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Sánchez-Arguiano MJ, Miñambres E, Cuenca-Fito E, Suberviola B, Burón-Mediavilla FJ, Ballesteros MA. Chronic critical illness after trauma injury: outcomes and experience in a trauma center. Acta Chir Belg 2023; 123:618-624. [PMID: 35881765 DOI: 10.1080/00015458.2022.2106626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/23/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine the prevalence, risk factors and functional results of chronic critical illness (CCI) in polytrauma patients. DESIGN Single-center observational retrospective study. SETTING ICU at a tertiary hospital in Santander, Spain, between 2015 and 2019. PATIENTS Adult trauma patients who survived beyond 48 h after injury. CCI was defined as the need for mechanical ventilation for at least 14 days or tracheostomy for difficult weaning. MEASUREMENTS AND MAIN RESULTS About 62/575 developed CCI. These patients were characterized by higher ISS score [17 (SD 10) vs. 13.8 (SD 8.2); p < 0.001] and higher NISS (26 (SD 11) vs. 19.2 (SD 10.5); p = 0.001). CCI group had greater proportion of hospital-acquired infections (100% vs. 18.1%; p < 0.001), and acute kidney failure (33.9% vs. 22.8% p < 0.001). During the first 24 h of admission, CCI group required in a greater proportion surgical intervention (50% vs. 29%; p = 0.001), and blood products (31.3% vs. 20.5%; p < 0.047). Hospital ward stay was longer in CCI patients [9.5 days (IQR 5-16.9) vs. 43.9 (IQR 30.3-53) p < 0.001]. The CCI mortality was higher (19.5% vs. 8.1%; p = 0.004). Surgical intervention in the first 24 h (OR 2.5 95% CI 1.1-4.1), age (> 55 years) (OR 2.1 95%CI 1.1-4.2), ISS score (OR 1.1 95%CI 1.02-1.3), GCS score (OR 0.8 95%CI 0.4-23.2) and multiple organ failure (OR 9.5 95%CI 3.9-23.2) were predictors of CCI in the multivariate analysis. CONCLUSIONS CCI after severe trauma appears in a considerable proportion of patients. Early identification and implementation of specific interventions could change the evolution of this process.
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Affiliation(s)
| | - Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Elena Cuenca-Fito
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Borja Suberviola
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - María A Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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Murlidharan A. Predictive Value of Frailty Index in Comparison to Traditional Markers of Sepsis in Predicting Mortality among Elderly Admitted in Tertiary Care Hospital. JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022; 70:11-12. [DOI: 10.5005/japi-11001-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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3
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Roedl K, Jarczak D, Boenisch O, de Heer G, Burdelski C, Frings D, Sensen B, Nierhaus A, Kluge S, Wichmann D. Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy. J Clin Med 2022; 11:jcm11041049. [PMID: 35207322 PMCID: PMC8876562 DOI: 10.3390/jcm11041049] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
The spread of SARS-CoV-2 caused a worldwide healthcare threat. High critical care admission rates related to Coronavirus Disease 2019 (COVID-19) respiratory failure were observed. Medical advances helped increase the number of patients surviving the acute critical illness. However, some patients require prolonged critical care. Data on the outcome of patients with a chronic critical illness (CCI) are scarce. Single-center retrospective study including all adult critically ill patients with confirmed COVID-19 treated at the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, Germany, between 1 March 2020 and 8 August 2021. We identified 304 critically ill patients with COVID-19 during the study period. Of those, 55% (n = 167) had an ICU stay ≥21 days and were defined as chronic critical illness, and 45% (n = 137) had an ICU stay <21 days. Age, sex and BMI were distributed equally between both groups. Patients with CCI had a higher median SAPS II (CCI: 39.5 vs. no-CCI: 38 points, p = 0.140) and SOFA score (10 vs. 6, p < 0.001) on admission. Seventy-three per cent (n = 223) of patients required invasive mechanical ventilation (MV) (86% vs. 58%; p < 0.001). The median duration of MV was 30 (17–49) days and 7 (4–12) days in patients with and without CCI, respectively (p < 0.001). The regression analysis identified ARDS (OR 3.238, 95% CI 1.827–5.740, p < 0.001) and referral from another ICU (OR 2.097, 95% CI 1.203–3.654, p = 0.009) as factors significantly associated with new-onset of CCI. Overall, we observed an ICU mortality of 38% (n = 115) in the study cohort. In patients with CCI we observed an ICU mortality of 28% (n = 46) compared to 50% (n = 69) in patients without CCI (p < 0.001). The 90-day mortality was 28% (n = 46) compared to 50% (n = 70), respectively (p < 0.001). More than half of critically ill patients with COVID-19 suffer from CCI. Short and long-term survival rates in patients with CCI were high compared to patients without CCI, and prolonged therapy should not be withheld when resources permit prolonged therapy.
