract
MAIN OBJECTIVES Echocardiographic parameters have been used to predict outcomes for specific intensive care unit (ICU) populations. We sought to define echocardiographic parameters for ICU patients receiving continuous renal replacement therapy (CRRT). DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS This is a historical cohort study of consecutive ICU patients at Mayo Clinic (Rochester, Minnesota) who received CRRT from December 9, 2006, through November 13, 2015. Only patients with an echocardiographic examination within 7 days of CRRT initiation were considered. RESULTS The study included 1,276 patients. Decreased left ventricular ejection fraction (LVEF; ≤45%) was noted in 361/1,120 (32%) and increased right ventricular systolic pressure (RVSP; ≥40 mm Hg) was noted in 529/798 (66%). Right ventricular systolic dysfunction was observed in 320/820 (39%). The most common valvular abnormality was tricuspid regurgitation (244/1,276 [19%]). Stratification of these parameters by ICU type (medical, surgical, cardiothoracic, cardiac) showed that most echocardiographic abnormalities were significantly more prevalent among cardiac ICU patients: LVEF ≤45% (67/105 [64%]), RVSP ≥40 mm Hg (63/79 [80%]) and tricuspid regurgitation (50/130 [38%]). We compared patients with acute kidney injury (AKI) vs end-stage renal disease and showed that decreased LVEF (284/921 [31%] vs 78/201 [39%]), was significantly less prevalent among patients with AKI, but increased RVSP was more prevalent (445/651 [68%] vs 84/147 [57%]) with AKI. CONCLUSIONS ICU patients who required CRRT had increased prevalence of pulmonary hypertension and right and left ventricular systolic dysfunction. Prediction of adverse outcomes with echocardiographic parameters in this patient population can lead to identification of modifiable risk factors.
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Affiliation(s)
- Panagiotis Kompotiatis
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
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Mk MV, Krishna B, Sampath S. Secular Trends in an Indian Intensive Care Unit-database Derived Epidemiology: The Stride Study. Indian J Crit Care Med 2019; 23:251-257. [PMID: 31435142 PMCID: PMC6698356 DOI: 10.5005/jp-journals-10071-23175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Context The Indian Society of Critical Care Medicine (ISCCM), had taken an initiative to enable all Indian ICUs (Intensive Care Unit) to capture and store relevant data in a systematic manner in an electronic database: “CHITRA” (Customized Health in Intensive Care Trainable Research and Analysis tool). Aims This study was aimed at capturing, and summarising longitudinal epidemiological data from a single tertiary care hospital ICU (Intensive Care Unit), based on a pre-existing database and the CHITRA system. Settings and design Prospective Observational Materials and methods Data was extracted from two databases, a pre-existing database, arbitrarily named pre-CHITRA (January 2006 to April 2014), and the CHITRATM database (October 2015 to January 2018). Diagnoses of the patients admitted were tabulated using the ICD10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) coding format. The outcomes were summarised and cross tabulated. Statistical analysis used Cross tabulations were used to display summarized data, analysis of outcomes were done using t test and regression analyses, and correspondence analysis was used to explore associations of descriptors. Results A total of 18940 patients were admitted, with a male preponderance, and the median age was fifty-two years. Most of admissions were from emergency (62%). The age (0.3, p = 0.000, CI (0.2 - 0.38)) and mean APACHE II score of patients had increased over the years (0.18, p = 0.000 CI (0.12-0.25). The ICU mortality had decreased significantly over the years (–0.04, p = 0.000, CI (–0.05 to –0.03)). The most common admission diagnosis in the pre-CHITRA database was general symptoms and signs (ICD10 R50-R69), and in the CHITRA database was Type1 Respiratory failure (ICD 10 J96.90). Conclusion This study has shown the utility of the CHITRA system in capturing epidemiological data from a single centre. Key messages The utility of the CHITRA system in capturing epidemiological data has been shown. How to cite this article Manu Varma MK, Krishna B, Sampath S. Secular Trends in an Indian Intensive Care Unit-Database Derived Epidemiology: The Stride Study. Indian J Crit Care Med 2019;23(6):251–257.
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Affiliation(s)
- Manu Varma Mk
- Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sriram Sampath
- Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
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209
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Kim EY, Oldham WM. Innate T cells in the intensive care unit. Mol Immunol 2019; 105:213-223. [PMID: 30554082 PMCID: PMC6331274 DOI: 10.1016/j.molimm.2018.09.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/22/2018] [Accepted: 09/29/2018] [Indexed: 12/15/2022]
Abstract
Rapid onset of acute inflammation is a hallmark of critical illnesses that bring patients to the intensive care unit (ICU). In critical illness, innate T cells rapidly reach full activation and drive a robust acute inflammatory response. As "cellular adjuvants," innate T cells worsen inflammation and mortality in several common critical illnesses including sepsis, ischemia-reperfusion injury, stroke, and exacerbations of respiratory disease. Interestingly, innate T cell subsets can also promote a protective and anti-inflammatory response in sepsis, ischemia-reperfusion injury, and asthma. Therapies that target innate T cells have been validated in several models of critical illness. Here, we review the role of natural killer T (NKT) cells, mucosal-associated invariant T (MAIT) cells and γδ T cells in clinical and experimental critical illness.
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Affiliation(s)
- Edy Yong Kim
- Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, MA, 02115, United States; Harvard Medical School, Boston, MA, 02115, United States.
| | - William M Oldham
- Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, MA, 02115, United States; Harvard Medical School, Boston, MA, 02115, United States
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210
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Granholm A, Christiansen CF, Christensen S, Perner A, Møller MH. Performance of SAPS II according to ICU length of stay: Protocol for an observational study. Acta Anaesthesiol Scand 2019; 63:122-127. [PMID: 30066446 DOI: 10.1111/aas.13233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Severity scores, including the Simplified Acute Physiology Score (SAPS) II, are widely used in the intensive care unit (ICU) to predict mortality outcomes using data from ICU admission or shortly hereafter. For patients with longer ICU length of stay (LOS), the predictive performance of admission-based severity scores may deteriorate compared to patients with shorter ICU LOS. This protocol and statistical analysis plan outlines a study that will assess the influence of ICU LOS on the performance of SAPS II for predicting 90-day post-ICU mortality. METHODS A Danish nationwide cohort study including adult (≥18 years) ICU patients admitted to a Danish ICU between 1 January 2012 and 30 June 2016. The study will be conducted using the Danish Intensive Care Database (DID), which contains data routinely, prospectively, and consecutively reported for all Danish ICU admissions. Discrimination of SAPS II for predicting 90-day post-ICU mortality will be assessed for the entire cohort and stratified according to ICU LOS. A first-level recalibration of SAPS II will be performed, and if adequate, standardised mortality ratios and calibration stratified according to ICU LOS will be reported. CONCLUSIONS The outlined large, nationwide cohort study will provide important, contemporary information about the influence of ICU LOS on severity score performance relevant for ICU clinicians, researchers, and administrators. Publication of the protocol and statistical analysis plan prior to study conduct ensures transparency, and limits the risk of publication bias, post hoc changes in analyses, and challenges with multiple comparisons.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | | | | | - Anders Perner
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
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Oliveira EG, Garcia PC, Citolino Filho CM, de Souza Nogueira L. The influence of delayed admission to intensive care unit on mortality and nursing workload: a cohort study. Nurs Crit Care 2018; 24:381-386. [PMID: 30478867 DOI: 10.1111/nicc.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/19/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The results of studies regarding the relationship between length of stay of patients in emergency departments (EDs) and mortality in intensive care units (ICUs) are contradictory, and nothing is known about the impact of delayed admission of patients to ICUs on nursing workload. AIMS AND OBJECTIVES To assess the influence of the time lapse between ED and ICU admissions on mortality and nursing workload in relation to intensive care patients. DESIGN This was a retrospective cohort study that examined the medical records of patients who were 15 years of age or older and admitted directly to the ICU from the ED. METHODS The data were collected between 2014 and 2016 in a hospital located in São Paulo, Brazil. Nursing workload was measured by the Nursing Activities Score. Multiple linear and logistic regressions were applied, with a significance level of 5%. RESULTS Of the 534 patients analysed, the majority were men (57·49%); the mean age was 55·37 ± 19·64 years. Length of stay in the ED was not associated with nursing workload at the time of admission of patients to the ICU or during their stay in the unit. For mortality, this variable was a risk factor along with cause of admission, length of stay in the ICU and the Simplified Acute Physiology Score 3 score. For every additional hour that patients remained in the ED, their chance of dying in the ICU increased by 1%. CONCLUSION Length of stay of patients in the ED was a risk factor for mortality in the ICU; however, this variable did not have any influence on nursing workload. RELEVANCE TO CLINICAL PRACTICE Strategies need to be implemented to optimize the availability of ICU beds and reduce the length of stay of critical patients in the ED as delays in admitting such patients to the ICU have an impact on mortality.
