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Motazedian P, Beauregard N, Letourneau I, Olaye I, Syed S, Lam E, Di Santo P, Mathew R, Clark EG, Sood MM, Lalu MM, Hibbert B, Bugeja A. Central Venous Oxygen Saturation for Estimating Mixed Venous Oxygen Saturation and Cardiac Index in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med 2024:00003246-990000000-00369. [PMID: 39258966 DOI: 10.1097/ccm.0000000000006398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVES The objectives of our systematic review and meta-analyses were to determine the diagnostic accuracy of central venous oxygen saturation (Scvo2) in estimating mixed venous oxygen saturation (Svo2) and cardiac index in critically ill patients. DATA SOURCES A systematic search using MEDLINE, Cochrane Central Register of Controlled Trials, and Embase was completed on May 6, 2024. STUDY SELECTION Studies of patients in the ICU for whom Scvo2 and at least one reference standard test was performed (thermodilution and/or Svo2) were included. DATA EXTRACTION Individual patient data were used to calculate the pooled intraclass correlation coefficient (ICC) for Svo2 and Spearman correlation for cardiac index. The Quality Assessment of Diagnostic Accuracy Studies-2 and Grading Recommendations Assessment, Development, and Evaluation tools were used for the risk of bias and certainty of evidence assessments. DATA SYNTHESIS Of 3427 studies, a total of 18 studies with 1971 patients were identified. We meta-analyzed 16 studies (1335 patients) that used Svo2 as a reference and three studies (166 patients) that used thermodilution as reference. The ICC for reference Svo2 was 0.83 (95% CI, 0.75-0.89) with a mean difference of 2.98% toward Scvo2. The Spearman rank correlation for reference cardiac index is 0.47 (95% CI, 0.46-0.48; p < 0.0001). CONCLUSIONS There is moderate reliability for Scvo2 in predicting Svo2 in critical care patients with variability based on sampling site and presence of sepsis. There is limited evidence on the independent use of Scvo2 in predicting cardiac index.
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Affiliation(s)
- Pouya Motazedian
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Nickolas Beauregard
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
| | - Isabelle Letourneau
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ida Olaye
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
| | - Sarah Syed
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
| | - Eric Lam
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Pietro Di Santo
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ann Bugeja
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Lee MW, Vallejo A, Furey KB, Woll SM, Klar M, Roman LD, Wright JD, Matsuo K. Racial and ethnic differences in early death among gynecologic malignancy. Am J Obstet Gynecol 2024; 231:231.e1-231.e11. [PMID: 38460831 DOI: 10.1016/j.ajog.2024.03.003] [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: 12/06/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Racial and ethnic differences in early death after cancer diagnosis have not been well studied in gynecologic malignancy. OBJECTIVE This study aimed to assess population-level trends and characteristics of early death among patients with gynecologic malignancy based on race and ethnicity in the United States. STUDY DESIGN The National Cancer Institute's Surveillance, Epidemiology, and End Results Program was queried to examine 461,300 patients with gynecologic malignancies from 2000 to 2020, including uterine (n=242,709), tubo-ovarian (n=119,989), cervical (n=68,768), vulvar (n=22,991), and vaginal (n=6843) cancers. Early death, defined as a mortality event within 2 months of the index cancer diagnosis, was evaluated per race and ethnicity. RESULTS At the cohort level, early death occurred in 21,569 patients (4.7%), including 10.5%, 5.5%, 2.9%, 2.5%, and 2.4% for tubo-ovarian, vaginal, cervical, uterine, and vulvar cancers, respectively (P<.001). In a race- and ethnicity-specific analysis, non-Hispanic Black patients with tubo-ovarian cancer had the highest early death rate (14.5%). Early death racial and ethnic differences were the largest in tubo-ovarian cancer (6.4% for Asian vs 14.5% for non-Hispanic Black), followed by uterine (1.6% for Asian vs 4.9% for non-Hispanic Black) and cervical (1.8% for Hispanic vs 3.8% to non-Hispanic Black) cancers (all, P<.001). In tubo-ovarian cancer, the early death rate decreased over time by 33% in non-Hispanic Black patients from 17.4% to 11.8% (adjusted odds ratio, 0.67; 95% confidence interval, 0.53-0.85) and 23% in non-Hispanic White patients from 12.3% to 9.5% (adjusted odds ratio, 0.77; 95% confidence interval, 0.71-0.85), respectively. The early death between-group difference diminished only modestly (12.3% vs 17.4% for 2000-2002 [adjusted odds ratio for non-Hispanic White vs non-Hispanic Black, 0.54; 95% confidence interval, 0.45-0.65] and 9.5% vs 11.8% for 2018-2020 [adjusted odds ratio, 0.65; 95% confidence interval, 0.54-0.78]). CONCLUSION Overall, approximately 5% of patients with gynecologic malignancy died within the first 2 months from cancer diagnosis, and the early death rate exceeded 10% in non-Hispanic Black individuals with tubo-ovarian cancer. Although improving early death rates is encouraging, the difference among racial and ethnic groups remains significant, calling for further evaluation.
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Affiliation(s)
- Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Katelyn B Furey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Sabrina M Woll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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Pattison N. Critical care outreach and rapid response teams: Are they the panacea to all hospital patient deterioration problems? Intensive Crit Care Nurs 2024; 82:103643. [PMID: 38394981 DOI: 10.1016/j.iccn.2024.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, East and North Herts NHS Trust, Imperial College Healthcare NHS Trust, Imperial College London, UK.
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Carrandi A, Liew C, Maiden MJ, Litton E, Taylor C, Thompson K, Higgins A. Costs of Australian intensive care: A systematic review. CRIT CARE RESUSC 2024; 26:153-158. [PMID: 39072237 PMCID: PMC11282335 DOI: 10.1016/j.ccrj.2024.03.003] [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: 02/03/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 07/30/2024]
Abstract
Objective Intensive care unit (ICU) cost estimates are critical to achieving healthcare system efficiency and sustainability. We aimed to review the published literature describing ICU costs in Australia. Design A systematic review was conducted to identify studies that estimated the cost of ICU care in Australia. Studies conducted in specific patient cohorts or on specific treatments were excluded. Data sources Relevant studies were sourced from a previously published review (1970-2016), a systematic search of MEDLINE and EMBASE (2016-5 May 2023), and reference checking. Review methods A tool was developed to assess study quality and risk of bias (maximum score 57/57). Total and component costs were tabulated and indexed to 2022 Australian Dollars. Costing methodologies and study quality assessments were summarised. Results Six costing studies met the inclusion criteria. Study quality scores were low (15/41 to 35/47). Most studies were conducted only in tertiary metropolitan public ICUs; sample sizes ranged from 100 to 10,204 patients. One study used data collected within the past 10 years. Mean daily ICU costs ranged from $966 to $5381 and mean total ICU admission costs $4888 to $14,606. Three studies used a top-down costing approach, deriving cost estimates from budget reports. The other three studies used both bottom-up and top-down costing approaches. Bottom-up approaches collected individual patient resource use. Conclusions Available ICU cost estimates are largely outdated and lack granular data. Future research is needed to estimate ICU costs that better reflect current practice and patient complexity and to determine the best methods for generating these estimates.
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Affiliation(s)
- Alayna Carrandi
- Australian and New Zealand Clinical Trials Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cheelim Liew
- Eastern Health, Box Hill Hospital, Department of Intensive Care Services, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew J. Maiden
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Litton
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Colman Taylor
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Kelly Thompson
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District. Kingswood, NSW, Australia
| | - Alisa Higgins
- Australian and New Zealand Clinical Trials Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
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Lilly CM, Kirk D, Pessach IM, Lotun G, Chen O, Lipsky A, Lieder I, Celniker G, Cucchi EW, Blum JM. Application of Machine Learning Models to Biomedical and Information System Signals From Critically Ill Adults. Chest 2024; 165:1139-1148. [PMID: 37923292 PMCID: PMC11214904 DOI: 10.1016/j.chest.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Machine learning (ML)-derived notifications for impending episodes of hemodynamic instability and respiratory failure events are interesting because they can alert physicians in time to intervene before these complications occur. RESEARCH QUESTION Do ML alerts, telemedicine system (TS)-generated alerts, or biomedical monitors (BMs) have superior performance for predicting episodes of intubation or administration of vasopressors? STUDY DESIGN AND METHODS An ML algorithm was trained to predict intubation and vasopressor initiation events among critically ill adults. Its performance was compared with BM alarms and TS alerts. RESULTS ML notifications were substantially more accurate and precise, with 50-fold lower alarm burden than TS alerts for predicting vasopressor initiation and intubation events. ML notifications of internal validation cohorts demonstrated similar performance for independent academic medical center external validation and COVID-19 cohorts. Characteristics were also measured for a control group of recent patients that validated event detection methods and compared TS alert and BM alarm performance. The TS test characteristics were substantially better, with 10-fold less alarm burden than BM alarms. The accuracy of ML alerts (0.87-0.94) was in the range of other clinically actionable tests; the accuracy of TS (0.28-0.53) and BM (0.019-0.028) alerts were not. Overall test performance (F scores) for ML notifications were more than fivefold higher than for TS alerts, which were higher than those of BM alarms. INTERPRETATION ML-derived notifications for clinically actioned hemodynamic instability and respiratory failure events represent an advance because the magnitude of the differences of accuracy, precision, misclassification rate, and pre-event lead time is large enough to allow more proactive care and has markedly lower frequency and interruption of bedside physician work flows.