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de Campos Biazon TMP, Libardi CA, Junior JCB, Caruso FR, da Silva Destro TR, Molina NG, Borghi-Silva A, Mendes RG. The effect of passive mobilization associated with blood flow restriction and combined with electrical stimulation on cardiorespiratory safety, neuromuscular adaptations, physical function, and quality of life in comatose patients in an ICU: a randomized controlled clinical trial. Trials 2021; 22:969. [PMID: 34969405 PMCID: PMC8719392 DOI: 10.1186/s13063-021-05916-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background Intensive care unit-acquired atrophy and weakness are associated with high mortality, a reduction in physical function, and quality of life. Passive mobilization (PM) and neuromuscular electrical stimulation were applied in comatose patients; however, evidence is inconclusive regarding atrophy and weakness prevention. Blood flow restriction (BFR) associated with PM (BFRp) or with electrical stimulation (BFRpE) was able to reduce atrophy and increase muscle mass in spinal cord-injured patients, respectively. Bulky venous return occurs after releasing BFR, which can cause unknown repercussions on the cardiovascular system. Hence, the aim of this study was to investigate the effect of BFRp and BFRpE on cardiovascular safety and applicability, neuromuscular adaptations, physical function, and quality of life in comatose patients in intensive care units (ICUs). Methods Thirty-nine patients will be assessed at baseline (T0–18 h of coma) and randomly assigned to the PM (control group), BFRp, or BFRpE groups. The training protocol will be applied in both legs alternately, twice a day with a 4-h interval until coma awake, death, or ICU discharge. Cardiovascular safety and applicability will be evaluated at the first training session (T1). At T0 and 12 h after the last session (T2), muscle thickness and quality will be assessed. Global muscle strength and physical function will be assessed 12 h after T2 and ICU and hospital discharge for those who wake up from coma. Six and 12 months after hospital discharge, physical function and quality of life will be re-assessed. Discussion In view of applicability, the data will be used to inform the design and sample size of a prospective trial to clarify the effect of BFRpE on preventing muscle atrophy and weakness and to exert the greatest beneficial effects on physical function and quality of life compared to BFRp in comatose patients in the ICU. Trial registration Universal Trial Number (UTN) Registry UTN U1111-1241-4344. Retrospectively registered on 2 October 2019. Brazilian Clinical Trials Registry (ReBec) RBR-2qpyxf. Retrospectively registered on 21 January 2020, http://ensaiosclinicos.gov.br/rg/RBR-2qpyxf/ Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05916-z.
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Affiliation(s)
- Thaís Marina Pires de Campos Biazon
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Cleiton Augusto Libardi
- Laboratory of Neuromuscular Adaptations to Resistance Training, Department of Physical Education, Federal University of São Carlos, São Carlos, Brazil
| | - Jose Carlos Bonjorno Junior
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil.,Department of Anesthesiology and Intensive Care Unit at the Irmandade da Santa Casa de Misericórdia de São Carlos, São Carlos, Brazil
| | - Flávia Rossi Caruso
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Tamara Rodrigues da Silva Destro
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Naiara Garcia Molina
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil.
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Hermann B, Hauw-Berlemont C, Augy JL, Monnier A, Boissier F, Aissaoui N, Fagon JY, Diehl JL, Guérot E. Epidemiology and Predictors of Long-Stays in Medical ICU: A Retrospective Cohort Study. J Intensive Care Med 2020; 36:1066-1074. [PMID: 32909917 DOI: 10.1177/0885066620956622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Prolonged stays in ICU have been associated with overconsumption of resources but little is known about their epidemiology. We aimed to identify predictors and prognostic factors of extended stays, studying a long-stay population. METHODS We present a retrospective cohort study between July 2000 and December 2013 comparing patients hospitalized in a medical ICU for ≥30 days (long-stay patients-LSP) with patients hospitalized for <30 days (short-stay patients-SSP). Admission characteristics were collected from the local database for every patient and evolution during the ICU stay was retrieved from LSP files. RESULTS Among 8906 patients hospitalized in the ICU, 417 (4.7%) were LSP. At admission, male sex (adjusted odds-ratio (aOR) 1.4 [1.1; 1.7]), inpatient (aOR 2.0 [1.6; 2.4]) and in-ICU hospitalizations for respiratory (aOR 2.9 [1.6; 3.5]) or infectious diseases (aOR 1.6 [1.1; 2.5]) were all independently associated with a long stay in the ICU, while hospitalizations for metabolic (aOR 0.2 [0.1; 0.5]) or cardiovascular diseases (aOR 0.3 [0.2; 0.5]) were in favor of a short stay. In-ICU and in-hospital LSP mortality were 38.8% and 48.2%. Age (aOR 1.02 [1.00-1.04]), catecholamines (aOR 3.9 [1.9; 8.5]), renal replacement therapy (aOR 2.4 [1.3; 4.3]), primary disease-related complications (aOR 2.5 [1.4; 4.6]) and nosocomial infections (aOR 4.1 [1.8; 10.1]) were independently associated with mortality in LSP. CONCLUSION LSP were highly comorbid patients mainly hospitalized for respiratory diseases. Their mortality was mostly related to nosocomial infections but the majority were discharged alive from the hospital.