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Affiliation(s)
- Ester Góes Oliveira
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
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212
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Pertzov B, Eliakim-Raz N, Atamna H, Trestioreanu AZ, Yahav D, Leibovici L. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) for the treatment of sepsis in adults - A systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:280-289. [PMID: 30472427 DOI: 10.1016/j.cmi.2018.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/14/2018] [Accepted: 11/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The pleiotropic effect of hydroxymethylglutaryl-CoA reductase inhibitors (statins) might have a beneficial effect in sepsis through several mechanisms. The aim was to assess the efficacy and safety of statins, compared with placebo, for the treatment of sepsis in adults. METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2017, Issue 12), OVID MEDLINE (from 1966 to January 2018), Embase (Ovid SP, from 1974 to January 2018), and LILACS (from 1986 to January 2018). We also searched the trial registries ISRCTN and ClinicalTrials.gov to January 2018. The eligibility criteria were randomized controlled trials comparing the treatment of statins versus placebo in adult patients who were hospitalized due to sepsis. Participants were adults (16 years and older) hospitalized because of sepsis or who developed sepsis during admission. Interventions were treatment with hydroxymethylglutaryl-CoA reductase inhibitors (statins) versus no treatment or placebo. We performed a systematic review of all randomized controlled trials published until January 2018, assessing the efficacy and safety of statins in sepsis treatment. Two primary outcomes were assessed: 30-day overall mortality and deterioration to severe sepsis during management. Secondary outcomes were hospital mortality, need for mechanical ventilation and drug related adverse events. RESULTS Fourteen trials evaluating 2628 patients were included. Statins did not reduce 30-day all-cause mortality neither in all patients (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.83-1.10), nor in a subgroup of patients with severe sepsis (RR 0.97, 95% CI 0.84-1.12). The certainty of evidence for both outcomes was high. There was no change in the rate of adverse events between study arms (RR 1.24, 95% CI 0.94 to 1.63). The certainty of evidence for this outcome was high. CONCLUSIONS The use of statin therapy in adults for the indication of sepsis is not recommended.
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Affiliation(s)
- B Pertzov
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Atamna
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Z Trestioreanu
- Department of Family Medicine, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel
| | - D Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Comparison of Mortality Risk Prediction Among Patients ≥70 Versus <70 Years of Age in a Cardiac Intensive Care Unit. Am J Cardiol 2018; 122:1773-1778. [PMID: 30227963 DOI: 10.1016/j.amjcard.2018.08.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 11/21/2022]
Abstract
Older adults account for an increasing number of cardiac intensive care unit (CICU) admissions. This study sought to determine the predictive value of illness severity scores for mortality in CICU patients ≥70 years of age. Adult patients admitted to the CICU from 2007 to 2015 at one tertiary care hospital were reviewed. Severity of illness scores were calculated on the first CICU day. Area under the receiver-operator characteristic curve (AUROC) values were used to assess discrimination for hospital mortality in patients ≥70 versus <70 years of age. We included 10,004 patients with a mean age of 67.4 ± 15.2 years (37.4% female); 4,771 patients (47.7%) were ≥70 years of age. Patients ≥70 years of age had greater illness severity and more extensive co-morbidities compared with patients <70 years of age. Patients ≥70 years of age had higher hospital mortality (11.6% vs 6.8%, odds ratio 1.80, 95% confidence interval 1.57 to 2.07, p <0.001), with a progressive increase in mortality as a function of decade. Severity of illness scores had lower AUROC values for hospital mortality in patients ≥70 years of age compared with patients <70 years of age (all p <0.05 by DeLong test). The Braden skin score on CICU admission predicted hospital mortality with an AUROC value only slightly lower than these scores. Increasing age decade was associated with decreased postdischarge survival by Kaplan-Meier analysis (p <0.001 by log-rank). In conclusion, contemporary CICU patients ≥70 years of age have greater illness severity, more co-morbidities and higher mortality than patients <70 years of age, yet severity of illness scores are less accurate for predicting mortality in CICU patients ≥70 years of age, emphasizing the need for more effective risk-stratification methods in this population.
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O'Shea AMJ, Fortis S, Vaughan Sarrazin M, Moeckli J, Yarbrough WC, Schacht Reisinger H. Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration. J Crit Care 2018; 49:64-69. [PMID: 30388490 DOI: 10.1016/j.jcrc.2018.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. MATERIALS AND METHOD Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010-2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33). RESULTS In rural hospitals, patients (N = 9665) were less likely to have a respiratory (12.9% v. 18.9%; p < .001) diagnosis, more likely diagnosed with sepsis (17.6% v. 4.9%), and had a higher illness severity score (42.0 vs. 41.4; p = .01) compared to urban (N = 65,846) counterparts. Mortality within ICU did not vary across facility rurality. In unadjusted analyses, facility rurality (rural vs. urban) was associated with reduced inter-hospital transfers (OR = 0.74; 95% CI = [0.69, 0.80]; p < .001) and a shorter ICU length of stay (RR = 0.82; 95% CI = [0.74, 0.91]; p < .001). This did not hold when the hierarchical data was accounted for. CONCLUSIONS Despite challenges, low complexity ICUs in rural VA facilities fare similarly to urban counterparts. Being part of a national healthcare system may have benefits to explore in sustaining critical care access in rural areas outside the VA healthcare system.
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Affiliation(s)
- Amy M J O'Shea
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Spyridon Fortis
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Mary Vaughan Sarrazin
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jane Moeckli
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA
| | - W C Yarbrough
- Department Pulmonary/Critical Care, VA North Texas Healthcare System, Dallas, TX, USA; Department of Internal Medicine, U.T. Southwestern Medical Center, Dallas, TX, USA
| | - Heather Schacht Reisinger
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Byrne BE, Vincent CA, Faiz OD. Inequalities in Implementation and Different Outcomes During the Growth of Laparoscopic Colorectal Cancer Surgery in England: A National Population-Based Study from 2002 to 2012. World J Surg 2018; 42:3422-3431. [PMID: 29633102 PMCID: PMC6132863 DOI: 10.1007/s00268-018-4615-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM Laparoscopic colorectal cancer surgery has developed from unproven technique to mainstay of treatment. This study examined the application and relative outcomes of laparoscopic and open colorectal cancer surgery over time, as laparoscopic uptake and experience have grown. METHODS Adults undergoing elective laparoscopic and open colorectal cancer surgery in the English NHS during 2002-2012 were included. Age, sex, Charlson Comorbidity Index and Index of Multiple Deprivation were compared over time. Post-operative 30-day mortality, length of stay, failure to rescue reoperation and the associated mortality rate were examined. RESULTS Laparoscopy rates rose from 1.1 to 50.8%. Patients undergoing laparoscopic surgery had lower comorbidity by 0.24 points (95% confidence intervals (CI) 0.20-0.27) and lower socioeconomic deprivation by 0.16 deciles (95% CI 0.12-0.20) than those having open procedures. Overall mortality fell by 48.0% from 2002-2003 to 2011-2002 and was 37.8% lower after laparoscopic surgery. Length of stay and mortality after surgical re-intervention also fell. However, re-intervention rates were higher after laparoscopic procedures by 7.8% (95% CI 0.9-15.2%). CONCLUSIONS There was clear and persistent inequality in the application of laparoscopic colorectal cancer surgery during this study. Further work must explore and remedy inequalities to maximise patient benefit. Higher re-intervention rates after laparoscopy are unexplained and differ from randomized controlled trials. This may reflect differences in surgeons and practice between research and usual care settings and should be further investigated.
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Affiliation(s)
- B E Byrne
- Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - C A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - O D Faiz
- Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital, Harrow, UK
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Hermes C, Acevedo-Nuevo M, Berry A, Kjellgren T, Negro A, Massarotto P. Gaps in pain, agitation and delirium management in intensive care: Outputs from a nurse workshop. Intensive Crit Care Nurs 2018; 48:52-60. [DOI: 10.1016/j.iccn.2018.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/16/2018] [Accepted: 01/28/2018] [Indexed: 11/27/2022]
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217
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English SW, McIntyre L, Saigle V, Chassé M, Fergusson DA, Turgeon AF, Lauzier F, Griesdale D, Garland A, Zarychanski R, Algird A, van Walraven C. The Ottawa SAH search algorithms: protocol for a multi- centre validation study of primary subarachnoid hemorrhage prediction models using health administrative data (the SAHepi prediction study protocol). BMC Med Res Methodol 2018; 18:94. [PMID: 30219029 PMCID: PMC6139177 DOI: 10.1186/s12874-018-0553-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/31/2018] [Indexed: 01/07/2023] Open
Abstract
Background Conducting prospective epidemiological studies of hospitalized patients with rare diseases like primary subarachnoid hemorrhage (pSAH) are difficult due to time and budgetary constraints. Routinely collected administrative data could remove these barriers. We derived and validated 3 algorithms to identify hospitalized patients with a high probability of pSAH using administrative data. We aim to externally validate their performance in four hospitals across Canada. Methods Eligible patients include those ≥18 years of age admitted to these centres from January 1, 2012 to December 31, 2013. We will include patients whose discharge abstracts contain predictive variables identified in the models (ICD-10-CA diagnostic codes I60** (subarachnoid hemorrhage), I61** (intracranial hemorrhage), 162** (other nontrauma intracranial hemorrhage), I67** (other cerebrovascular disease), S06** (intracranial injury), G97 (other postprocedural nervous system disorder) and CCI procedural codes 1JW51 (occlusion of intracranial vessels), 1JE51 (carotid artery inclusion), 3JW10 (intracranial vessel imaging), 3FY20 (CT scan (soft tissue of neck)), and 3OT20 (CT scan (abdominal cavity)). The algorithms will be applied to each patient and the diagnosis confirmed via chart review. We will assess each model’s sensitivity, specificity, negative and positive predictive value across the sites. Discussion Validating the Ottawa SAH Prediction Algorithms will provide a way to accurately identify large SAH cohorts, thereby furthering research and altering care.