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Affiliation(s)
- Craig M Lilly
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA; UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology and Surgery, University of Massachusetts, Worcester, MA; University of Massachusetts Chan Medical School, University of Massachusetts, Worcester, MA; Clinical and Population Health Research Program, University of Massachusetts, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts, Worcester, MA.
| | - David Kirk
- WakeMed Health & Hospitals, Raleigh/Cary, NC
| | - Itai M Pessach
- The Chaim Sheba Medical Center and Tel-Aviv University, Tel Hashomer, Israel; Clew Medical, Netanya, Israel
| | - Gurudev Lotun
- UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA
| | | | - Ari Lipsky
- The Chaim Sheba Medical Center and Tel-Aviv University, Tel Hashomer, Israel; Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Eric W Cucchi
- UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA
| | - James M Blum
- Department of Anesthesiology, University of Iowa, Iowa City, IA
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Bodí M, Samper MA, Sirgo G, Esteban F, Canadell L, Berrueta J, Gómez J, Rodríguez A. Assessing the impact of real-time random safety audits through full propensity score matching on reliable data from the clinical information system. Int J Med Inform 2024; 184:105352. [PMID: 38330523 DOI: 10.1016/j.ijmedinf.2024.105352] [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: 11/15/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Evidence-based care processes are not always applied at the bedside in critically ill patients. Numerous studies have assessed the impact of checklists and related strategies on the process of care and patient outcomes. We aimed to evaluate the effects of real-time random safety audits on process-of-care and outcome variables in critical care patients. METHODS This prospective study used data from the clinical information system to evaluate the impact of real-time random safety audits targeting 32 safety measures in two intensive care units during a 9-month period. We compared endpoints between patients attended with safety audits and those not attended with safety audits. The primary endpoint was mortality, measured by Cox hazard regression after full propensity-score matching. Secondary endpoints were the impact on adherence to process-of-care measures and on quality indicators. RESULTS We included 871 patients; 228 of these were attended in ≥ 1 real-time random safety audits. Safety audits were carried out on 390 patient-days; most improvements in the process of care were observed in safety measures related to mechanical ventilation, renal function and therapies, nutrition, and clinical information system. Although the group of patients attended in safety audits had more severe disease at ICU admission [APACHE II score 21 (16-27) vs. 20 (15-25), p = 0.023]; included a higher proportion of surgical patients [37.3 % vs. 26.4 %, p = 0.003] and a higher proportion of mechanically ventilated patients [72.8 % vs. 40.3 %, p < 0.001]; averaged more days on mechanical ventilation, central venous catheter, and urinary catheter; and had a longer ICU stay [12.5 (5.5-23.3) vs. 2.9 (1.7-5.9), p < 0.001], ICU mortality did not differ significantly between groups (19.3 % vs. 18.8 % in the group without safety rounds). After full propensity-score matching, Cox hazard regression analysis showed real-time random safety audits were associated with a lower risk of mortality throughout the ICU stay (HR 0.31; 95 %CI 0.20-0.47). CONCLUSIONS Real-time random safety audits are associated with a reduction in the risk of ICU mortality. Exploiting data from the clinical information system is useful in assessing the impact of them on the care process, quality indicators, and mortality.
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Affiliation(s)
- Maria Bodí
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain.
| | - Manuel A Samper
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Gonzalo Sirgo
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Federico Esteban
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Laura Canadell
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Julen Berrueta
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Josep Gómez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Alejandro Rodríguez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain
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Gunnels MS, Thompson SL, Jenifer Y. Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review. Crit Care Nurse 2024; 44:31-40. [PMID: 38555969 DOI: 10.4037/ccn2024942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes. OBJECTIVE To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication? METHODS An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both. RESULTS Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention. CONCLUSIONS Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.
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Affiliation(s)
- Marshall S Gunnels
- Marshall S. Gunnels is a nurse in the neuroscience intensive care unit at Mayo Clinic, Rochester, Minnesota
| | - Susan L Thompson
- Susan L. Thompson is a clinical nurse specialist in the multispecialty intensive care unit at Mayo Clinic
| | - Yvette Jenifer
- Yvette Jenifer is a clinical nurse specialist at Johns Hopkins Bayview Medical Center and the Doctor of Nursing Practice Advanced Practice project coordinator at Johns Hopkins School of Nursing, Baltimore, Maryland
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Heybati K, Ochal D, Hogan W, Al-Khateeb H, Sklar D, Herasevich S, Litzow M, Shah M, Torghabeh MH, Durani U, Bauer P, Gajic O, Yadav H. Temporal trends in critical care utilization and outcomes in allogeneic hematopoietic stem cell transplant recipients. Ann Hematol 2024; 103:957-967. [PMID: 38170240 DOI: 10.1007/s00277-023-05612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
Historically, the prognosis of allogeneic hematopoietic stem cell transplant (allo-HCT) recipients who require intensive care unit (ICU) admission has been poor. We aimed to describe the epidemiological trends of ICU utilization and outcomes in allo-HCT patients. We conducted a retrospective cohort study including adults (≥ 18) undergoing allo-HCT between 01/01/2005 and 31/12/2020 at Mayo Clinic, Rochester. Temporal trends in outcomes were assessed by robust linear regression modelling. Risk factors for hospital mortality were chosen a priori and assessed with multivariable logistic regression modelling. Of 1,249 subjects, there were 486 ICU admissions among 287 individuals. Although older patients underwent allo-HCT (1.64 [95% CI: 1.11 to 2.45] years per year; P = 0.025), there was no change in ICU utilization over time (P = 0.91). The ICU and hospital mortality rates were 19.2% (55/287) and 28.2% (81/287), respectively. There was a decline in ICU mortality (-0.38% [95% CI: -0.70 to -0.06%] per year; P = 0.035). The 1-year post-HCT mortality for those requiring ICU admission was 56.1% (161/287), with no significant difference over time, versus 15.8% (141/891, 71 missing) among those who did not. The frequency and duration of invasive mechanical ventilation (IMV) declined. In multivariable analyses, higher serum lactate, higher sequential organ failure assessment (SOFA) scores, acute respiratory distress (ARDS), and need for IMV were associated with greater odds of hospital mortality. Over time, rates of ICU utilization have remained stable, despite increasing patient age. Several trends suggest improvement in outcomes, notably lower ICU mortality and frequency of IMV. However, long-term survival remains unchanged. Further work is needed to improve long-term outcomes in this population.
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Affiliation(s)
- Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Domenic Ochal
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Sklar
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Svetlana Herasevich
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Philippe Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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Du Z, Liu X, Li Y, Wang L, Tian J, Zhang L, Yang L. Depressive symptoms over time among survivors after critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 87:41-47. [PMID: 38306945 DOI: 10.1016/j.genhosppsych.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Critical illness survivors frequently experience various degrees of depressive symptoms, which hinder their recovery and return to daily life. However, substantial variability in the prevalence of depressive symptoms has been reported among critical illness survivors. The exact prevalence remains uncertain. METHODS A systematic search was performed in PubMed, Embase, CINAHL, and PsycINFO from inception to August 2023 for observational studies that reported depressive symptoms in adult critical illness survivors. The random-effects model was used to estimate the prevalence of depressive symptoms. Subgroup analysis and meta-regression were conducted to explore potential moderators of heterogeneity. Study quality was evaluated using the Joanna Briggs Institute's tool and the GRADE approach. RESULTS Fifty-two studies with 24,849 participants met the inclusion criteria. Overall prevalence estimate of depressive symptoms was 21.1% (95% CI, 18.3-24.1%). The prevalence of depressive symptoms remains stable over time. Point prevalence estimates were 21.3% (95% CI, 9.9-35.4%), 19.9% (95% CI, 14.6-25.9%), 18.5% (95% CI, 9.6-29.2%), 21.0% (95% CI, 16.8-25.5%), and 22.6% (95% CI, 14.4-31.8%) at <3, 3, 6, 12, and > 12 months after discharge from intensive care unit (ICU), respectively. CONCLUSIONS Depressive symptoms may impact 1 in 5 adult critically ill patients within 1 year or more following ICU discharge. An influx of rehabilitation service demand is expected, and risk stratification to make optimal clinical decisions is essential. More importantly, to propose measures for the prevention and improvement of depressive symptoms in patients after critical care, given the continuous, dynamic management of ICU patients, including ICU stay, transition to general wards, and post-hospital.