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Affiliation(s)
- Bertrand Hermann
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Faculté de Médecine, Université de Paris, Paris, France.,INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Caroline Hauw-Berlemont
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Loup Augy
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - Alexandra Monnier
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Service de Réanimation médicale, 36604Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Florence Boissier
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Service de Réanimation médicale, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402 (ALIVE group), 70618Université de Poitiers, Poitiers, France
| | - Nadia Aissaoui
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Faculté de Médecine, Université de Paris, Paris, France.,INSERM U970, 20 rue Leblanc, Paris, France
| | - Jean-Yves Fagon
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Luc Diehl
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Faculté de Médecine, Université de Paris, Paris, France.,INSERM, UMR_S1140: Innovations Thérapeutiques en Hémostase, Faculté des Sciences Pharmaceutiques et Biologiques, Paris Descartes University, Paris, France
| | - Emmanuel Guérot
- Réanimation médicale, Hôpital Européen Georges Pompidou, 26930Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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What can be learned from crude intensive care unit mortality? Methodological implications. J Crit Care 2020; 59:130-135. [PMID: 32673999 DOI: 10.1016/j.jcrc.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/26/2020] [Accepted: 06/20/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Demonstrate the practical range of information that can be obtained about ICU mortality/survival from limited administrative data. MATERIALS AND METHODS Prospectively collected administrative data (length-of stay, survival/mortality, referring service) from a university medical center's General ICU was subjected to retrospective analysis to demonstrate ways of presenting and analyzing mortality/survival information. RESULTS 16,022 patients (87,624 patient-days) admitted over 23 years were included. 28% of all deaths occurred on ICU day 1. When considering all admissions, mortality on ICU day 1 was 2%, while the overall crude mortality rate revealed that the chances of dying during an ICU stay was 8.6%. Mortality rates in the overall population steadily increased over ICU days 1-5, plateaued during days 6 to 50, decreasing after day 50. The general surgery subgroup had a similar pattern. This contrasted with the internal medicine subgroup where mortality steadily increased over the initial 14 ICU days then plateauing at rates of 40-50%. INTERPRETATION Simple calculations using the few variables found in administrative database enhanced information provided by the crude mortality rate and demonstrated that temporal patterns of mortality change as stay lengthens. These results highlight the limitations of just using overall crude mortality rates.
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Roedl K, Amann D, Eichler L, Fuhrmann V, Kluge S, Müller J. The chronic ICU patient: Is intensive care worthwhile for patients with very prolonged ICU-stay (≥ 90 days)? Eur J Intern Med 2019; 69:71-76. [PMID: 31494021 DOI: 10.1016/j.ejim.2019.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Due to medical advances, an increasing number of patients are surviving the acute critical illness. However, some patients require a prolonged critical care treatment. Data on outcome and functional status of patients with an ICU-stay ≥90 days are scarce. METHODS Single-center retrospective study including all adult patients with ICU stay ≥90 days treated at the department of intensive care medicine at the university medical center Hamburg-Eppendorf, Germany, between January 1st 2008 and December 31st 2016. RESULTS Out of 65,249 patients, we identified 96 (0.1%) patients with a very prolonged ICU stay. Median age was 61 (49.8-67) years, 30 (31%) patients were female. Patients were admitted to ICU due to abdominal (28%) reasons, followed by sepsis (23%) and transplantation (15%). Fourteen patients received organ-transplantation: 9 received liver-, 4 lung- and 1 heart-transplantation. All patients needed mechanical ventilation (MV), median duration was 74.1 (55-95.1) days. Sixty-Three (66%) patients survived the ICU-stay and 1-Year survival rate was 28%. Overall eight (8%) patients had a favourable outcome after 1-Year. Severity of illness (SOFA, SAPS II) on admission were comparable. Length of MV, use of renal replacement therapy (both p < .01) and maximum lactate (5.3 vs 11.5 mmol/l; p < .001) were significantly higher in ICU non-survivors. ICU-stay was significantly longer in ICU non-survivors (137 vs 107 days; p < .05). Cox-regression-model revealed age (HR 1.02, 95% CI 1.00-1.04, p < .05) and surgical admission (HR 0.50, 95% CI 0.28-0.90, p < .05) as independent predictors of 1-year mortality. CONCLUSIONS Only a small number of patients requires a very prolonged ICU stay. Two-third of patients survive the ICU stay and about one-third 1-Year. However, about 10% of patients have a remarkable recovery with a favourable overall outcome after 1-Year.
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Affiliation(s)
- Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Dorothee Amann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Lars Eichler
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jakob Müller
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Anaesthesia, Tabea Hospital, Hamburg, Germany.