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Affiliation(s)
- S W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, K1Y 4E9, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - L McIntyre
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - V Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Chassé
- Department of Medicine, Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - D A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - A F Turgeon
- Centre de recherche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - F Lauzier
- Centre de recherche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Québec, Université Laval, Québec City, QC, Canada
| | - D Griesdale
- Deparment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - A Garland
- Department of Internal Medicine, Sections of Critical Care and Respirology, University of Manitoba, Winnipeg, MB, Canada
| | - R Zarychanski
- Department of Internal Medicine, Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - A Algird
- Department of Neurosurgy, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - C van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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de Hoogt PA, Reisinger KW, Tegels JJW, Bosmans JWAM, Tijssen F, Stoot JHMB. Functional Compromise Cohort Study (FCCS): Sarcopenia is a Strong Predictor of Mortality in the Intensive Care Unit. World J Surg 2018; 42:1733-1741. [PMID: 29285609 PMCID: PMC5934455 DOI: 10.1007/s00268-017-4386-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Functional compromise in elderly patients is considered to be a significant contributing factor in increased postoperative morbidity and mortality. It is described as a state of reduced physiologic reserves including, e.g., sarcopenia, cachexia, malnutrition and frailty with increased susceptibility to adverse health outcomes. Aim of this study was to investigate the association of sarcopenia with mortality in ICU patients. METHODS A retrospective analysis of a total of 687 patients admitted to the ICU from January 2013 until December 2014 was performed. Indirect measurements of functional compromise in these patients were conducted. Sarcopenia was assessed using the L3 muscle index by using Osirix© on computed tomography scans. Groningen Frailty Indicator (GFI) and Short Nutritional Assessment Questionnaire (SNAQ) scores were extracted from the digital patient filing system and were used to assess frailty and nutritional status. These factors were analyzed using logistic regression analysis as predictor for in-hospital mortality and 6-month mortality, which was the primary endpoint along with other secondary outcome measures. RESULTS Age was an independent predictor of in-hospital mortality, OR 1.043 (95% CI 1.030-1.057, p < 0.001). Analysis of sarcopenia showed OR 2.361 (95% CI 1.138-4.895, p = 0.021), for GFI OR 1.012 (95% CI 0.919-1.113, p = 0.811) and for SNAQ OR 1.262 (95% CI 1.091-1.460, p = 0.002). CONCLUSION This study shows a promising role for the sarcopenia score as a predictor of mortality on the ICU, based upon CT imaging at L3 level and SNAQ score. Further research is necessary to test this in larger cohorts and to develop a possible instrument to predict mortality in the intensive care unit.
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Affiliation(s)
- P A de Hoogt
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. .,Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
| | - K W Reisinger
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - J J W Tegels
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - J W A M Bosmans
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - F Tijssen
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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Fortis S, O'Shea AMJ, Beck BF, Nair R, Goto M, Kaboli PJ, Perencevich EN, Reisinger HS, Sarrazin MV. An automated computerized critical illness severity scoring system derived from APACHE III: modified APACHE. J Crit Care 2018; 48:237-242. [PMID: 30243204 DOI: 10.1016/j.jcrc.2018.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the performance of an automated computerized ICU severity scoring derived from the APACHE III. MATERIALS AND METHODS Within a retrospective cohort of patients admitted to Veterans Health Administration ICUs between 2009 and 2015, we created an automated illness severity score(modified APACHE or mAPACHE), that we extracted from the electronic health records, using the same scoring as the APACHE III excluding the Glasgow Coma Scale, urine output, arterial blood gas components of APACHE III. We assessed the mAPACHE discrimination by using the area under the curve(AUC), and calibration by using the Hosmer-Lemeshow test and calculating the difference between observed and expected mortality across equal-sized risk deciles for death. RESULTS The ICU and 30-day mortality was 5.07% of 7.82%, respectively (n = 490,955 patients). The AUC of mAPACHE for ICU and 30-day mortality was 0.771 and 0.786, respectively. The Hosmer-Lemeshow test was significant for both ICU and 30-day mortality (p < .001). The absolute difference between observed and expected mortality did not exceed ±1.53% across equal-sized deciles of risk for death. The AUC for ICU mortality was >0.7 in all admission diagnosis categories except in endocrine, respiratory, and sepsis. The AUC for 30-day mortality was >0.7 in every category. CONCLUSION mAPACHE has adequate performance to predict mortality.
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Affiliation(s)
- Spyridon Fortis
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
| | - Amy M J O'Shea
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Brice F Beck
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - Rajeshwari Nair
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Michihiko Goto
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Peter J Kaboli
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Eli N Perencevich
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Heather S Reisinger
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Mary V Sarrazin
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Rubens M, Saxena A, Ramamoorthy V, Das S, Khera R, Hong J, Armaignac D, Veledar E, Nasir K, Gidel L. Increasing Sepsis Rates in the United States: Results From National Inpatient Sample, 2005 to 2014. J Intensive Care Med 2018; 35:858-868. [DOI: 10.1177/0885066618794136] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives:To examine the trends in hospitalization rates, mortality, and costs for sepsis during the years 2005 to 2014.Methods:This was a retrospective serial cross-sectional analysis of patients ≥18 years admitted for sepsis in National Inpatient Sample. Trends in sepsis hospitalizations were estimated, and age- and sex-adjusted rates were calculated for the years 2005 to 2014.Results:There were 541 694 sepsis admissions in 2005 and increased to 1 338 905 in 2014. Sepsis rates increased significantly from 1.2% to 2.7% during the years 2005 to 2014 (relative increase: 123.8%; Ptrend< .001). However, the relative increase changed by 105.8% ( Ptrend< .001) after adjusting for age and sex and maintained significance. Although total cost of hospitalization due to sepsis increased significantly from US$22.2 to US$38.1 billion ( Ptrend< .001), the mean hospitalization cost decreased significantly from US$46,470 to US$29,290 ( Ptrend< .001).Conclusions:Hospitalizations for sepsis increased during the years 2005 to 2014. Our study paradoxically found declining rates of in-hospital mortality, length of stay, and mean hospitalization cost for sepsis. These findings could be due to biases introduced by International Classification of Diseases, Ninth Revision, Clinical Modification coding rules and increased readmission rates or alternatively due to increased awareness and surveillance and changing disposition status. Standardized epidemiologic registries should be developed to overcome these biases.
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Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
| | | | - Sankalp Das
- Employee Health and Wellness Advantage, Baptist Health South Florida, Miami, FL, USA
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Hong
- Division of Cardiovascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Donna Armaignac
- Teleheath Center of Excellence, Baptist Health South Florida, Miami, FL, USA
| | - Emir Veledar
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Khurram Nasir
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Louis Gidel
- Teleheath Center of Excellence, Baptist Health South Florida, Miami, FL, USA
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Preliminary Validation of the Montreal Cognitive Assessment Tool among Sepsis Survivors: A Prospective Pilot Study. Ann Am Thorac Soc 2018; 15:1108-1110. [DOI: 10.1513/annalsats.201804-233oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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222
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Heo J, Hong Y, Han SS, Kim WJ, Kwon JW, Moon KW, Jeong JH, Kim YJ, Lee SH, Lee SJ. Changes in the Characteristics and Long-term Mortality Rates of Intensive Care Unit Patients from 2003 to 2010: A Nationwide Population-Based Cohort Study Performed in the Republic of Korea. Acute Crit Care 2018; 33:135-145. [PMID: 31723877 PMCID: PMC6786693 DOI: 10.4266/acc.2018.00164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/24/2018] [Accepted: 08/21/2018] [Indexed: 01/21/2023] Open
Abstract
Background There are few studies on intensive care unit (ICU) patients in the Republic of Korea. We analyzed the characteristics and mortality changes of all ICU patients over the last 8 years. Methods This study used the cohort of the National Health Insurance Corporation, which provides medical care to all residents of the Republic of Korea. The cohort consists of patients aged 20 years or older between 2003 and 2010 with a history of ICU admission. We analyzed changes in sex, age, household income, number of hospital beds, emergency admissions, and reasons for admission using the Cochran-Armitage trend test. The adjusted hazard ratios (HRs) of mortality according to these variables and year of admission were calculated by Cox proportional hazards regression. Results The proportion of patients aged ≥70 years increased over that period, as did their average age (by 3.6 years). During the 8-year study period, the 3-year mortality rate was 32.91%-35.83%. The overall mortality was higher in males and older patients, in those with a lower household income and higher Charlson Comorbidity Index (CCI) score, those admitted to a hospital with a smaller number of beds, and those admitted via the emergency room. There was no significant change in crude mortality rate over the 8-year study period; however, the adjusted HR showed a decreasing trend. Conclusions Patients admitted to the ICU were older and had higher CCI score. Nevertheless, there was a temporal trend toward a decrease in the HR of long-term mortality.