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Affiliation(s)
- Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Xiaojun Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Yuanyuan Li
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - Lina Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Jiaqi Tian
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Ling Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Lijuan Yang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China; Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China.
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Roos-Blom MJ, Bakhshi-Raiez F, Brinkman S, Arbous MS, van den Berg R, Bosman RJ, van Bussel BCT, Erkamp ML, de Graaff MJ, Hoogendoorn ME, de Lange DW, Moolenaar D, Spijkstra JJ, de Waal RAL, Dongelmans DA, de Keizer NF. Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study. J Crit Care 2024; 79:154461. [PMID: 37951771 DOI: 10.1016/j.jcrc.2023.154461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry. MATERIALS AND METHODS We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC). RESULTS 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021. CONCLUSIONS Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.
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Affiliation(s)
- Marie-José Roos-Blom
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | - Ferishta Bakhshi-Raiez
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Sylvia Brinkman
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - M Sesmu Arbous
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Leiden University Medical Center, Intensive Care Medicine, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roy van den Berg
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Elisabeth TweeSteden Hospital, Intensive Care Medicine, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, the Netherlands
| | - Rob J Bosman
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; OLVG, Intensive Care Medicine, Amsterdam, the Netherlands
| | - Bas C T van Bussel
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Maastricht University Medical Center, Intensive Care Medicine, 6229 HX Maastricht, the Netherlands
| | - Michiel L Erkamp
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Dijklander Ziekenhuis, Intensive Care Medicine, Purmerend, the Netherlands
| | - Mart J de Graaff
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; St. Antonius Hospital, Intensive Care Medicine, Nieuwegein, the Netherlands
| | - Marga E Hoogendoorn
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Isala, Department of Anesthesiology and Intensive Care, Zwolle, the Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; University Medical Center, University of Utrecht, Intensive Care Medicine, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - David Moolenaar
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Martini Hospital, Intensive Care Medicine, Groningen, the Netherlands
| | - Jan Jaap Spijkstra
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam UMC location Free University, Intensive Care Medicine, Boelelaan, 1117 Amsterdam, the Netherlands
| | - Ruud A L de Waal
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amphia Hospital, Intensive Care Medicine, Molengracht 21, 4818 CK Breda, the Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Intensive Care Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Critical Care and Occupational Therapy Practice Across the Lifespan. Am J Occup Ther 2023; 77:7713410220. [PMID: 38166053 DOI: 10.5014/ajot.2023.77s3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
This AOTA Position Statement defines the distinct role and value of occupational therapy practitioners in critical care settings across the lifespan. Occupational therapy practitioners are essential interprofessional team members who address the needs of critically ill individuals by implementing evidence-based critical care guidelines that aim to improve the quality of survivorship.
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Tronstad O, Flaws D, Patterson S, Holdsworth R, Fraser JF. Creating the ICU of the future: patient-centred design to optimise recovery. Crit Care 2023; 27:402. [PMID: 37865760 PMCID: PMC10589962 DOI: 10.1186/s13054-023-04685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Intensive Care survival continues to improve, and the number of ICU services is increasing globally. However, there is a growing awareness of the detrimental impact of the ICU environment on patients, families, and staff. Excessive noise and suboptimal lighting especially have been shown to adversely impact physical and mental recovery during and after an ICU admission. Current ICU designs have not kept up with advances in medical technology and models of care, and there is no current 'gold-standard' ICU design. Improvements in ICU designs are needed to optimise care delivery and patient outcomes. METHODS This manuscript describes a mixed-methods, multi-staged participatory design project aimed at redesigning and implementing two innovative ICU bedspaces. Guided by the action effect method and the consolidated framework for implementation research, the manuscript describes the processes taken to ensure the patient-centred problems were properly understood, the steps taken to develop and integrate solutions to identified problems, and the process of implementation planning and rebuilding in a live ICU. RESULTS Two innovative ICU bedspaces were rebuilt and implemented. They feature solutions to address all identified problems, including noise reduction, optimisation of lighting, access to nature via digital solutions, and patient connectivity and engagement, with solutions developed from various specialty fields, including IT improvements, technological innovations, and design and architectural solutions. Early evaluation demonstrates an improved lighting and acoustic environment. CONCLUSIONS Optimising the ICU bedspace environment and improving the lighting and acoustic environment is possible. The impact on patient outcomes needs to be evaluated.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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13
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Lee MW, Vallejo A, Mandelbaum RS, Yessaian AA, Pham HQ, Muderspach LI, Roman LD, Klar M, Wright JD, Matsuo K. Temporal trends of failure-to-rescue following perioperative complications in vulvar cancer surgery in the United States. Gynecol Oncol 2023; 177:1-8. [PMID: 37597497 DOI: 10.1016/j.ygyno.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/09/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Failure-to-rescue, defined as mortality following a perioperative complication, is a perioperative quality indicator studied in various surgeries, but not in vulvar cancer surgery. The objective of this study was to assess failure-to-rescue in patients undergoing surgical therapy for vulvar cancer. METHODS This cross-section study queried the National Inpatient Sample. The study population was 31,077 patients who had surgical therapy for vulvar cancer from 1/2001-9/2015. The main outcomes were (i) perioperative morbidity (29 indicators) and (ii) mortality following a perioperative complication during the index admission for vulvar surgery (failure-to-rescue), assessed with a multivariable binary logistic regression model. RESULTS The cohort-level median age was 69 years, and 14,337 (46.1%) had medical comorbidity. Perioperative complications were reported in 4736 (15.2%) patients during the hospital admission for vulvar surgery. In multivariable analysis, patient factors including older age, medical comorbidity, and morbid obesity, and treatment factors with prior radiotherapy and radical vulvectomy were associated with perioperative complications (P < 0.05). The number of patients with morbid obesity, higher comorbidity index, and prior radiotherapy increased over time (P-trends < 0.001). Among 4736 patients who developed perioperative complications, 55 patients died during the hospital admission for vulvar surgery (failure-to-rescue rate, 1.2%). In multivariable analysis, cardiac arrest (adjusted-odds ratio [aOR] 27.25), sepsis or systemic inflammatory response syndrome (aOR 11.54), pneumonia (aOR 6.03), shock (aOR 4.37), and respiratory failure (aOR 3.10) were associated with failure-to-rescue (high-risk morbidities). There was an increasing trend of high-risk morbidities from 2.0% to 3.7% over time, but the failure-to-rescue from high-risk morbidities decreased from 9.1% to 2.8% (P-trend < 0.05). CONCLUSION Vulvar cancer patients undergoing surgical treatment had increased comorbidity over time with an increase in high-risk complications. However, failure-to-rescue rate has decreased significantly.
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Affiliation(s)
- Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Bosco V, Froio A, Mercuri C, Sansone V, Garofalo E, Bruni A, Guillari A, Bruno D, Talarico M, Mastrangelo H, Longhini F, Doldo P, Simeone S. The Impact of an Intensive Care Diary on the Psychological Well-Being of Patients and Their Family Members: Longitudinal Study Protocol. Healthcare (Basel) 2023; 11:2583. [PMID: 37761780 PMCID: PMC10531207 DOI: 10.3390/healthcare11182583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Thanks to medical and technological advancements, an increasing number of individuals survive admission to intensive care units. However, survivors often experience negative outcomes, including physical impairments and alterations in mental health. Anxiety, depression, cognitive impairments, post-traumatic stress disorders, and functional disorders are known collectively as post-intensive care syndrome (PICS). Among the key triggering factors of this syndrome, memory impairment appears to play a significant role. AIMS This study aims to evaluate the impact of an intensive care diary on the psychological well-being of patients and their relatives after discharge from the ICU. DESIGN Prospective observational study. EXPECTED RESULTS The results of this study evaluate the impact of an ICU diary on the quality of life of ICU survivors and their family members.