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8
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Lai CC, Tseng KL, Ho CH, Chiang SR, Chen CM, Chan KS, Chao CM, Hsing SC, Cheng KC. Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay. J Thorac Dis 2019; 11:2051-2057. [PMID: 31285898 DOI: 10.21037/jtd.2019.04.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Reasons for the prolonged critical care support include uncertainty of outcome, the complex dynamic created between physicians with care team members and the patient's family over a general unwillingness to surrender to unfavorable outcomes. The purpose of this study was to investigate outcomes and identify risk factors of patients with acute respiratory failure (ARF) who required a prolonged intensive care unit (ICU) stay (≥21 days). It may provide reference to screen patients who are suitable for hospice care. Methods The medical records of all ARF patients with a prolonged ICU stay were retrospectively reviewed. The primary outcome was in-hospital mortality. Results We identified 1,189 patients. Sepsis (n=896, 75.4%) was the most common cause of prolonged ICU stays, following by renal failure (n=232, 19.5%), and unstable hemodynamic status vasopressors or arrhythmia (n=208, 17.5%). Using multivariable logistic regression, we identified eight risk factors of death: age >75 years, ICU stay for more than 28 days, APACHE II score ≥25, unstable hemodynamic status, renal failure, hepatic failure, massive gastrointestinal tract bleeding, and using a fraction of inspired oxygen (FiO2) ≥40%. The overall in-hospital mortality rate was 53.6% (n=637), and it up to 75.3% (216/287) for patients with at least three risk factors. Conclusions The outcome of patients with ARF who required prolonged ICU stay was poor. They had a high risk of in-hospital mortality. Palliative care should be considered as a reasonable option for the patients at high risk of death.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Kuei-Ling Tseng
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan
| | - Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan
| | - Chin-Ming Chen
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan.,Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Khee-Siang Chan
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Shu-Chen Hsing
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan.,Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan
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Curry AS, Chadda S, Danel A, Nguyen DL. Early introduction of a semi-elemental formula may be cost saving compared to a polymeric formula among critically ill patients requiring enteral nutrition: a cohort cost-consequence model. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:293-300. [PMID: 29892200 PMCID: PMC5993029 DOI: 10.2147/ceor.s155312] [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] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Gastrointestinal (GI) intolerance is associated with adverse outcomes in critically ill patients receiving enteral nutrition (EN). The objective of this analysis is to quantify the cost of GI intolerance and the cost implications of starting with semi-elemental EN in intensive care units (ICUs). STUDY DESIGN A US-based cost-consequence model was developed to compare the costs for patients with and without GI intolerance and the costs with semi-elemental or standard EN while varying the proportion of GI intolerance cases avoided. MATERIALS AND METHODS ICU data on GI intolerance prevalence and outcomes in patients receiving EN were derived from an observational study. ICU stay costs were obtained from literature and the costs of EN from US customers' price lists. The model was used to conduct a threshold analysis, which calculated the minimum number of cases of GI intolerance that would have to be avoided to make the initial use of semi-elemental formula cost saving for the cohort. RESULTS Out of 100 patients receiving EN, 31 had GI intolerance requiring a median ICU stay of 14.4 days versus 11.3 days for each patient without GI intolerance. The model calculated that semi-elemental formula was cost saving versus standard formula when only three cases of GI intolerance were prevented per 100 patients (7% of GI intolerance cases avoided). CONCLUSION In the US setting, the model predicts that initial use of semi-elemental instead of standard EN can result in cost savings through the reduction in length of ICU stay if >7% of GI intolerance cases are avoided.