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Affiliation(s)
- Jeongwon Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoonki Hong
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.,Division of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae Hoon Jeong
- Department of Statistics, Kangwon National University, Chuncheon, Korea
| | - Young-Ju Kim
- Department of Statistics, Kangwon National University, Chuncheon, Korea
| | - Seung-Hwan Lee
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung-Joon Lee
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients. Intensive Care Med 2018; 44:1483-1492. [PMID: 30141173 DOI: 10.1007/s00134-018-5347-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Intensive care unit (ICU) admission of allogeneic hematopoietic stem cell transplant (HSCT) recipients is associated with relatively poor outcome. Since longitudinal data on this topic remains scarce, we analyzed reasons for ICU admission as well as short- and long-term outcome of critically ill HSCT recipients. METHODS A total of 942 consecutive adult patients were transplanted at Hannover Medical School from 2000 to 2013. Of those, 330 patients were at least admitted once to the ICU and included in this retrospective study. To analyze time-dependent improvements, we separately compared patient characteristics as well as reasons and outcome of ICU admission for the periods 2000-2006 and 2007-2013. RESULTS The main reasons for ICU admission were acute respiratory failure (ARF) in 35%, severe sepsis/septic shock in 23%, and cardiac problems in 18%. ICU admission was clearly associated with shortened survival (p < 0.001), but survival of ICU patients after hospital discharge reached 44% up to 5 years and was comparable to that of non-ICU HSCT patients. When ICU admission periods were compared, patients were older (48 vs. 52 years; p < 0.005) and the percentage of ARF as leading cause for ICU admission decreased from 43% in the first to 30% in the second period. Over time ICU and hospital survival improved from 44 to 60% (p < 0.01) and from 26 to 43% (p < 0.01), respectively. The 1- and 3-year survival rate after ICU admission increased significantly from 14 to 32% and from 11 to 23% (p < 0.01). CONCLUSIONS Besides ARF and septic shock, cardiac events were especially a major reason for ICU admission. Both short- and long-term survival of critically ill HSCT patients has improved significantly in recent years, and survival of HSCT recipients discharged from hospital is not significantly affected by a former ICU stay.
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224
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Brown SM, Beesley SJ, Lanspa MJ, Grissom CK, Wilson EL, Parikh SM, Sarge T, Talmor D, Banner-Goodspeed V, Novack V, Thompson BT, Shahul S. Esmolol infusion in patients with septic shock and tachycardia: a prospective, single-arm, feasibility study. Pilot Feasibility Stud 2018; 4:132. [PMID: 30123523 PMCID: PMC6091011 DOI: 10.1186/s40814-018-0321-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 07/17/2018] [Indexed: 12/14/2022] Open
Abstract
Background High adrenergic tone appears to be associated with mortality in septic shock, while adrenergic antagonism may improve survival. In preparation for a randomized trial, we conducted a prospective, single-arm pilot study of esmolol infusion for patients with septic shock and tachycardia that persists after adequate volume expansion. Methods From April 2016 to March 2017, we enrolled patients admitted to an intensive care unit with sepsis who were receiving vasopressor infusion and were tachycardic despite adequate volume expansion. All patients received a continuous intravenous infusion of esmolol, targeted to heart rate 80–90/min, while receiving vasopressors. The feasibility outcomes were proportion of eligible patients consented, compliance with pre-infusion safety check, and compliance with the titration protocol. The primary clinical outcome was organ-failure-free days (OFFD) at 28 days. Results We enrolled 7 of 10 eligible patients. Mean age was 46 (± 19) years, and mean admission APACHE II was 28 (± 8). Median norepinephrine infusion rate at the initiation of esmolol infusion was 0.20 (0.14–0.23) μg/kg/min. Compliance with the safety check was 100%; compliance with components of the titration protocol was 98–100%. OFFD were 26 (24.5–26); all patients survived to day 90. Median peak esmolol infusion was 50 (25–50) μg/kg/min. Median peak norepinephrine infusion rate during esmolol infusion was 0.46 (0.13–0.50) μg/kg/min. Four patients achieved target heart rate. Protocol-defined stop events, suggesting possible intolerance to a given infusion rate, occurred in three patients, all of whom were receiving at least 50 μg/kg/min of esmolol. Conclusions In a pilot, single-arm study, we report the first published experience with esmolol infusion in tachycardic patients with septic shock in the United States. These findings support a phase 2 trial of esmolol infusion for septic shock. Lower infusion rates of esmolol infusion may be better tolerated and more feasible than higher infusion rates for such a trial. Trial registration This study was retrospectively registered at ClinicalTrials.gov (NCT02841241) on 19 July 2016. Electronic supplementary material The online version of this article (10.1186/s40814-018-0321-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel M Brown
- 1Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT USA.,2Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT USA.,7Shock Trauma Intensive Care Unit, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84107 USA
| | - Sarah J Beesley
- 1Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT USA.,2Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT USA
| | - Michael J Lanspa
- 1Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT USA.,2Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT USA
| | - Colin K Grissom
- 1Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT USA.,2Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT USA
| | - Emily L Wilson
- 1Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT USA
| | - Samir M Parikh
- 3Nephrology and Vascular Biology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Todd Sarge
- 4Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Daniel Talmor
- 4Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | - Victor Novack
- 4Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - B Taylor Thompson
- 5Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Sajid Shahul
- 6Department of Anesthesia, University of Chicago, Chicago, IL USA
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Pérez-González A, Almudí-Ceinos D, López Del Moral O, Martín-Alfonso S, Rico-Feijoo J, López Del Moral J, Aldecoa C. Is mortality in elderly septic patients as high as expected? Long-term mortality in a surgical sample cohort. Med Intensiva 2018; 43:464-473. [PMID: 30025749 DOI: 10.1016/j.medin.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. MATERIALS AND METHODS A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. RESULTS A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. CONCLUSIONS The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality.
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Affiliation(s)
- A Pérez-González
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - D Almudí-Ceinos
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - O López Del Moral
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - S Martín-Alfonso
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - J Rico-Feijoo
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - J López Del Moral
- Clinical Medicine Department, Alfonso X Medical School, Madrid, Spain
| | - C Aldecoa
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
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Thompson K, Taylor C, Jan S, Li Q, Hammond N, Myburgh J, Saxena M, Venkatesh B, Finfer S. Health-related outcomes of critically ill patients with and without sepsis. Intensive Care Med 2018; 44:1249-1257. [DOI: 10.1007/s00134-018-5274-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/07/2018] [Indexed: 01/10/2023]
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Acceptability and feasibility of an interprofessional end-of-life/palliative care educational intervention in the intensive care unit: A mixed-methods study. Intensive Crit Care Nurs 2018; 48:75-84. [PMID: 29937078 DOI: 10.1016/j.iccn.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to describe a seven hour End-of-Life/Palliative Care educational intervention including online content related to symptom management, communication and decision-making capacity and an in-person group integration activity, from the perspective of the interprofessional team in terms of its acceptability and feasibility. RESEARCH DESIGN A mixed-methods study design was used. SETTING AND SAMPLE The study was conducted in a medical-surgical Intensive Care Unit in Montreal, Canada. The sample consisted of 27 clinicians of the Intensive Care Unit interprofessional team who completed the End-of-Life/Palliative Care educational intervention, and participated in focus groups and completed a self-administered questionnaire. MAIN OUTCOME MEASURES The main outcomes were the acceptability and feasibility of the educational intervention. FINDINGS The intervention was perceived to be appropriate and suitable in providing clinicians with knowledge and skills in symptom management and communication through self-reflection and self-evaluation, provision of assessment tools and promotion of interprofessional teamwork. The online format was more feasible, but the in-person group activity was key for the integration of knowledge and the promotion of interprofessional discussions. CONCLUSION Findings suggest that an interprofessional educational intervention integrating on-line content with in-person training has the potential to support clinicians in providing quality End-of-Life/Palliative Care in the Intensive Care Unit.