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Affiliation(s)
- Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Annamaria Froio
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Caterina Mercuri
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Vincenza Sansone
- Department of Experimental Medicine, Luigi Vanvitelli University, 80131 Naples, Italy;
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Assunta Guillari
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Daniela Bruno
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Michaela Talarico
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | | | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Patrizia Doldo
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
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15
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Potter KM, Dunn H, Krupp A, Mueller M, Newman S, Girard TD, Miller S. Identifying Comorbid Subtypes of Patients With Acute Respiratory Failure. Am J Crit Care 2023; 32:294-301. [PMID: 37391366 DOI: 10.4037/ajcc2023980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Patients with acute respiratory failure have multiple risk factors for disability following their intensive care unit stay. Interventions to facilitate independence at hospital discharge may be more effective if personalized for patient subtypes. OBJECTIVES To identify subtypes of patients with acute respiratory failure requiring mechanical ventilation and compare post-intensive care functional disability and intensive care unit mobility level among subtypes. METHODS Latent class analysis was conducted in a cohort of adult medical intensive care unit patients with acute respiratory failure receiving mechanical ventilation who survived to hospital discharge. Demographic and clinical medical record data were collected early in the stay. Clinical characteristics and outcomes were compared among subtypes by using Kruskal-Wallis tests and χ2 tests of independence. RESULTS In a cohort of 934 patients, the 6-class model provided the optimal fit. Patients in class 4 (obesity and kidney impairment) had worse functional impairment at hospital discharge than patients in classes 1 through 3. Patients in class 3 (alert patients) had the lowest magnitude of functional impairment (P < .001) and achieved the earliest out-of-bed mobility and highest mobility level of all subtypes (P < .001). CONCLUSIONS Acute respiratory failure survivor subtypes identified from clinical data available early in the intensive care unit stay differ in post-intensive care functional disability. Future research should target high-risk patients in early rehabilitation trials in the intensive care unit. Additional investigation of contextual factors and mechanisms of disability is critical to improving quality of life in acute respiratory failure survivors.
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Affiliation(s)
- Kelly M Potter
- Kelly M. Potter was a PhD candidate at the Medical University of South Carolina College of Nursing during the study and is now a research assistant professor at the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania
| | - Heather Dunn
- Heather Dunn is a clinical assistant professor at University of Iowa College of Nursing, Iowa City, Iowa
| | - Anna Krupp
- Anna Krupp is an assistant professor at University of Iowa College of Nursing
| | - Martina Mueller
- Martina Mueller is a professor of biostatistics at the Medical University of South Carolina College of Nursing, Charleston, South Carolina
| | - Susan Newman
- Susan Newman is an associate professor and assistant dean at the Medical University of South Carolina College of Nursing
| | - Timothy D Girard
- Timothy D. Girard is an associate professor and director of the CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh
| | - Sarah Miller
- Sarah Miller is an associate professor at the Medical University of South Carolina College of Nursing
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Liu X, Armaignac DL, Becker C, Hiddleson C, Dubouchet EM, Rincon T, Amelung PJ, French R, Scurlock C, Atallah L, Badawi O. Improving ICU Risk Predictive Models Through Automation Designed for Resiliency Against Documentation Bias. Crit Care Med 2023; 51:376-387. [PMID: 36576215 DOI: 10.1097/ccm.0000000000005750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Electronic health records enable automated data capture for risk models but may introduce bias. We present the Philips Critical Care Outcome Prediction Model (CCOPM) focused on addressing model features sensitive to data drift to improve benchmarking ICUs on mortality performance. DESIGN Retrospective, multicenter study of ICU patients randomized in 3:2 fashion into development and validation cohorts. Generalized additive models (GAM) with features designed to mitigate biases introduced from documentation of admission diagnosis, Glasgow Coma Scale (GCS), and extreme vital signs were developed using clinical features representing the first 24 hours of ICU admission. SETTING eICU Research Institute database derived from ICUs participating in the Philips eICU telecritical care program. PATIENTS A total of 572,985 adult ICU stays discharged from the hospital between January 1, 2017, and December 31, 2018, were included, yielding 509,586 stays in the final cohort; 305,590 and 203,996 in development and validation cohorts, respectively. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Model discrimination was compared against Acute Physiology and Chronic Health Evaluation (APACHE) IVa/IVb models on the validation cohort using the area under the receiver operating characteristic (AUROC) curve. Calibration assessed by actual/predicted ratios, calibration-in-the-large statistics, and visual analysis. Performance metrics were further stratified by subgroups of admission diagnosis and ICU characteristics. Historic data from two health systems with abrupt changes in Glasgow Coma Scale (GCS) documentation were assessed in the year prior to and after data shift. CCOPM outperformed APACHE IVa/IVb for ICU mortality (AUROC, 0.925 vs 0.88) and hospital mortality (AUROC, 0.90 vs 0.86). Better calibration performance was also attained among subgroups of different admission diagnoses, ICU types, and over unique ICU-years. The CCOPM provided more stable predictions compared with APACHE IVa within an external cohort of greater than 120,000 patients from two health systems with known changes in GCS documentation. CONCLUSIONS These mortality risk models demonstrated excellent performance compared with APACHE while appearing to mitigate bias introduced through major shifts in GCS documentation at two large health systems. This provides evidence to support using automated capture rather than trained personnel for capture of GCS data used in benchmarking ICUs on mortality performance.
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Affiliation(s)
- Xinggang Liu
- Johnson & Johnson, Data Science Portfolio Management, New Brunswick, NJ
| | | | | | | | | | | | | | - Robin French
- Philips, Connected Care, Virtual Care Solutions, Baltimore, MD
| | - Corey Scurlock
- Westchester Medical Center, Valhalla, NY
- New affiliation for Dr. Scurlock: Equum Medical, New York, NY
| | - Louis Atallah
- Philips, Connected Care, Virtual Care Solutions, Baltimore, MD
| | - Omar Badawi
- University of Maryland School of Pharmacy, Baltimore, MD
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Sadiq AM, Kilonzo KG. Pattern of diseases and clinical outcomes in medical intensive care unit at a tertiary hospital in northeastern Tanzania: A three-year retrospective study. PLoS One 2023; 18:e0282269. [PMID: 36827317 PMCID: PMC9955624 DOI: 10.1371/journal.pone.0282269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The availability of medical intensive care unit (MICU) services is limited, which is the main obstacle to providing optimal care to critically ill patients. Describing disease patterns and clinical outcomes will help make better use of the limited resources. This retrospective study was conducted to determine the pattern and outcome of MICU admissions to aid continuous quality improvement in obstetric care. MATERIALS AND METHODS This was a retrospective study conducted in a tertiary hospital in northeastern Tanzania. Data on participant characteristics were collected from patient records for all MICU admissions to identify the pattern of disease, length of stay, and clinical outcome from 1st January 2018 to 31st December 2020. Descriptive statistics were presented as frequencies, proportions, and tables. The odds ratio was generated for the relationship between MICU admission outcome and participant characteristics. A p-value <0.05 was considered statistically significant. RESULTS Of the 1425 patients analyzed, 780 (54.7%) were males. Most patients (61.5%) were admitted to the MICU from the emergency department. The overall mortality rate was 37.6%. Mortality was associated with being over 75 years old (OR 1.66, 95% CI 1.20-2.30, P 0.002), being transferred from the medical ward (OR 1.46, 95% CI 1.16-1.82, P 0.001), having a communicable disease (OR 2.63, 95% CI 1.98-3.50, P <0.001), and having cardiovascular disease (OR 1.46, 95% CI 1.14-1.86, P 0.002). CONCLUSION The overall mortality rate in the MICU was high. Elderly patients, transfers from the medical ward, and short ICU stays were significantly associated with the poor outcome of MICU patients. Further studies are needed to better appreciate the causes underlying MICU admission outcomes.
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Affiliation(s)
- Abid M. Sadiq
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- * E-mail:
| | - Kajiru G. Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
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Paul N, Ribet Buse E, Knauthe AC, Nothacker M, Weiss B, Spies CD. Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review. BMJ Open 2023; 13:e070962. [PMID: 36806060 PMCID: PMC9944310 DOI: 10.1136/bmjopen-2022-070962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Care bundles are considered a key tool to improve bedside quality of care in the intensive care unit (ICU). We explored their effect on long-term patient-relevant outcomes. DESIGN Systematic literature search and scoping review. DATA SOURCES We searched PubMed, Embase, CINAHL, APA PsycInfo, Web of Science, CDSR and CENTRAL for keywords of intensive care, care bundles, patient-relevant outcomes, and follow-up studies. ELIGIBILITY CRITERIA Original articles with patients admitted to adult ICUs assessing bundle implementations and measuring long-term (ie, ICU discharge or later) patient-relevant outcomes (ie, mortality, health-related quality of life (HrQoL), post-intensive care syndrome (PICS), care-related outcomes, adverse events, and social health). DATA EXTRACTION AND SYNTHESIS After dual, independent, two-stage selection and charting, eligible records were critically appraised and assessed for bundle type, implementation strategies, and effects on long-term patient-relevant outcomes. RESULTS Of 2012 records, 38 met inclusion criteria; 55% (n=21) were before-after studies, 21% (n=8) observational cohort studies, 13% (n=5) randomised controlled trials, and 11% (n=4) had other designs. Bundles pertained to sepsis (n=11), neurocognition (n=6), communication (n=4), early rehabilitation (n=3), pharmacological discontinuation (n=3), ventilation (n=2) or combined bundles (n=9). Almost two-thirds of the studies reported on survival (n=24), 45% (n=17) on care-related outcomes (eg, discharge disposition), and 13% (n=5) of studies on HrQoL. Regarding PICS, 24% (n=9) assessed cognition, 13% (n=5) physical health, and 11% (n=4) mental health, up to 1 year after discharge. The effects of bundles on long-term patient-relevant outcomes was inconclusive, except for a positive effect of sepsis bundles on survival. The inconclusive effects may have been due to the high risk of bias in included studies and the variability in implementation strategies, instruments, and follow-up times. CONCLUSIONS There is a need to explore the long-term effects of ICU bundles on HrQoL and PICS. Closing this knowledge gap appears vital to determine if there is long-term patient value of ICU bundles.