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Affiliation(s)
| | - Shkun Chadda
- Health Economics, SIRIUS Market Access, London UK
| | - Aurélie Danel
- Market Access, Nestlé Health Science, Vevey, Switzerland
| | - Douglas L Nguyen
- University of California-Irvine Department of Medicine, Orange, CA, USA
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Wise R, de Vasconcellos K, Skinner D, Rodseth R, Gopalan D, Muckart D, Banoo Z, Bisseru T, Blakemore S, de Meyer J, Faurie M, Govender K, Hardcastle T, Jeena P, Kalafatis N, Kistan K, Kisten T, Lee C, Mitchell C, Moodley M, Morgan M, Ramkilliwana A, Ramjee R, Reddy D, Robroch A, Singh S, von Rahden R, Biccard B. Outcomes 30 days after ICU admission: the 30DOS study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1402553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Robert Wise
- Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa
- Clinical Unit, Critical Care, Edendale Hospital, Pietermaritzburg, South Africa
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kim de Vasconcellos
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Critical Care, King Edward VIII Hospital, Durban, South Africa
| | - David Skinner
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Reitze Rodseth
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Dean Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - David Muckart
- Discipline of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Zohra Banoo
- KwaZulu-Natal Department of Health District, Ethekweni Paediatric Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Discipline of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
| | - Tashmin Bisseru
- Paediatrics, Life Hilton Hospital, Pietermaritzburg, South Africa
| | - Steve Blakemore
- Aneasthesiology, St Augustine's Hospital, Durban, South Africa
| | - Jenine de Meyer
- Inkosi Albert Luthuli Central Hospital, National Health Laboratory Services, Durban, South Africa
- Clinical Unit, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Michael Faurie
- Discipline of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Kom Govender
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Timothy Hardcastle
- Clinical Unit, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Trauma Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Trauma Training Unit, University of KwaZulu-Natal, Durban, South Africa
| | - Prakash Jeena
- Paediatric Intensive Care Unit, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Nicky Kalafatis
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Kroshlan Kistan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Theroshnie Kisten
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Carolyn Lee
- Head Clinical Department: Internal Medicine, Pietermaritzburg, South Africa
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Colin Mitchell
- Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Magesvaran Moodley
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Morgan
- Discipline of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
- Paediatrics, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa
| | - Arisha Ramkilliwana
- Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Rajesh Ramjee
- Anaesthesiology, Prince Mshiyeni Memorial Hospital, Durban, South Africa
| | - Darshan Reddy
- Department of Cardiothoracic Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Afke Robroch
- Wilhemina’s Childrens Hospital, UMC, Utrecht, The Netherlands
| | - Shivani Singh
- Discipline of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
- Paediatric Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Richard von Rahden
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Intensive Care Unit, Grey’s Hospital, Pietermaritzburg, South Africa
| | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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11
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Coping as a Multifaceted Construct: Associations With Psychological Outcomes Among Family Members of Mechanical Ventilation Survivors. Crit Care Med 2017; 44:1710-7. [PMID: 27065467 DOI: 10.1097/ccm.0000000000001761] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and evaluate a preliminary multifaceted model for coping among family members of patients who survive mechanical ventilation. DESIGN AND SETTING In this multicenter cross-sectional survey, we interviewed family members of mechanically ventilated patients at the time of transfer from the ICU to the hospital ward. We constructed a theoretic model of coping that included characteristics attributable to family members, family-clinician rapport, and patients. We then explored relationships between coping factors and symptoms of psychological distress (anxiety, depression, and posttraumatic stress). SUBJECTS Fifty-six family members of survivors of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS Psychological distress measured by the Hospital Anxiety and Depression Scale and Posttraumatic Stress Scale. Optimism measured using the Life Orientation Test scale, resiliency by Conner-Davidson Resilience Scale, and social support using the Patient Reported Outcomes Measurement Information System inventory. Family members had moderate levels of psychological distress with median total Hospital Anxiety and Depression Scale equal to 14 (interquartile range, 5-20) and Posttraumatic Stress Scale equal to 22 (interquartile range, 15-31). Among family member characteristics, greater optimism (p = 0.001, Hospital Anxiety and Depression Scale; p = 0.010, Posttraumatic Stress Scale), resilience (p = 0.012, Hospital Anxiety and Depression Scale), and social support (p = 0.013, Hospital Anxiety and Depression Scale) were protective against psychological distress. On the contrary, characteristics of family-clinician rapport such as communication quality and presence of conflict did not have any associations with psychological distress. CONCLUSION To our knowledge, this is the first study to explore coping as a multifaceted construct and its relationship with family psychological outcomes among survivors of mechanical ventilation. We found certain family characteristics of coping such as optimism, resilience, and social support to be associated with less psychological distress. Further research is warranted to identify potentially modifiable aspects of coping that might guide future interventions.
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Pintado MC, Villa P, Luján J, Trascasa M, Molina R, González-García N, de Pablo R. Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay. Med Intensiva 2015; 40:289-97. [PMID: 26706825 DOI: 10.1016/j.medin.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/23/2015] [Accepted: 08/07/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days. DESIGN A prospective observational study was carried out. SETTING A Spanish medical-surgical ICU. PATIENTS Patients over 75 years of age admitted to the ICU. PRIMARY VARIABLES OF INTEREST ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality. RESULTS A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status. CONCLUSIONS Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater.