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228
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Griesdale D, Jones PM. In asking the right questions, be cautious of confounding by indication. Can J Anaesth 2018; 65:979-984. [PMID: 29949091 DOI: 10.1007/s12630-018-1172-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, Gordon & Leslie Diamond Health Care Center, University of British Columbia, Rm 11225 - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Medicine, Divisions of Critical Care Medicine and Neurology, University of British Columbia, Vancouver, BC, Canada.
| | - Philip M Jones
- Departments of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
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Poole S, Kidd SP, Saeed K. A review of novel technologies and techniques associated with identification of bloodstream infection etiologies and rapid antimicrobial genotypic and quantitative phenotypic determination. Expert Rev Mol Diagn 2018; 18:543-555. [PMID: 29790810 DOI: 10.1080/14737159.2018.1480369] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The antimicrobial aspect of management of patients with blood stream infections (BSI) and sepsis is time critical. In an era of increasing antimicrobial resistance, rapid detection and identification of bacteria with antimicrobial susceptibility is crucial to direct therapy early in the course of illness. Molecular techniques offer a potential solution to this. Areas covered: In the present review the authors have discussed a number of novel solutions utilizing a variety of molecular techniques for pathogen detection, identification and antimicrobial susceptibility. The review is not designed to be an exhaustive literature review covering all diagnostic solutions ever developed, instead the authors have focused on what they have had experience using, evaluating or currently view as new and exciting with potential to revolutionize BSI diagnosis. The authors searched PubMed (Medline) and Google Scholar with terms: BSI, Bacteraemia, Candidaemia, Diagnostics, AST, Rapid, AMR, Novel and Blood Culture. The authors attended recent clinical microbiology technology congresses. Expert commentary: There are multiple exciting novel technologies at differing stages of development with potential to revolutionize diagnosis of BSI. More work is needed as well as a standardized assessment of different platforms in order to better understand the clinical and financial impacts these will have in clinical microbiology laboratories.
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Affiliation(s)
- Stephen Poole
- a Hampshire Hospitals NHS Foundation Trust , Department of Microbiology , Basingstoke and Winchester , UK
| | - Stephen P Kidd
- a Hampshire Hospitals NHS Foundation Trust , Department of Microbiology , Basingstoke and Winchester , UK
| | - Kordo Saeed
- a Hampshire Hospitals NHS Foundation Trust , Department of Microbiology , Basingstoke and Winchester , UK.,b University of Southampton , School of medicine , Southampton , UK
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230
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Marafino BJ, Dudley RA, Shah NH, Chen JH. Accurate and interpretable intensive care risk adjustment for fused clinical data with generalized additive models. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2018; 2017:166-175. [PMID: 29888065 PMCID: PMC5961794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Risk adjustment models for intensive care outcomes have yet to realize the full potential of data unlocked by the increasing adoption of EHRs. In particular, they fail to fully leverage the information present in longitudinal, structured clinical data - including laboratory test results and vital signs - nor can they infer patient state from unstructured clinical narratives without lengthy manual abstraction. A fully electronic ICU risk model fusing these two types of data sources may yield improved accuracy and more personalized risk estimates, and in obviating manual abstraction, could also be used for real-time decision-making. As a first step towards fully "electronic" ICU models based on fused data, we present results of generalized additive modeling applied to a sample of over 36,000 ICU patients. Our approach outperforms those based on the SAPS and OASIS systems (A UC: 0.908 vs. 0.794 and 0.874), and appears to yield more granular and easily visualized risk estimates.
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Affiliation(s)
- Ben J Marafino
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
| | - R Adams Dudley
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, and Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA
| | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA
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231
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How does prior health status (age, comorbidities and frailty) determine critical illness and outcome? Curr Opin Crit Care 2018; 22:500-5. [PMID: 27478965 DOI: 10.1097/mcc.0000000000000342] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Critical illness has a significant impact on an individual's physical and mental health. However, it is less clear to what degree outcomes after critical illness are due to patients' preexisting characteristics, rather than the critical illness itself. In this review, we summarize recent findings regarding the role of age, comorbidity and frailty on long-term outcomes after critical illness. RECENT FINDINGS Age, comorbidity and frailty are all associated with an increased risk of critical illness. Although severity of illness drives the risk of acute mortality, recent data suggest that longer term outcomes are much more closely aligned with prior health status. There are growing data regarding the important role of noncardiovascular comorbidity, including psychiatric illness and obesity, in determining long-term outcomes. Finally, preadmission frailty is associated with poor long-term outcomes after critical illness; further data are needed to evaluate the attributable impact of critical illness on the health trajectories of frail individuals. SUMMARY Age, comorbidity and frailty play a critical role in determining the long-term outcomes of patients requiring intensive care.
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232
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Baykara N, Akalın H, Arslantaş MK, Hancı V, Çağlayan Ç, Kahveci F, Demirağ K, Baydemir C, Ünal N. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:93. [PMID: 29656714 PMCID: PMC5901868 DOI: 10.1186/s13054-018-2013-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. METHODS A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded. RESULTS Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients. CONCLUSIONS A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality. TRIAL REGISTRATION ClinicalTrials.gov ID NCT03249246 . Date: August 15, 2017. Retrospectively registered.
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Affiliation(s)
- Nur Baykara
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Halis Akalın
- Department of Infectious Disease, School of Medicine, Uludağ University, Bursa, Turkey
| | - Mustafa Kemal Arslantaş
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Marmara University, Istanbul, Turkey
| | - Volkan Hancı
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Çiğdem Çağlayan
- Department of Public Health, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ferda Kahveci
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Uludağ University, Bursa, Turkey
| | - Kubilay Demirağ
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Ege University, İzmir, Turkey
| | - Canan Baydemir
- Department of Biostatistics and Medical informatics, School of Medicine, Kocaeli, Turkey
| | - Necmettin Ünal
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Ankara University, Ankara, Turkey
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Organ support therapy in the intensive care unit and return to work: a nationwide, register-based cohort study. Intensive Care Med 2018; 44:418-427. [PMID: 29616288 DOI: 10.1007/s00134-018-5157-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/28/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The association between severity of illness and ability to return to work is unclear. Therefore, we investigated return to work and associations with measures of illness severity in ICU survivors. METHODS We conducted this cohort study using Danish registry data for the period 2005-2014 on ICU patients who were discharged alive from hospital, had an ICU length of stay (LOS) of at least 72 h, were not treated with dialysis before hospital admission and were working prior to admission. We assessed (1) the cumulative incidence (chance) of return to work (2005-2017) and receipt of social benefits after discharge from a hospital stay with ICU admission and (2) the association between organ support therapies (renal replacement therapy, cardiovascular support and mechanical ventilation), and during 2011-2014 SAPS II and ICU LOS, and return to work, using multivariable Cox regression. RESULTS Among 5762 ICU survivors, 68% returned to work within 2 years after hospital discharge. Disability and sickness benefits constituted 89% of social benefits among patients not returning to work and 59% among patients withdrawing from work following an initial return to work. Mechanical ventilation (HR 0.70, 95% CI [0.65-0.77]), but not RRT (HR 0.85, 95% CI [0.71-1.02]), cardiovascular support (HR 0.93, 95% CI [0.82-1.07]) and increasing SAPS II, was associated with decreased chance of return to work. Increasing ICU LOS was also associated with a decreased chance of return to work. CONCLUSIONS The majority of a nationwide cohort of ICU survivors returned to work. Sick leave and receipt of disability pension were common following ICU admission. Mechanical ventilation and longer ICU LOS were associated with reduced chances of return to work.
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234
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A systematic review on risk factors associated with sepsis in patients admitted to intensive care units. Aust Crit Care 2018; 32:155-164. [PMID: 29574007 DOI: 10.1016/j.aucc.2018.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We sought to systematically review data on the risk factors influencing the incidence of sepsis in patients admitted to intensive care units (ICUs). REVIEW METHODS An electronic search was undertaken in PubMed, MEDLINE, Scopus, and the Cochrane Library for studies reporting the risk factors of sepsis from the earliest available date up to December 30, 2016. RESULTS Among the 2978 articles, 14 studies met the inclusion criteria with a total of 56 164 participants from nine countries. The extracted risk factors were from the following categories: demographic, critical care interventions, surgery-related factors, pre-existing comorbidities, severity of organ injury, and biomarkers and biochemical and molecular indicators. From demographic factors, older age and male gender were associated with an increased risk of sepsis among ICU-admitted patients. CONCLUSION Our analysis comprehensively summarised the risk factors of sepsis in patients admitted to medical, surgical, neurologic, trauma, and general ICUs. Age, sex, and comorbidities were non-modifiable risk factors; however, critical care interventions and surgery-related factors were modifiable factors and suggest that improving the care of surgical patients and effective management of critical care interventions may play a key role in decreasing the development of sepsis in patients admitted to the ICUs.
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235
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Salvatierra GG, Gulek BG, Erdik B, Bennett D, Daratha KB. In-Hospital Sepsis Mortality Rates Comparing Tertiary and Non-Tertiary Hospitals in Washington State. J Emerg Med 2018. [PMID: 29523426 DOI: 10.1016/j.jemermed.2018.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND More than a million people a year in the United States experience sepsis or sepsis-related complications, and sepsis remains the leading cause of in-hospital deaths. Unlike many other leading causes of in-hospital mortality, sepsis detection and treatment are not dependent on the presence of any technology or services that differ between tertiary and non-tertiary hospitals. OBJECTIVE To compare sepsis mortality rates between tertiary and non-tertiary hospitals in Washington State. METHODS A retrospective longitudinal, observational cohort study of 73 Washington State hospitals for 2010-2015 using data from a standardized state database of hospital abstracts. Abstract records on adult patients (n = 86,378) admitted through the emergency department (ED) from 2010 through 2015 in all tertiary (n = 7) and non-tertiary (n = 66) hospitals in Washington State. RESULTS The overall mortality rate for all hospitals was 6.5%. In the fully adjusted model, the odds ratio for in-hospital death was higher in non-tertiary hospitals compared with tertiary hospitals (odds ratio 1.25; 95% confidence interval 1.17-1.35; p < 0.001). CONCLUSIONS We observed higher sepsis mortality rates in non-tertiary hospitals, compared with tertiary hospitals. Because most patients who are treated for sepsis are treated outside of tertiary hospitals, and the number of patients treated for sepsis in non-tertiary hospitals seems to be rising, a better understanding of the cause or causes for this differential is crucial.