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Affiliation(s)
- Nicolas Paul
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elena Ribet Buse
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna-Christina Knauthe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany (AWMF), Philipps-Universität Marburg, Marburg, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia D Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Paul N, Weiss B. Post-Intensive Care Syndrome after Critical Illness: An Imperative for Effective Prevention. J Clin Med 2022; 11:6203. [PMID: 36294524 PMCID: PMC9604815 DOI: 10.3390/jcm11206203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Over the last decades, the importance of intensive care has considerably increased [...].
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Affiliation(s)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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20
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Abstract
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
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21
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Vlake JH, van Bommel J, Wils EJ, Korevaar TI, Taccone F, Schut AF, Elderman JH, Labout JA, Raben AM, Dijkstra A, Achterberg S, Jurriens AL, Van Mol MM, Gommers D, Van Genderen ME. Effect of intensive care unit-specific virtual reality (ICU-VR) to improve psychological well-being in ICU survivors: study protocol for an international, multicentre, randomised controlled trial-the HORIZON-IC study. BMJ Open 2022; 12:e061876. [PMID: 36127077 PMCID: PMC9490570 DOI: 10.1136/bmjopen-2022-061876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A substantial proportion of intensive care unit (ICU) survivors develop psychological impairments after ICU treatment, part of the postintensive care syndrome, resulting in a decreased quality of life. Recent data suggest that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients is feasible and safe, improves satisfaction with ICU aftercare, and might improve psychological sequelae. In the present trial, we firstly aim to determine whether ICU-VR is effective in mitigating post-traumatic stress disorder (PTSD)-related symptoms and secondly to determine the optimal timing for initiation with ICU-VR. METHODS AND ANALYSIS This international, multicentre, randomised controlled trial will be conducted in 10 hospitals. Between December 2021 and April 2023, we aim to include 300 patients who have been admitted to the ICU ≥72 hours and were mechanically ventilated ≥24 hours. Patients will be followed for 12 consecutive months. Patients will be randomised in a 1:1:1 ratio to the early ICU-VR group, the late ICU-VR group, or the usual care group. All patients will receive usual care, including a mandatory ICU follow-up clinic visit 3 months after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR within 2 weeks after ICU discharge. Patients in the late VR group will receive ICU-VR during the post-ICU follow-up visit. The primary objective is to assess the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to determine optimal timing for ICU-VR, to assess the effects on anxiety-related and depression-related symptoms and health-related quality of life, and to assess patient satisfaction with ICU aftercare and perspectives on ICU-VR. ETHICS AND DISSEMINATION The Medical Ethics Committee United, Nieuwegein, the Netherlands, approved this study and local approval was obtained from each participating centre (NL78555.100.21). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals. TRIAL REGISTRATION NUMBER NL9812.
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Affiliation(s)
- Johan Hendrik Vlake
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, Netherlands
| | | | - Evert-Jan Wils
- Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, Netherlands
| | - Tim Im Korevaar
- Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Academic Centre for Thyroid Diseases, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Fabio Taccone
- Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Fc Schut
- Intensive Care, Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Jan H Elderman
- Intensive Care, IJsselland Hospital, Capelle aan den IJssel, Zuid-Holland, Netherlands
| | - Joost Am Labout
- Intensive Care, Maasstad Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Adrienne Mtj Raben
- Intensive Care, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, Netherlands
| | - Annemieke Dijkstra
- Intensive Care, Van Weel-Bethesda Hospital, Middelharnis, Goeree-Overflakkee, Netherlands
| | | | - Amber L Jurriens
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Margo Mc Van Mol
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Diederik Gommers
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
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22
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Zhang F, Xia Q, Zhang L, Wang H, Bai Y, Wu W. A bibliometric and visualized analysis of early mobilization in intensive care unit from 2000 to 2021. Front Neurol 2022; 13:848545. [PMID: 35923825 PMCID: PMC9339903 DOI: 10.3389/fneur.2022.848545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Early mobilization in the intensive care unit (ICU) is a hotspot. This study aims to provide a bibliometric perspective of the progress in this field. Methods We extracted publications on ICU early mobilization published in the Web of Science Core Collection database from 2000 to 2021. VOSviewer was used to construct co-occurrence and co-citation relationships for authors, references, and keywords; Citespace was used to visualize knowledge mapping of subject categories, countries, and keywords with the strongest citation bursts. Results A total of 4,570 publications were analyzed, with a steady increase in publications in the field of ICU early mobilization. From a macro perspective, research on ICU early mobilization involves multidisciplinary involvement, including critical care medicine, neurology, and nursing; as for the meso perspective, the United States is the major contributor. Needham DM and Schweickert WD are the key researchers in this field. Moreover, the core journal is Critical Care Medicine, with the most publications and citations. The microscopic level, dominated by references and keywords, illustrates that the hotspot and frontier of research on ICU early mobilization focus on ICU-acquired weakness, delirium, the prognosis of critical illness, and severe COVID-19. Conclusion This study presents a research landscape of ICU early mobilization from different perspectives. These findings will contribute to a better understanding of the current state of research in critical care medicine and provide the available information for future research ideas.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Xia
- Intensive Care Unit, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lianlian Zhang
- Intensive Care Unit, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenyan Wu
- Intensive Care Unit, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Wenyan Wu
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23
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Kim SJ, Park K, Kim K. Post-intensive care syndrome and health-related quality of life in long-term survivors of intensive care unit. Aust Crit Care 2022:S1036-7314(22)00088-1. [PMID: 35843808 DOI: 10.1016/j.aucc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to provide preliminary data for improving the health-related quality of life of long-term intensive care unit survivors by identifying the relationship between health-related quality of life and post-intensive care syndrome. METHODS Using a descriptive correlation research design, data from patients who visited the outpatient department for continuous treatment after discharge from the intensive care unit were analysed. Post-intensive care syndrome was measured by physical, cognitive, and mental problems. Data were collected from 1st August to 31st December, 2019, and 121 intensive care unit survivors participated in the study. RESULTS Health-related quality of life showed a negative correlation with physical, mental, and cognitive problems. The factors associated with health-related quality of life were physical and mental problems, education level, sedatives and neuromuscular relaxants, and marital status. CONCLUSIONS To improve the health-related quality of life of intensive care unit survivors, post-intensive care syndrome prevention is important, and a systematic strategy is required through a long-term longitudinal trace study. In addition, intensive care unit nurses and other healthcare professionals need to provide early interventions to reduce post-intensive care syndrome.