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Affiliation(s)
- M C Pintado
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - P Villa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Luján
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Trascasa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - R Molina
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - N González-García
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - R de Pablo
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Nicolo M, Heyland DK, Chittams J, Sammarco T, Compher C. Clinical Outcomes Related to Protein Delivery in a Critically Ill Population: A Multicenter, Multinational Observation Study. JPEN J Parenter Enteral Nutr 2015; 40:45-51. [PMID: 25900319 DOI: 10.1177/0148607115583675] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/20/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Optimal intake of energy and protein is associated with improved outcomes, although outcomes relative to protein intake are very limited. Our purpose was to evaluate the impact of prescribed protein delivery on mortality and time to discharge alive (TDA) using data from the International Nutrition Survey 2013. We hypothesized that greater protein delivery would be associated with lower mortality and shorter TDA. METHODS The sample included patients in the intensive care unit (ICU) ≥ 4 days (n = 2828) and a subsample in the ICU ≥ 12 days (n = 1584). Models were adjusted for evaluable nutrition days, age, body mass index, sex, admission type, acuity scores, and geographic region. Percentages of prescribed protein and energy intake were compared with mortality outcomes using logistic regression and with Cox proportional hazards for TDA. RESULTS Mean intake for the 4-day sample was protein 51 g (60.5% of prescribed) and 1100 kcal (64.1% of prescribed); for the 12-day sample, mean intake was protein 57 g (66.7% of prescribed) and 1200 kcal (70.7% of prescribed). Achieving ≥ 80% of prescribed protein intake was associated with reduced mortality (4-day sample: odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.91; 12-day sample: OR, 0.60; 95% CI, 0.39-0.93), but ≥ 80% of prescribed energy intake was not. TDA was shorter with ≥ 80% prescribed protein (hazard ratio [HR], 1.25; 95% CI, 1.04-1.49) in the 12-day sample but longer with ≥ 80% prescribed energy in the 4-day sample (HR, 0.82; 95% CI, 0.69-0.96). CONCLUSION Achieving at least 80% of prescribed protein intake may be important to survival and shorter TDA in ICU patients. Efforts to achieve prescribed protein intake should be maximized.
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Affiliation(s)
- Michele Nicolo
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daren K Heyland
- Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Therese Sammarco
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Charlene Compher
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Indikationen und Outcome beatmeter Patienten einer neurologischen Intensivstation. DER NERVENARZT 2012; 83:741-50. [DOI: 10.1007/s00115-011-3411-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Aiub A, Fajardo RV, Lourenço PM, Presto B, Kurtz P, Almeida GF, Nobre GF, Kalichsztein M, Japiassú AM. AGE AND ACUTE-SEVERITY ILLNESS PORTEND DAILY ACTIVITY DYSFUNCTION 6 MONTHS AFTER HOSPITAL DISCHARGE. J Am Geriatr Soc 2011; 59:1155-7. [DOI: 10.1111/j.1532-5415.2011.03443.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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McDermid RC, Stelfox HT, Bagshaw SM. Frailty in the critically ill: a novel concept. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:301. [PMID: 21345259 PMCID: PMC3222010 DOI: 10.1186/cc9297] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The concept of frailty has been defined as a multidimensional syndrome characterized by the loss of physical and cognitive reserve that predisposes to the accumulation of deficits and increased vulnerability to adverse events. Frailty is strongly correlated with age, and overlaps with and extends aspects of a patient's disability status (that is, functional limitation) and/or burden of comorbid disease. The frail phenotype has more specifically been characterized by adverse changes to a patient's mobility, muscle mass, nutritional status, strength and endurance. We contend that, in selected circumstances, the critically ill patient may be analogous to the frail geriatric patient. The prevalence of frailty amongst critically ill patients is currently unknown; however, it is probably increasing, based on data showing that the utilization of intensive care unit (ICU) resources by older people is rising. Owing to the theoretical similarities in frailty between geriatric and critically ill patients, this concept may have clinical relevance and may be predictive of outcomes, along with showing important interaction with several factors including illness severity, comorbid disease, and the social and structural environment. We believe studies of frailty in critically ill patients are needed to evaluate how it correlates with outcomes such as survival and quality of life, and how it relates to resource utilization, such as length of mechanical ventilation, ICU stay and duration of hospitalization. We hypothesize that the objective measurement of frailty may provide additional support and reinforcement to clinicians confronted with end-of-life decisions on the appropriateness of ICU support and/or withholding of life-sustaining therapies.
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Affiliation(s)
- Robert C McDermid
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Centre, 8440-112 ST NW, Edmonton, Canada T6G 2B7
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Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman M, Webb SAR. Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. Br J Anaesth 2010; 104:459-64. [PMID: 20185517 DOI: 10.1093/bja/aeq025] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Critical illness leading to prolonged length of stay (LOS) in an intensive care unit (ICU) is associated with significant mortality and resource utilization. This study assessed the independent effect of ICU LOS on in-hospital and long-term mortality after hospital discharge. METHODS Clinical and mortality data of 22 298 patients, aged 16 yr and older, admitted to ICU between 1987 and 2002 were included in this linked-data cohort study. Cox's regression with restricted cubic spline function was used to model the effect of LOS on in-hospital and long-term mortality after adjusting for age, gender, acute physiology score (APS), maximum number of organ failures, era of admission, elective admission, Charlson's co-morbidity index, and diagnosis. The variability each predictor explained was calculated by the percentage of the chi(2) statistic contribution to the total chi(2) statistic. RESULTS Most hospital deaths occurred within the first few days of ICU admission. Increasing LOS in ICU was not associated with an increased risk of in-hospital mortality after adjusting for other covariates, but was associated with an increased risk of long-term mortality after hospital discharge. The variability on the long-term mortality effect associated with ICU LOS (2.3%) appeared to reach a plateau after the first 10 days in ICU and was not as important as age (35.8%), co-morbidities (18.6%), diagnosis (10.9%), and APS (3.6%). CONCLUSIONS LOS in ICU was not an independent risk factor for in-hospital mortality, but it had a small effect on long-term mortality after hospital discharge after adjustment for other risk factors.