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Affiliation(s)
- Gail G Salvatierra
- School of Nursing, California State University San Marcos, San Marcos, California
| | - Bernice G Gulek
- College of Nursing, Washington State University, Spokane, Washington
| | - Baran Erdik
- College of Nursing, Washington State University, Spokane, Washington
| | - Deborah Bennett
- School of Nursing, California State University San Marcos, San Marcos, California
| | - Kenn B Daratha
- College of Nursing, Washington State University, Spokane, Washington; Providence Medical Research Center, Providence Sacred Heart Medical Center, Spokane, Washington; Department of Medical Education and Biomedical Informatics, University of Washington, Spokane and Seattle, Washington
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Loss SH, Nunes DSL, Franzosi OS, Salazar GS, Teixeira C, Vieira SRR. Chronic critical illness: are we saving patients or creating victims? Rev Bras Ter Intensiva 2018; 29:87-95. [PMID: 28444077 PMCID: PMC5385990 DOI: 10.5935/0103-507x.20170013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/05/2016] [Indexed: 12/15/2022] Open
Abstract
The technological advancements that allow support for organ dysfunction have led
to an increase in survival rates for the most critically ill patients. Some of
these patients survive the initial acute critical condition but continue to
suffer from organ dysfunction and remain in an inflammatory state for long
periods of time. This group of critically ill patients has been described since
the 1980s and has had different diagnostic criteria over the years. These
patients are known to have lengthy hospital stays, undergo significant
alterations in muscle and bone metabolism, show immunodeficiency, consume
substantial health resources, have reduced functional and cognitive capacity
after discharge, create a sizable workload for caregivers, and present high
long-term mortality rates. The aim of this review is to report on the most
current evidence in terms of the definition, pathophysiology, clinical
manifestations, treatment, and prognosis of persistent critical illness.
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Affiliation(s)
- Sergio Henrique Loss
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | - Diego Silva Leite Nunes
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Oellen Stuani Franzosi
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Departamento de Nutrição, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Cassiano Teixeira
- Faculdade de Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil.,Departamento de Clínica Médica, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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237
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Abstract
The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer. Then, novel approaches can be implemented to take the best care of patients.
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238
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Granholm A, Perner A, Krag M, Hjortrup PB, Haase N, Holst LB, Marker S, Collet MO, Jensen AKG, Møller MH. Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Acta Anaesthesiol Scand 2018; 62:336-346. [PMID: 29210058 DOI: 10.1111/aas.13048] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/18/2017] [Accepted: 11/17/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). METHODS We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates. RESULTS The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2 ) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. CONCLUSIONS The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.
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Affiliation(s)
- A. Granholm
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - A. Perner
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - M. Krag
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - P. B. Hjortrup
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - N. Haase
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - L. B. Holst
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - S. Marker
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - M. O. Collet
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - A. K. G. Jensen
- Centre for Research in Intensive Care; Copenhagen Denmark
- Section of Biostatistics; University of Copenhagen; Copenhagen Denmark
| | - M. H. Møller
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
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239
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de Vries VA, Müller MCA, Sesmu Arbous M, Biemond BJ, Blijlevens NMA, Kusadasi N, Choi GCW, Vlaar APJ, van Westerloo DJ, Kluin-Nelemans HC, van den Bergh WM. Time trend analysis of long term outcome of patients with haematological malignancies admitted at dutch intensive care units. Br J Haematol 2018; 181:68-76. [PMID: 29468848 DOI: 10.1111/bjh.15140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/21/2017] [Indexed: 01/18/2023]
Abstract
A few decades ago, the chances of survival for patients with a haematological malignancy needing Intensive Care Unit (ICU) support were minimal. As a consequence, ICU admission policy was cautious. We hypothesized that the long-term outcome of patients with a haematological malignancy admitted to the ICU has improved in recent years. Furthermore, our objective was to evaluate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE) II score. A total of 1095 patients from 5 Dutch university hospitals were included from 2003 until 2015. We studied the prevalence of patients' characteristics over time. By using annual odds ratios, we analysed which patients' characteristics could have had influenced possible trends in time. A approximated mortality rate was compared with the ICU mortality rate, to study the predictive value of the APACHE II score. Overall one-year mortality was 62%. The annual decrease in one-year mortality was 7%, whereas the APACHE II score increased over time. Decreased mortality rates were particularly observed in high-risk patients (acute myeloid leukaemia, old age, low platelet count, bleeding as admission reason and need for mechanical ventilation within 24 h of ICU admission). Furthermore, the APACHE II score overestimates mortality in this patient category.
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Affiliation(s)
- Vera A de Vries
- Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcella C A Müller
- Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Sesmu Arbous
- Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bart J Biemond
- Department of Haematology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole M A Blijlevens
- Department of Haematology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Nuray Kusadasi
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.,University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Goda C W Choi
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - David J van Westerloo
- Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Blackburn HN, Clark MT, Moorman JR, Lake DE, Calland JF. Identifying the low risk patient in surgical intensive and intermediate care units using continuous monitoring. Surgery 2018; 163:811-818. [PMID: 29433853 DOI: 10.1016/j.surg.2017.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/27/2017] [Accepted: 08/30/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Continuous predictive monitoring has been employed successfully to predict subclinical adverse events. Should low values on these models, however, reassure us that a patient will not have an adverse outcome? Negative predictive values of such models could help predict safe patient discharge. The goal of this study was to validate the negative predictive value of an ensemble model for critical illness (using previously developed models for respiratory instability, hemorrhage, and sepsis) based on bedside monitoring data in the intensive care units and intermediate care unit. METHODS We calculated the relative risk of 3 critical illnesses for all patients every 15 minutes (n= 124,588) for 2,924 patients downgraded from the surgical intensive care units and intermediate care unit between May 2014 to May 2016. We constructed an ensemble model to estimate at the time of intensive care units or intermediate care unit discharge the probability of favorable outcome after downgrade. RESULTS Outputs form the ensemble model stratified patients by risk of favorable and bad outcomes in both intensive care units/intermediate care unit; area under the receiver operating characteristic curve = .639/.629 respectively for favorable outcomes and .645/.641 for adverse events. These performance characteristics are commensurate with published models for predicting readmission. The ensemble model remained a statistically significant predictor after adjusting for hospital duration of stay and admitting service. The rate of favorable outcome in the highest and lowest deciles in the intensive care units were 76.2% and 27.3% (2.8-fold decrease) and 88.3% and 33.2% in the intermediate care unit (2.7-fold decrease), respectively. CONCLUSION An ensemble model for critical illness predicts favorable outcome after downgrade and safe patient discharge (hospital stay <7 days, no readmission, upgrade, or death).
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Affiliation(s)
- Holly N Blackburn
- UVA Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA, USA
| | - Matthew T Clark
- UVA Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA, USA
| | - J Randall Moorman
- Advanced Medical Predictive Devices, Diagnostics, and Displays; University of Virginia, Charlottesville, VA, USA
| | - Douglas E Lake
- Advanced Medical Predictive Devices, Diagnostics, and Displays; University of Virginia, Charlottesville, VA, USA
| | - J Forrest Calland
- Advanced Medical Predictive Devices, Diagnostics, and Displays; University of Virginia, Charlottesville, VA, USA.
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241
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Clark K, Milner KA, Beck M, Mason V. Measuring Family Satisfaction With Care Delivered in the Intensive Care Unit. Crit Care Nurse 2018; 36:e8-e14. [PMID: 27908955 DOI: 10.4037/ccn2016276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families' needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families' satisfaction with care in this setting. OBJECTIVE To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. METHOD A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. RESULTS Forty family members completed the survey. Overall, the mean score for families' satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families' satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient's condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families' experience. CONCLUSION Although patients' family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients' families, and patients will be targeted for quality improvement initiatives.