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Affiliation(s)
- Seung-Jun Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, South Korea
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24
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Viner Smith E, Ridley EJ, Rayner CK, Chapple LAS. Nutrition management of critically ill adult patients requiring non-invasive ventilation: a scoping review protocol. JBI Evid Synth 2022; 20:1814-1820. [PMID: 36164714 DOI: 10.11124/jbies-21-00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This scoping review will identify the current available literature and key concepts in the nutrition management of critically ill adult patients requiring non-invasive ventilation. INTRODUCTION Current international nutrition guidelines include recommendations for the nutrition management of critically ill patients who are receiving invasive mechanical ventilation; however, these guidelines do not address nutrition management of patients receiving non-invasive ventilation. This scoping review aims to explore and describe the existing available literature on the nutrition management of critically ill adults requiring non-invasive ventilation. INCLUSION CRITERIA This review will consider original research (qualitative, quantitative, or mixed methods studies) reporting on any nutrition parameter for critically ill adult patients (≥16 years) requiring non-invasive ventilation in the intensive care unit. Concepts of interest based on the general intensive care nutrition literature include route of nutrition, recommendations related to macro- or micro-nutrients, nutrition provision, barriers to nutrition provision, and strategies for nutrition management. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews using a three-step search strategy. MEDLINE, Embase, Scopus, and Web of Science will be searched to obtain original research available in English and published after 1990. Google Scholar will be searched for gray literature. Duplicates will be removed and studies will be selected by two independent reviewers based on the inclusion criteria. The same two reviewers will extract data in duplicate using a data extraction tool. Any disagreements will be resolved via consensus with a third reviewer. Data extraction will be synthesized in tabular and diagrammatic format.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia.,Nutrition Department, Alfred Health, Melbourne, Vic, Australia
| | - Christopher K Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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25
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Viner Smith E, Ridley EJ, Rayner CK, Chapple LAS. Nutrition Management for Critically Ill Adult Patients Requiring Non-Invasive Ventilation: A Scoping Review. Nutrients 2022; 14:1446. [PMID: 35406058 PMCID: PMC9003108 DOI: 10.3390/nu14071446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022] Open
Abstract
Nutrition management is a core component of intensive care medicine. Despite the increased use of non-invasive ventilation (NIV) for the critically ill, a paucity of evidence on nutrition management precludes recommendations for clinical practice. A scope of the available literature is required to guide future research on this topic. Database searches of MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were conducted to identify original research articles and available grey literature in English from 1 January 1990 to 17 November 2021 that included adult patients (≥16 years) receiving NIV within an Intensive Care Unit. Data were extracted on: study design, aim, population, nutrition concept, context (ICU type, NIV: use, duration, interface), and outcomes. Of 1730 articles, 16 met eligibility criteria. Articles primarily included single-centre, prospective, observational studies with only 3 randomised controlled trials. Key concepts included route of nutrition (n = 7), nutrition intake (n = 4), energy expenditure (n = 2), nutrition status (n = 1), and nutrition screening (n = 1); 1 unpublished thesis incorporated multiple concepts. Few randomised clinical trials that quantify aspects of nutrition management for critically ill patients requiring NIV have been conducted. Further studies, particularly those focusing on the impact of nutrition during NIV on clinical outcomes, are required to inform clinical practice.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; (C.K.R.); (L.S.C)
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Emma J. Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC 3004, Australia;
- Nutrition Department, Alfred Health, Melbourne, VIC 3004, Australia
| | - Christopher K. Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; (C.K.R.); (L.S.C)
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Lee-anne S. Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; (C.K.R.); (L.S.C)
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia
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Udeh C, Perez-Protto S, Canfield CM, Sreedharan R, Factora F, Hata JS. Outcomes Associated with ICU Telemedicine and Other Risk Factors in a Multi-Hospital Critical Care System: A Retrospective, Cohort Study for 30-Day In-Hospital Mortality. Telemed J E Health 2022; 28:1395-1403. [PMID: 35294855 DOI: 10.1089/tmj.2021.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Intensive care unit telemedicine (ICU-TM) is expanding due to increasing demands for critical care, but impact on outcomes remains controversial. This study evaluated the association of ICU-TM and other clinical factors with 30-day, in-hospital mortality. Methods: This retrospective, cohort study included 151,780 consecutive ICU patients admitted to nine hospitals in the Cleveland Clinic Health System from 2010 to 2020. Patients were identified from an institutional datamart and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) registry. Primary outcome was 30-day in-hospital mortality. Analyses included multivariate logistic regression modeling, and survival analysis. Results: Overall, unadjusted 30-day, in-hospital mortality incidence was significantly different with (5.6%) or without ICU-TM (7.2%), and risk ratio was 0.78 (95% confidence interval [CI] 0.75-0.81) (p < 0.0001). Mortality rate for ICU-TM and no ICU-TM was 2.4/1,000 versus 3.2/1,000 patient days, respectively (p < 0.0001). Multivariate logistic regression showed that ICU-TM was associated with reduced 30-day mortality (odds ratio 0.78, 95% CI 0.72-0.83). Increased risk was seen with cardiac arrest admissions, males, acute stroke, weekend admission, emergency admission, race (non-white), sepsis, APACHE IV score, ICU length of stay (LOS), and the interaction term, emergency surgical admissions. Reduced risk was associated with hospital LOS, surgical admission, and the interaction terms (weekend admissions with ICU-TM and after-hour admissions with ICU-TM). The model c-statistic was 0.77. Median ICU and hospital lengths of stay were significantly reduced with ICU-TM, with no difference in 48-h mortality or 48-h mortality rate. Conclusion: ICU telemedicine exposure appears to be one of several operational and clinical factors associated with reduced 30-day, in-hospital mortality.
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Affiliation(s)
- Chiedozie Udeh
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Silvia Perez-Protto
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Christina M Canfield
- Cleveland Clinic Foundation, Division of Medical Operations, Cleveland, Ohio, USA
| | - Roshni Sreedharan
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Faith Factora
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - J Steven Hata
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
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27
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Paul N, Knauthe AC, Ribet Buse E, Nothacker M, Weiss B, Spies C. Use of patient-relevant outcome measures to assess the long-term effects of care bundles in the ICU: a scoping review protocol. BMJ Open 2022; 12:e058314. [PMID: 35168987 PMCID: PMC8852753 DOI: 10.1136/bmjopen-2021-058314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There is only moderate adherence to evidence-based practice in critical care. Care bundles can be used to increase adherence to best clinical practice. Components of bundle interventions, bundle implementation rates, barriers and facilitators of bundle implementation, and the effect of care bundles on short-term patient outcomes such as intensive care unit (ICU) mortality all appear to be regularly studied. However, over the last years, critical care research has turned towards long-term patient-relevant outcomes after discharge from the ICU. To our knowledge, there is no systematic overview on the long-term effect of care bundle implementation on patient-relevant outcomes. We present a protocol for a scoping review of the available literature on the effect of the implementation of care bundles in the ICU on long-term patient-relevant outcomes. METHODS AND ANALYSIS This scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O'Malley framework. The recommendations of the Joanna Briggs Institute for Scoping Reviews will also be followed. A systematic literature research will be performed using electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CDSR and CENTRAL). A preliminary search has been conducted on 1 September 2021, yielding 1929 entries. The main search, data extraction and charting has not been started yet. This scoping review will provide an overview of the long-term patient-relevant outcomes that have been used to assess the implementation of care bundles in the ICU. It will be the first study to summarise the long-term impact of care bundles for critically ill patients and identify research gaps to inform future research. ETHICS AND DISSEMINATION Due to the utilisation of already published primary studies, ethical approval is dispensable. Results of this work will be published in a peer-reviewed journal.
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Affiliation(s)
- Nicolas Paul
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna-Christina Knauthe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elena Ribet Buse
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany (AWMF), Philipps-Universität Marburg, Marburg, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Ingraham NE, Vakayil V, Pendleton KM, Robbins AJ, Freese RL, Palzer EF, Charles A, Dudley RA, Tignanelli CJ. Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill. J Intensive Care Med 2022; 37:185-194. [PMID: 33353475 DOI: 10.1177/0885066620982905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them. STUDY DESIGN AND METHODS A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS). RESULTS The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease. CONCLUSION Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.
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Affiliation(s)
- Nicholas E Ingraham
- Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA
| | - Victor Vakayil
- School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA
- Department of Surgery, 311816University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kathryn M Pendleton
- Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alexandria J Robbins
- Department of Surgery, 311816University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, 311816University of Minnesota, Minneapolis, MN, USA
| | - Elise F Palzer
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, 311816University of Minnesota, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, 2331University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Gillings School of Global Public Health, 2331University of North Carolina, Chapel Hill, NC, USA
| | - R Adams Dudley
- Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA
- Institute for Health Informatics, 311816University of Minnesota Academic Health Center, Minneapolis, MN, USA
| | - Christopher J Tignanelli
- Department of Surgery, 311816University of Minnesota Medical School, Minneapolis, MN, USA
- Institute for Health Informatics, 311816University of Minnesota Academic Health Center, Minneapolis, MN, USA
- Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN, USA
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29
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Vlake JH, van Bommel J, Wils EJ, Bienvenu J, Hellemons ME, Korevaar TI, Schut AF, Labout JA, Schreuder LL, van Bavel MP, Gommers D, van Genderen ME. Intensive Care Unit-Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial. J Med Internet Res 2022; 24:e32368. [PMID: 34978530 PMCID: PMC8812141 DOI: 10.2196/32368] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/01/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective This study aimed to explore the effects of ICU-VR on mental health and on patients’ perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=–2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=–3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR’s widespread availability and application during follow-up. Trial Registration Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-021-05271-z
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Affiliation(s)
- Johan H Vlake
- Department of Intensive Care, Erasmus MC, Rotterdam, Netherlands.,Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | | | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Joe Bienvenu
- Department of Psychiatry and Behavioral Sciences, John Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Tim Im Korevaar
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Anna Fc Schut
- Department of Intensive Care, Ikazia hospital, Rotterdam, Netherlands
| | - Joost Am Labout
- Department of Intensive Care, Maasstad hospital, Rotterdam, Netherlands
| | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus MC, Rotterdam, Netherlands
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A Decade of Post-Intensive Care Syndrome: A Bibliometric Network Analysis. Medicina (B Aires) 2022; 58:medicina58020170. [PMID: 35208494 PMCID: PMC8880008 DOI: 10.3390/medicina58020170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives: In 2012, the umbrella term post-intensive care syndrome (PICS) was introduced to capture functional long-term impairments of survivors of critical illness. We present a bibliometric network analysis of the PICS research field. Materials and Methods: The Web of Science core database was searched for articles published in 2012 or later using ‘post-intensive care syndrome’ and variant spellings. Using VOSviewer, we computed co-authorship networks of countries, institutions, and authors, as well as keyword co-occurrence networks. We determined each country’s relative research effort and Category Normalized Citation Index over time and analyzed the 100 most-cited articles with respect to article type, country of origin, and publishing journal. Results: Our search yielded 379 articles, of which 373 were analyzed. Annual PICS research output increased from 11 (2012) to 95 articles (2020). Most PICS research originates from the US, followed by England, Australia, the Netherlands, and Germany. We found various collaborations between countries, institutions, and authors, with recent collaborative networks of English and Australian institutions. Article keywords cover aspects of cognitive, mental health, and physical impairments, and more recently, COVID-19. Only a few keywords and articles pertained to PICS prevention and treatment. Conclusions: Our analysis of Web of Science-indexed PICS articles highlights the stark increase in PICS research output in recent years, primarily originating from US- and Europe-based authors and institutions. Despite the research field’s growth, knowledge gaps with respect to PICS prevention and treatment remain.