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Affiliation(s)
- T A Williams
- The University of Western Australia, Crawley, Australia.
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Huber M, Rumetshofer R, Stradal KH, Attems J, Lintner F. Catheter-related Leuconostoc bacteremia secondary to pulmonary Mycobacterium xenopi infection. Wien Klin Wochenschr 2010; 119:674-7. [PMID: 18043889 DOI: 10.1007/s00508-007-0848-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
Abstract
Infection caused by Leuconostoc spp. is very rare. We report a case of Leuconostoc bacteremia in a patient receiving antimycobacterial chemotherapy for pulmonary Mycobacterium xenopi infection. In addition, the patient presented several known characteristic predisposing factors associated with Leuconostoc infection, such as severe underlying disease, previous long-term antibiotic treatment, indwelling intravascular catheter, prolonged parenteral feeding, previous methicillin-resistant Staphylococcus epidermidis (MRSE) bacteremia with subsequent vancomycin treatment, and prolonged hospitalization. Leuconostoc spp. were isolated from several blood cultures and from a retracted intravascular catheter. After removal of the intravascular catheter the patient's condition improved without additional antibiotic treatment. To our knowledge, this is the first report of a patient with Leuconostoc spp. infection secondary to pulmonary non-tuberculous mycobacteriosis.
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Affiliation(s)
- Monika Huber
- Pathologisch-Bakteriologisches Institut, SMZ Otto Wagner Spital, Baumgartner Höhe, Vienna, Austria.
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A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit. ACTA ACUST UNITED AC 2009; 67:341-8; discussion 348-9. [PMID: 19667888 DOI: 10.1097/ta.0b013e3181a5cc34] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Trauma centers successfully save lives of severely injured patients who would have formerly died. However, survivors often have multiple complications and morbidities associated with prolonged intensive care unit (ICU) stays. Because the reintegration of patients into the society to lead an active and a productive life is the ultimate goal of trauma center care, we questioned whether our "success" may condemn these patients to a fate worse than death? METHODS Charts on all patients > or =18 years with ICU stay > or =10 days, discharged alive between June 1, 2002, and May 31, 2005, were reviewed. Patients with complete spinal cord injuries were excluded. Demographics, Injury Severity Score (ISS), presence of severe traumatic brain injury (TBI; Head Abbreviated Injury Scale [AIS] score = 4 or 5), presence of extremity fractures, need for operative procedures, ventilator days, complications, and discharge disposition were collected. Glasgow Outcome Scale score was calculated on discharge. Patients were contacted by phone to determine general health, work status, and using this data, Glasgow Outcome Scale score and a modified Functional Independence Measure (FIM) score were calculated. RESULTS Two hundred and forty-one patients met inclusion criteria. Thirty-three patients died postdischarge from the hospital and 39 were known to be alive from the electronic medical records but were unable to be contacted. Sixty-nine patients could not be tracked down and were ultimately considered as lost to follow-up. The remaining 100 patients who were successfully contacted participated in the study. Eighty-one percent were men with a mean age of 42 years, mean and median ISS of 28. Severe TBI was present in 50 (50%) patients. Mean and median follow-up was 3.3 years from discharge. At the time of follow-up, 92 (92%) patients were living at home, 5 in nursing homes, and 3 in assisted living, a shelter, or halfway house. FIM scores ranged from 6 to 12 with 55% reached a maximal FIM score of 12. One quarter of patients had FIM scores < or =10 and 10% had locomotion scores of < or =2 (very dependent). Seventy percent considered themselves to be less active. Seventy-six patients were either working or in full-time school before their trauma. Of the 24 patients not working preinjury, 12 were > or =55 years of age. At the time of follow-up, 37 patients (49%) were back to work or school. Severe TBI patients (57%, 21 of 37) were less likely to return to work when compared with 38% (12 of 38; p = 0.03) without severe TBI. There was no relationship with age, ISS, presence of any TBI, head AIS, presence of any extremity fracture, extremity AIS, or ventilator days in patients who did or did not return to work. CONCLUSIONS These data demonstrate that ICU survivors >3 years after severe injury have significant impairments including inability to return to work or regain previous levels of activity and that the goal of reintegrating patients back into the society is not being met. Further studies better defining the limitations and barriers to improved quality of life are necessary. Survival, although important, is no longer a sufficient outcome to measure trauma center success.