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Affiliation(s)
- Kathleen Clark
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Kerry A Milner
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts. .,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing. .,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing. .,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts.
| | - Marlene Beck
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Virginia Mason
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
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Chok L, Bachli EB, Steiger P, Bettex D, Cottini SR, Keller E, Maggiorini M, Schuepbach RA. Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital: a cohort study. BMC Health Serv Res 2018; 18:84. [PMID: 29402271 PMCID: PMC5800035 DOI: 10.1186/s12913-018-2869-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity and referring institution, and screened whether implementation of Swiss-DRG affected admission policy, ICU length-of-stay (ICU-LOS) or ICU mortality. METHODS Retrospective, single centre, cohort study conducted at the University Hospital Zurich, Switzerland between January 2009 and end of September 2013. Demographic and clinical data was retrieved from a quality assurance database. RESULTS Admissions (n = 17,231) before the introduction of Swiss-DRG were used to model expected admissions after DRG, and then compared to the observed admissions. Forecasting matched observations in patients with a high clinical severity admitted from internal units and external hospitals (admitted / predicted: 709 / 703, [95% Confidence Interval (CI), 658-748] and 302 / 332, [95% CI, 269-365] respectively). In patients with low severity of disease, in-house admissions became more frequent than expected and external admission were less frequent (admitted / predicted: 1972 / 1910, [95% CI, 1898-1940] and 436 / 518, [95% CI, 482-554] respectively). Various mechanisms related to Swiss-DRG may have led to these changes. DRG could not be linked to significant changes in regard to ICU-LOS and ICU mortality. CONCLUSIONS DRG introduction had not affected ICU admissions policy, except for an increase of in-house patients with a low clinical severity of disease. DRG had neither affected ICU mortality nor ICU-LOS.
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Affiliation(s)
- Lionel Chok
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Department of Internal Medicine, Hospital Uster, Brunnenstrasse 42, CH-8610, Uster, Zurich, Switzerland
| | - Esther B Bachli
- Department of Internal Medicine, Hospital Uster, Brunnenstrasse 42, CH-8610, Uster, Zurich, Switzerland
| | - Peter Steiger
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Silvia R Cottini
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Emanuela Keller
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Marco Maggiorini
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Sartelli M, Kluger Y, Ansaloni L, Hardcastle TC, Rello J, Watkins RR, Bassetti M, Giamarellou E, Coccolini F, Abu-Zidan FM, Adesunkanmi AK, Augustin G, Baiocchi GL, Bala M, Baraket O, Beltran MA, Jusoh AC, Demetrashvili Z, De Simone B, de Souza HP, Cui Y, Davies RJ, Dhingra S, Diaz JJ, Di Saverio S, Dogjani A, Elmangory MM, Enani MA, Ferrada P, Fraga GP, Frattima S, Ghnnam W, Gomes CA, Kanj SS, Karamarkovic A, Kenig J, Khamis F, Khokha V, Koike K, Kok KYY, Isik A, Labricciosa FM, Latifi R, Lee JG, Litvin A, Machain GM, Manzano-Nunez R, Major P, Marwah S, McFarlane M, Memish ZA, Mesina C, Moore EE, Moore FA, Naidoo N, Negoi I, Ofori-Asenso R, Olaoye I, Ordoñez CA, Ouadii M, Paolillo C, Picetti E, Pintar T, Ponce-de-Leon A, Pupelis G, Reis T, Sakakushev B, Kafil HS, Sato N, Shah JN, Siribumrungwong B, Talving P, Tranà C, Ulrych J, Yuan KC, Catena F. Raising concerns about the Sepsis-3 definitions. World J Emerg Surg 2018; 13:6. [PMID: 29416555 PMCID: PMC5784683 DOI: 10.1186/s13017-018-0165-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/17/2018] [Indexed: 02/08/2023] Open
Abstract
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
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Affiliation(s)
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- General Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Timothy C. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Jordi Rello
- Department of Clinical Research & Innovation in Pneumonia and Sepsis, Vall d’Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Richard R. Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH USA
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH USA
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Eleni Giamarellou
- 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece
| | | | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Goran Augustin
- Department of Surgery, University Hospital Centre, Zagreb, Croatia
| | - Gian L. Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Marcelo A. Beltran
- Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Asri Che Jusoh
- Department of General Surgery, Kuala Krai Hospital, Kelantan, Malaysia
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | - Hamilton P. de Souza
- Department of Surgery, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - R. Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago
| | - Jose J. Diaz
- Division of Acute Care Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD USA
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Agron Dogjani
- Department of Surgery, University Hospital of Trauma, Tirana, Albania
| | - Mutasim M. Elmangory
- Sudan National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
| | - Mushira A. Enani
- Department of Medicine, Infectious Disease Division, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Paula Ferrada
- Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Gustavo P. Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Wagih Ghnnam
- Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Carlos A. Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Souha S. Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Jakub Kenig
- Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Faryal Khamis
- Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenneth Y. Y. Kok
- Department of Surgery, The Brunei Cancer Centre, Jerudong Park, Jerudong, Brunei
| | - Arda Isik
- Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | | | - Rifat Latifi
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ USA
| | - Jae G. Lee
- Department of Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | - Andrey Litvin
- Surgical Disciplines, Immanuel Kant Baltic Federal University/Regional Clinical Hospital, Kaliningrad, Russian Federation
| | - Gustavo M. Machain
- Department of Surgery, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | | | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Sanjay Marwah
- Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- Department of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Ziad A. Memish
- Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Cristian Mesina
- Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
| | - Ernest E. Moore
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA
| | - Frederick A. Moore
- Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, College of Medicine, University of Florida, Gainesville, FL USA
| | - Noel Naidoo
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | - Iyiade Olaoye
- Department of Surgery, University of Ilorin, Teaching Hospital, Ilorin, Nigeria
| | - Carlos A. Ordoñez
- Department of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia
| | - Mouaqit Ouadii
- Department of Surgery, Hassan II University Hospital, Medical School of Fez, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Ciro Paolillo
- Department of Emergency Medicine, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - Tadeja Pintar
- Department of Surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Alfredo Ponce-de-Leon
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guntars Pupelis
- Department of General and Emergency Surgery, Riga East University Hospital “Gailezers”, Riga, Latvia
| | - Tarcisio Reis
- Emergency Post-Operative Department, Otavio De Freitas Hospital, Recife, Brazil
- Osvaldo Cruz Hospital Recife, Recife, Brazil
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Norio Sato
- Department of Aeromedical Services for Emergency and Trauma Care, Graduate School of Medicine, Ehime University, Ehime, Japan
| | - Jay N. Shah
- Department of Surgery, Patan Hospital, Patan Academy of Health Sciences Lalitpur, Kathmandu, Nepal
| | - Boonying Siribumrungwong
- Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Rangsit, Pathum Thani Thailand
| | - Peep Talving
- Department of Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Jan Ulrych
- First Department of Surgery, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | - Kuo-Ching Yuan
- Department of Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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Weisberg A, Park P, Cherry-Bukowiec JR. Early Goal-Directed Therapy: The History and Ongoing Impact on Management of Severe Sepsis and Septic Shock. Surg Infect (Larchmt) 2018; 19:142-146. [PMID: 29356599 DOI: 10.1089/sur.2017.221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The use of early goal-directed therapy (EGDT) for the management of severe sepsis and septic shock, a practice put forth by Dr. Rivers et al. in 2001, ushered in a new era of targeted sepsis therapy. After its publication, several further studies helped validate the protocolized approach to sepsis management, ultimately leading to its incorporation into the Surviving Sepsis Campaign guidelines. Since that time, however, a trio of large multi-center randomized controlled trials have taken place to evaluate the efficacy of EGDT when compared with usual care and have demonstrated that strict adherence to the entirety of the original EGDT protocol is unnecessary for improved outcomes. Some recommendations, such as higher goal hemoglobin and hematocrit levels and liberal crystalloid fluid resuscitation, are likely harmful. Despite controversy over a number of the recommendations, early identification of sepsis, source control, and prompt empiric antibiotic administration remain the mainstay of treatment for patients with sepsis and septic shock.
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Affiliation(s)
- Asher Weisberg
- 1 Division of Acute Care Surgery, University of Michigan , Ann Arbor, Michigan
| | - Pauline Park
- 1 Division of Acute Care Surgery, University of Michigan , Ann Arbor, Michigan
| | - Jill R Cherry-Bukowiec
- 1 Division of Acute Care Surgery, University of Michigan , Ann Arbor, Michigan.,2 Trauma Burn ICU, University of Michigan , Ann Arbor, Michigan
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245
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Van Dyck L, Casaer MP. Nutrition in the ICU: sometimes route does matter. Lancet 2018; 391:98-100. [PMID: 29128299 DOI: 10.1016/s0140-6736(17)32815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Lisa Van Dyck
- Clinical Department and Laboratory of Intensive Care Medicine, University Hospitals and Catholic University Leuven, 3000 Leuven, Belgium
| | - Michael P Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, University Hospitals and Catholic University Leuven, 3000 Leuven, Belgium.