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Sepsis and Septic Shock. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Virtual Reality to Improve Sequelae of the Postintensive Care Syndrome: A Multicenter, Randomized Controlled Feasibility Study. Crit Care Explor 2021; 3:e0538. [PMID: 34549192 PMCID: PMC8443843 DOI: 10.1097/cce.0000000000000538] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Psychologic sequelae after critical illness, part of the postintensive care syndrome, significantly decrease quality of life. A robustly effective treatment intervention is currently lacking. Virtual reality has beneficial effects on several non-ICU–related psychologic disorders. The aim of this study was to explore patient-related determinants of ICU-specific virtual reality, such as the timing of patients’ self-reported readiness to initiate virtual reality and the number of desired sessions and safety, and to explore the effects of ICU-specific virtual reality on mental health.
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Jawad I, Rashan S, Sigera C, Salluh J, Dondorp AM, Haniffa R, Beane A. A scoping review of registry captured indicators for evaluating quality of critical care in ICU. J Intensive Care 2021; 9:48. [PMID: 34353360 PMCID: PMC8339165 DOI: 10.1186/s40560-021-00556-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation. METHOD We searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance. RESULTS The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%). CONCLUSIONS Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.
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Affiliation(s)
- Issrah Jawad
- National Intensive Care Surveillance-MORU, Borella, Colombo, Western Province 08 Sri Lanka
| | - Sumayyah Rashan
- National Intensive Care Surveillance-MORU, Borella, Colombo, Western Province 08 Sri Lanka
| | - Chathurani Sigera
- National Intensive Care Surveillance-MORU, Borella, Colombo, Western Province 08 Sri Lanka
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Arjen M. Dondorp
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand 10400 Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rashan Haniffa
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand 10400 Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Abi Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand 10400 Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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National Trends and Variation of Functional Status Deterioration in the Medically Critically Ill. Crit Care Med 2021; 48:1556-1564. [PMID: 32886469 DOI: 10.1097/ccm.0000000000004524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Physical and psychologic deficits after an ICU admission are associated with lower quality of life, higher mortality, and resource utilization. This study aimed to examine the prevalence and secular changes of functional status deterioration during hospitalization among nonsurgical critical illness survivors over the past decade. DESIGN We performed a retrospective longitudinal cohort analysis. SETTING Analysis performed using the Cerner Acute Physiology and Chronic Health Evaluation outcomes database which included manually abstracted data from 236 U.S. hospitals from 2008 to 2016. PATIENTS We included nonsurgical adult ICU patients who survived their hospitalization and had a functional status documented at ICU admission and hospital discharge. Physical functional status was categorized as fully independent, partially dependent, or fully dependent. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Functional status deterioration occurred in 38,116 patients (29.3%). During the past decade, functional status deterioration increased in each disease category, as well as overall (prevalence rate ratio, 1.15; 95% CI, 1.13-1.17; p < 0.001). Magnitude of functional status deterioration also increased over time (odds ratio, 1.03; 95% CI, 1.03-1.03; p < 0.001) with hematological, sepsis, neurologic, and pulmonary disease categories having the highest odds of severe functional status deterioration. CONCLUSIONS Following nonsurgical critical illness, the prevalence of functional status deterioration and magnitude increased in a nationally representative cohort, despite efforts to reduce ICU dysfunction over the past decade. Identifying the prevalence of functional status deterioration and primary etiologies associated with functional status deterioration will elucidate vital areas for further research and targeted interventions. Reducing ICU debilitation for key disease processes may improve ICU survivor mortality, enhance quality of life, and decrease healthcare utilization.
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Virtual Reality Tailored to the Needs of Post-ICU Patients: A Safety and Immersiveness Study in Healthy Volunteers. Crit Care Explor 2021; 3:e0388. [PMID: 34079940 PMCID: PMC8162483 DOI: 10.1097/cce.0000000000000388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: ICU treatments frequently result in long-term psychologic impairments, negatively affecting quality of life. An effective treatment strategy is still lacking. The aim of this study was to describe and evaluate the safety and immersiveness of a newly designed ICU-specific virtual reality module. Design: A randomized controlled healthy volunteer trial. Setting: ICU of the Franciscus Gasthuis & Vlietland Hospital (Rotterdam, the Netherlands), a large teaching hospital. Participants: Forty-five virtual reality–naive healthy volunteers. Interventions: Volunteers were randomized to three arms: the head-mounted display virtual reality group (n = 15), the 2D group (n = 15), and the crossover group (n = 15). Safety was assessed by changes in vital signs and the occurrence of simulator sickness (Simulator Sickness Questionnaire). Immersiveness was assessed using the Igroup Presence Questionnaire. Measurements and Main Results: Volunteers in the head-mounted display virtual reality group experienced more mild symptoms of simulator sickness, expressed as symptoms of dizziness (p = 0.04) and stomach awareness (p = 0.04), than the 2D group. Nevertheless, none of the individual Simulator Sickness Questionnaire items were scored as being severe, no changes in vital signs were observed, and no sessions were prematurely stopped. Volunteers in the crossover group experienced a higher total presence (p < 0.001) when using head-mounted display virtual reality, expressed as a higher sense of presence (p < 0.001), more involvement (p < 0.01), and more experienced realism (p < 0.001). Conclusions: ICU-specific virtual reality appears safe and more immersive than 2D, implicating that ICU-specific virtual reality is feasible for clinical use. One should however be aware of simulator sickness-related symptoms. Future research is needed to confirm these findings in survivors of critical illness.
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Environmental Factors Affecting Early Mobilization and Physical Disability Post-Intensive Care: An Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health. Dimens Crit Care Nurs 2021; 40:92-117. [PMID: 33961378 DOI: 10.1097/dcc.0000000000000461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early mobilization (EM) is one of few potential protective factors associated with reduced physical disability post-intensive care (PD PIC). However, only 45% of intensive care units (ICUs) in the United States routinely practice EM despite its recognized benefits. OBJECTIVES To analyze the evidence on the relationship between critical care EM, PD PIC, and environmental factors, using the theoretical lens of the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF). METHOD The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the WHO ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. RESULTS Early mobilization was related to improved functioning on the disability continuum of the WHO ICF. Early mobilization was influenced by several WHO ICF environmental factors. Dedicated physical and occupational therapy teams in the ICU, interdisciplinary rounds, and positive family and staff perception of EM facilitated intervention delivery. However, poor staffing levels, negative unit culture, perceived workload burden, and lack of equipment, education, and financial support impeded delivery of EM. DISCUSSION Early mobilization is a promising intervention that may reduce PD PIC. However, environmental factors negatively influence delivery of EM in the ICU. Several gaps in EM research limit its acceptability in ICU practice. Existing EM research is challenged by poor methodological quality. Further study is necessary to better understand the role of EM on PD PIC and improve patient outcomes following critical illness.