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Moon KM, Han MS, Lee SK, Jeon HS, Lee YD, Cho Y, Na DJ. Clinical Characteristics and Prognosis of Lung Cancer Patients Admitted to the Medical Intensive Care Unit at a University Hospital. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyoung Min Moon
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Min Soo Han
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Sung Kyu Lee
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Ho Seok Jeon
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Yang Deok Lee
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Yongseon Cho
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Dong Jib Na
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
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Santana Cabrera L, Sánchez-Palacios M, Hernández Medina E, Eugenio Robaina P, Villanueva-Hernández A. [Characteristics and prognosis of patients with very long stay in an Intensive Care Unit]. Med Intensiva 2008; 32:157-62. [PMID: 18413119 DOI: 10.1016/s0210-5691(08)70931-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the characteristics and prognostic factors of elderly patients hospitalized for > or = 30 days in an Intensive Care Unit (ICU). DESIGN Retrospective analysis of prospectively collected simple data over 6 consecutive years. SETTING Polyvalent ICU of the Insular University Hospital in the Canary Islands (Spain). PATIENTS Adult patients > or = 70 years who were hospitalized in the ICU for a period of 30 or more days. PRIMARY VARIABLES OF INTEREST Demographic data, clinical diagnosis on ICU admission, Apache II, days of renal replacement therapy (RRT), days of mechanical ventilation and the outcome of the survivors one year later were collected. Mortality at one year of the surviving patients was studied. RESULTS During the study period, 3,786 patients were admitted to the ICU. Of these, 853 (22.5%) patients were > or = 70 years old and only 42 (4.92%) of these patients remained in the ICU for > or = 30 days. We compared the latter with the > or = 70 year old patients whose stay in the ICU stay was < 30 days. No statistically significant differences in ICU mortality, Apache II, age, gender and the need for RRT were found. As independent variables associated with the long stay, the multivariate analysis showed only the days of mechanical ventilation (p < 0.05). The surviving patients (> or = 70 years old and whose stay in the ICU was > or = 30 days) were older and 21 (65.62%) were still alive one year later. CONCLUSIONS ICU mortality rates in elderly patients with a stay < or > or = 30 days in the ICU were comparable. Survival at one year of the > or = 70 year-old patients whose long-term intensive care unit stay was > or = 30 days was high. These results are sufficient in our unit to justify prolonged ICU care for elderly patients.
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Affiliation(s)
- L Santana Cabrera
- Servicio de Medicina Intensiva, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
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22
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Dick P, Mlekusch W, Delle-Karth G, Nikfardjam M, Schillinger M, Heinz G. Decreasing incidence of critical limb ischemia after intra-aortic balloon pump counterpulsation. Angiology 2008; 60:235-41. [PMID: 18599494 DOI: 10.1177/0003319708319782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors investigated the incidence of critical limb ischemia (CLI) in 187 patients with intra-aortic balloon pump (IABP) support during a 6-year study period and determined risk factors and long-term outcome (median 5 years) after discharge from a cardiac intensive care unit. Cardiogenic shock following acute myocardial infarction was the predominant cause of IABP support. CLI occurred in 10% of the patients after IABP implantation. Nevertheless, in light of the overall high mortality in this patient population, CLI seems not a primary concern. Furthermore, its incidence significantly decreased during recent years. Duration of IABP support was a significant predictor for CLI.
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Affiliation(s)
- Petra Dick
- Department of Angiology, Medical University of Vienna, Vienna, Austria
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Strasser EM, Wessner B, Roth E. [Cellular regulation of anabolism and catabolism in skeletal muscle during immobilisation, aging and critical illness]. Wien Klin Wochenschr 2007; 119:337-48. [PMID: 17634890 DOI: 10.1007/s00508-007-0817-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 05/16/2007] [Indexed: 12/13/2022]
Abstract
Skeletal muscle atrophy is associated with situations of acute and chronical illness, such as sepsis, surgery, trauma and immobility. Additionally, it is a common problem during the physiological process of aging. The myofibrillar proteins myosin and actin, which are essential for muscle contraction, are the major targets during the process of protein degradation. This leads to a general loss of muscle mass, muscle strength and to increased muscle fatigue. In critically ill or immobile patients skeletal muscle atrophy is accompanied by enhanced inflammation, reduced wound healing, weaning complications and difficulties in mobilisation. During aging it results in falls, fractures, physical injuries and loss of mobility. Relating to the primary stimulators - hormones, muscle lengthening, stress, inflammation, neuronal activity - research is now focusing on the investigation of the signal transduction pathways, which influence protein synthesis and protein degradation during skeletal muscle atrophy.
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Affiliation(s)
- Eva-Maria Strasser
- Chirurgische Forschungslaboratorien, Medizinische Universität Wien, Wien, Austria
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Graf J, Janssens U. [Chronic critical disease--what does the long-term patient imply for intensive medicine]. Wien Klin Wochenschr 2006; 118:369-72. [PMID: 16865639 DOI: 10.1007/s00508-006-0628-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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