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Files DC, Neiberg R, Rushing J, Morris PE, Young MP, Ayonayon H, Harris T, Newman A, Rubin S, Shiroma E, Houston D, Miller ME, Kritchevsky SB. Influence of Prehospital Function and Strength on Outcomes of Critically Ill Older Adults. J Am Geriatr Soc 2018; 66:525-531. [PMID: 29322491 DOI: 10.1111/jgs.15255] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand the influence of prehospital physical function and strength on clinical outcomes of critically ill older adults. DESIGN Secondary analysis of prospective cohort study. SETTING Health, Aging and Body Composition (Health ABC) Study. PARTICIPANTS Of 3,075 older adult Health ABC participants, we identified 575 (60% white, 61% male, mean age 79) with prehospital function or grip strength measurements within 2 years of an intensive care unit stay. MEASUREMENTS The primary analysis evaluated the association between prehospital walk speed and mortality, and secondary analyses focused on associations between function or grip strength and mortality or hospital length of stay. Function and grip strength were analyzed as continuous and categorical predictors. RESULTS Slower prehospital walk speed was associated with greater risk of 30-day mortality (for each 0.1 m/s slower, odds ratio = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = .004). Grip strength, chair stands, and balance had weaker, non-statistically significant associations with 30-day mortality. Participants with slower prehospital walk speed (hazard ratio (HR) = 0.94, 95% CI = 0.90-0.98, P = .005) and weak grip strength (HR = 0.85, 95% CI = 0.73-0.99, P = .03) were less likely to be discharged from the hospital alive. All function and strength measures were significantly associated with 1-year mortality. CONCLUSION Slow prehospital walk speed was strongly associated with greater 30-day mortality and longer hospital stay in critically ill older adults, and measures of function and strength were associated with 1-year mortality. These data add to the accumulating evidence on the relationship between physical function and critical care outcomes.
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Affiliation(s)
- D Clark Files
- Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Winston-Salem, North Carolina.,Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, Winston-Salem, North Carolina.,Critical Illness, Injury and Recovery Research Center, Wake Forest University, Winston-Salem, North Carolina
| | - Rebecca Neiberg
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Julia Rushing
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Peter E Morris
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, Kentucky
| | - Michael P Young
- Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Winston-Salem, North Carolina
| | - Hilsa Ayonayon
- University of California, San Francisco, San Francisco, California
| | - Tamara Harris
- National Institutes of Health, National Institute on Aging, Bethesda, Maryland
| | - Anne Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan Rubin
- University of California, San Francisco, San Francisco, California
| | - Eric Shiroma
- National Institutes of Health, National Institute on Aging, Bethesda, Maryland
| | - Denise Houston
- Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, Winston-Salem, North Carolina
| | - Michael E Miller
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen B Kritchevsky
- Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, Winston-Salem, North Carolina
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Intensivist-reported Facilitators and Barriers to Discussing Post-Discharge Outcomes with Intensive Care Unit Surrogates. A Qualitative Study. Ann Am Thorac Soc 2018; 13:1546-52. [PMID: 27294981 DOI: 10.1513/annalsats.201603-212oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Intensive care unit (ICU) patients' expected post-discharge outcomes are rarely discussed in family meetings despite this information being centrally important to patients and their families. OBJECTIVES To characterize intensivist-identified barriers and facilitators to discussing post-discharge outcomes with surrogates of ICU patients. METHODS Qualitative study conducted via one-on-one, semistructured telephone interviews with 23 intensivists from 20 hospitals with accreditation council for graduate medical education-accredited critical care medicine programs in 16 states. A limited application of grounded theory methods was used to code transcribed interviews and identify themes and illustrative quotes. MEASUREMENTS AND MAIN RESULTS Intensivists reported tension between their professional responsibility to discuss likely functional outcomes versus uncertainty about their ability to predict those outcomes for an individual patient. They cited three main barriers as limiting their ability to conduct conversations about post-discharge outcomes with ICU surrogates: (1) incorrectly optimistic expectations for recovery among ICU surrogates, (2) having little or no contact with their patients after ICU discharge, and (3) minimal confidence applying existing outcomes research to individual patients. Despite these barriers, experience talking to ICU surrogates, seeing ICU survivors in the outpatient setting, and trusted research on functional outcomes were identified as important facilitators to discussing likely patient outcomes with surrogates. Intensivists generally welcomed questions from surrogates about post-discharge outcomes as opportunities to initiate conversations about prognosis and patient values. CONCLUSIONS In this sample of intensivists from 20 academic hospitals, experience conducting conversations with surrogates and interactions with ICU survivors as outpatients were identified as facilitating discussion of expected post-discharge outcomes while optimistic surrogate expectations and prognostic uncertainty were barriers. There was tension between self-perceived ability to prognosticate and belief in a professional obligation to discuss patient outcomes.
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248
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A Self-Fulfilling Hypothesis*. Crit Care Med 2018; 46:158-159. [DOI: 10.1097/ccm.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang CH, Lin HC, Chang YC, Maa SH, Wang JS, Tang WR. Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study. Medicine (Baltimore) 2017; 96:e9165. [PMID: 29390449 PMCID: PMC5758151 DOI: 10.1097/md.0000000000009165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although it is clear that ventilated intensive care unit (ICU) patients have worse outcomes than those who are not, information about the risk factors of in-hospital mortality remains important for medical groups to target interventions for these patients.The purpose of this study was to identify predictive factors of in-hospital mortality in ventilated ICU patients with an admission diagnosis of acute respiratory failure.We conducted a prospective cohort study in 3 medical ICUs in a 3600-bed university hospital. Consecutive patients with acute respiratory failure who received mechanical ventilation (MV) for at least 96 hours without evidence of pre-existing neuromuscular diseases were followed until discharge. Upon inclusion, the following parameters were collected or evaluated: demographics, clinical history (admission body mass index [BMI], etiology of acute respiratory failure, comorbidity, Charlson comorbidity index, laboratory data), Acute Physiology and Chronic Health Evaluation (APACHE) II, and right and left quadriceps femoris muscle force. The days of MV before extubation, ICU length of stay, survival status at discharge, and hospital length of stay were recorded from the hospital discharge summary. The primary endpoint was in-hospital mortality.In all, 113 patients (65.49% males) were recruited with a mean age of 69.78 years and mean APACHE II score of 22.63. The mean ICU length of stay was 14.88 ± 9.79 days. Overall in-hospital mortality was 25.66% (29 out of 113 patients). Multivariate analysis showed that the essential factors associated with increased in-hospital mortality were lower BMI (P = .013), and lower scores on the right or left quadriceps femoris muscle force (P = .002 and .010, respectively).Our study suggests that lower BMI and lower scores on lower limb muscle force may be associated with increased in-hospital mortality in ventilated ICU patients.
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Affiliation(s)
- Chiu-Hua Wang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital
- Department of Chinese Medicine, Chang Gung University, Taoyuan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City
| | - Suh-Hwa Maa
- Center for General Education, National Taitung University, Taitung
| | - Jong-Shyan Wang
- Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Chang Gung University
| | - Woung-Ru Tang
- School of Nursing, Chang Gung University, Taoyuan, Taiwan
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Eakin MN, Patel Y, Mendez-Tellez P, Dinglas VD, Needham DM, Turnbull AE. Patients' Outcomes After Acute Respiratory Failure: A Qualitative Study With the PROMIS Framework. Am J Crit Care 2017; 26:456-465. [PMID: 29092868 DOI: 10.4037/ajcc2017834] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND As mortality rates for patients treated in intensive care units decrease, greater understanding of the impact of critical illness on patients' well-being is needed. OBJECTIVE To describe the survivorship experience of patients who had acute respiratory failure by using the Patient Reported Outcomes Measurement Information System (PROMIS) framework. METHODS A total of 48 adult patients who had acute respiratory failure completed at least 1 semistructured telephone-based interview between 5 and 18 months after their stay in the intensive care unit. Participants were asked about overall well-being and important health outcomes. RESULTS Major themes were identified within each of the 3 PROMIS components: physical health, mental health, and social health. The following themes were particularly prominent: mobility impairments, pulmonary symptoms, fatigue, anxiety and depression symptoms, and decreased ability to work and participate in valued activities. Impacts on overall well-being and on relationships with friends and family members varied among the survivors. Some survivors reported gratitude, increased appreciation of life, and closer relationships to loved ones. Other survivors reported boredom, social isolation, and wishing they had not survived. CONCLUSIONS Survivors of acute respiratory failure reported substantial issues with their physical, mental, and social health. Holistic assessments of outcomes of survivors of critical illness should capture the complex beneficial and adverse impacts of critical illness on survivors' well-being and social health.
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Affiliation(s)
- Michelle N Eakin
- All are members of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a research associate, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull is an assistant professor, Division of Pulmonary and Critical Care Medicine, School of Medicine and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University.
| | - Yashika Patel
- All are members of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a research associate, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull is an assistant professor, Division of Pulmonary and Critical Care Medicine, School of Medicine and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Pedro Mendez-Tellez
- All are members of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a research associate, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull is an assistant professor, Division of Pulmonary and Critical Care Medicine, School of Medicine and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Victor D Dinglas
- All are members of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a research associate, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull is an assistant professor, Division of Pulmonary and Critical Care Medicine, School of Medicine and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Dale M Needham
- All are members of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a research associate, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull is an assistant professor, Division of Pulmonary and Critical Care Medicine, School of Medicine and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Alison E Turnbull
- All are members of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a research associate, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull is an assistant professor, Division of Pulmonary and Critical Care Medicine, School of Medicine and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
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