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Riegel M, Randall S, Ranse K, Buckley T. Healthcare professionals' values about and experience with facilitating end-of-life care in the adult intensive care unit. Intensive Crit Care Nurs 2021; 65:103057. [PMID: 33888382 DOI: 10.1016/j.iccn.2021.103057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs. RESEARCH DESIGN Using a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care. SETTING General adult intensive care unit at a tertiary referral hospital. RESULTS Compared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01). CONCLUSION Findings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia. https://twitter.com/@melissa_riegel
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia. https://twitter.com/@SueRandallPHC
| | - Kristen Ranse
- School of Nursing & Midwifery and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, QLD, Australia. https://twitter.com/@KristenRanse
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia. https://twitter.com/@TomBuckley6
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Lilly CM, Kovacevic JA. ICU Telemedicine Nighttime Support: Getting by With a Little Help From Your Friends. Chest 2021; 159:1317-1318. [PMID: 34021987 DOI: 10.1016/j.chest.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 10/21/2022] Open
Affiliation(s)
- Craig M Lilly
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, Worcester, MA; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA; UMass Memorial Medical Center, UMass Memorial Health Care, Worcester, MA.
| | - Jason A Kovacevic
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA; UMass Memorial Medical Center, UMass Memorial Health Care, Worcester, MA
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Canfield C, Perez-Protto S, Siuba M, Hata S, Udeh C. Beyond the Nuts and Bolts: Tele-Critical Care Patients, Workflows, and Activity Patterns. Telemed J E Health 2021; 28:73-83. [PMID: 33819430 DOI: 10.1089/tmj.2020.0452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Tele-critical care (TCC) adoption has been slow since its emergence in the early 2000s. The COVID-19 pandemic has renewed interest in telemedicine and may spur expansion or development of new TCC programs. This narrative addresses the Cleveland Clinic TCC service, (eHospital) to promote exchange of ideas to continually optimize the practice for current and future users. Methods: A descriptive narrative methodology is used in this report. Results: Cleveland Clinic's eHospital was established in 2014 to support nighttime critical care across system hospitals. It encompasses a tiered system of two-way audiovisual communication, telemetry, software platform that integrates the electronic health record, and a proprietary risk stratification algorithm for targeted electronic surveillance. The TCC team includes intensivists, advanced care providers, and registered nurses. Three coverage models evolved depending on onsite clinician availability. More than 133,000 patients have been served by eHospital to date, and span the typical spectrum of critical illness. Along with universal monitoring, ∼18% of patients received active interventions, the most common of which are categorized. Patterns of activity, typical workflows, and adaptations of bedside best practices are also described. Bookending the work shift are sign outs focused on pending critical issues, unstable patients, and those who can be triaged out of the intensive care unit. In between, TCC teams round periodically and interact with bedside teams. Conclusions: TCC adoption has proceeded slowly. Some acceleration is anticipated in a post-COVID-19 pandemic world. Our experience highlights operational practices that can facilitate successful TCC practice.
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Affiliation(s)
| | | | - Matthew Siuba
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven Hata
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chiedozie Udeh
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Margetis JL, Wilcox J, Thompson C, Mannion N. Occupational Therapy: Essential to Critical Care Rehabilitation. Am J Occup Ther 2021; 75:7502170010p1-7502170010p5. [PMID: 33657342 DOI: 10.5014/ajot.2021.048827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic reshaped the health care landscape, leading to the reassignment of essential health care workers to critical areas and widespread furloughs of providers deemed nonessential, including occupational therapy practitioners. Although multidisciplinary critical care teams often include occupational therapy practitioners, efforts to define, measure, and disseminate occupational therapy's unique contributions to critical care outcomes have been overlooked. This editorial provides recommendations to improve the occupational therapy profession's readiness to meet society's current and future pandemic needs. We propose a three-pronged strategy to strengthen occupational therapy clinical practice, education, and advocacy to illuminate the distinct value of occupational therapy in critical care.
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Affiliation(s)
- John L Margetis
- John Margetis, OTD, OTR/L, is Associate Professor of Clinical Occupational Therapy, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Jamie Wilcox
- Jamie Wilcox, OTD, OTR/L, is Assistant Professor of Clinical Occupational Therapy, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles;
| | - Chelsea Thompson
- Chelsea Thompson, MOT, OTR/L, BCPR, is Occupational Therapist, University of Chicago Medical Center, Chicago, IL
| | - Nicole Mannion
- Nicole Mannion, MA, OTR/L, is Occupational Therapist, Kindred Rehabilitation
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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The Burden of Mental Illness Among Survivors of Critical Care-Risk Factors and Impact on Quality of Life: A Multicenter Prospective Cohort Study. Chest 2021; 160:157-164. [PMID: 33640377 DOI: 10.1016/j.chest.2021.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Survivors of critical care may demonstrate mental health disorders in the months after discharge. RESEARCH QUESTION What are risk factors for mental health disorders after ICU discharge and is there an association between the burden of mental illness and health-related quality of life (HRQoL)? STUDY DESIGN AND METHODS Multicenter prospective cohort study that included 579 adult ICU survivors with an ICU stay of > 72 h in 10 ICUs. RESULTS The outcomes were anxiety and depression assessed by the Hospital Anxiety and Depression Scale, posttraumatic stress disorder (PTSD) assessed by the Impact Event Scale 6, and HRQoL assessed by the Short Form 12 version 2. The 6-month prevalences of any mental health disorder were 36.2% (the prevalences of anxiety, depression, and PTSD were 24.2%, 20.9%, and 15.4%, respectively). ICU survivors with mental health disorders showed worse HRQoL scores in both physical and mental dimensions than those without. The higher the number of psychiatric syndromes manifested, the worse the mental dimension of HRQoL. Age of < 65 years (P = .009), history of depression (P = .009), anxiety (P = .003) and depression (P = .02) symptoms at ICU discharge, physical dependence (P = .01), and decreased physical functional status (P = .04) at 6 months were associated with anxiety. History of depression (P = .001), depression symptoms at ICU discharge (P < .001), and decreased physical functional status at 6 months (P = .01) were associated with depression. Depression symptoms at ICU discharge (P = .01), physical dependence (P = .01), and decreased physical functional status (P = .02) at 6 months were associated with PTSD. INTERPRETATION The network of potential risk factors for mental illness among patients discharged from an ICU is complex and involves multiple factors (age, premorbid mental health, acute emotional stress, and physical impairment after ICU stay). The negative impact of the burden of mental illness on HRQoL among critical care survivors is of concern.
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A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study. J Clin Med 2021; 10:jcm10040872. [PMID: 33672672 PMCID: PMC7924347 DOI: 10.3390/jcm10040872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay.
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Weiss B, Paul N, Kraufmann B, Spies CD. [Avoiding Long-term Impairment in Critical Care Using Telemedicine: The ERIC Example]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:41-51. [PMID: 33412602 DOI: 10.1055/a-1130-4996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a high demand for critical care, which is forecasted to further grow in the future. Increasing patient morbidity and complexity concurring with a shortage of trained intensivists imposes challenges on critical care clinicians. Weathering these challenges, telemedical programs can help utilize and allocate resources more efficiently as well as foster adherence to best practice, thereby directly impacting quality of care. Studies have predominantly shown reductions in mortality and length of stay. Successful telemedical programs employ experienced intensivists, have well-functioning equipment and high acceptance among on-site clinicians. The multicenter, pragmatic, stepped wedge cluster-randomized controlled quality improvement trial Enhanced Recovery after Intensive Care (ERIC) pilots a new form of critical care provision in Germany. With a target study sample size of n = 1431 patients, the study aims to utilize telemedicine to increase adherence to a set of evidence- and consensus-based quality indicators for acute critical care. In an intersectoral case-care management, patients are followed three and six months after discharge from the intensive care unit to be assessed for long-term impairments and post-intensive care syndrome.
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Ling L, Ho CM, Ng PY, Chan KCK, Shum HP, Chan CY, Yeung AWT, Wong WT, Au SY, Leung KHA, Chan JKH, Ching CK, Tam OY, Tsang HH, Liong T, Law KI, Dharmangadan M, So D, Chow FL, Chan WM, Lam KN, Chan KM, Mok OF, To MY, Yau SY, Chan C, Lei E, Joynt GM. Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018. J Intensive Care 2021; 9:2. [PMID: 33407925 PMCID: PMC7788755 DOI: 10.1186/s40560-020-00513-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-020-00513-9.
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Affiliation(s)
- Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Chun Ming Ho
- Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong, China
| | - Pauline Yeung Ng
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Hoi Ping Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Cheuk Yan Chan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Alwin Wai Tak Yeung
- Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Shek Yin Au
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong, China
| | | | | | - Chi Keung Ching
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Oi Yan Tam
- Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China
| | - Hin Hung Tsang
- Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China
| | - Ting Liong
- Department of Intensive Care, United Christian Hospital, Hong Kong, China
| | - Kin Ip Law
- Department of Intensive Care, United Christian Hospital, Hong Kong, China
| | - Manimala Dharmangadan
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China.,Department of Intensive Care, Yan Chai Hospital, Hong Kong, China
| | - Dominic So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China.,Department of Intensive Care, Yan Chai Hospital, Hong Kong, China
| | - Fu Loi Chow
- Department of Intensive Care, Caritas Medical Centre, Hong Kong, China
| | - Wai Ming Chan
- Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Koon Ngai Lam
- Department of Intensive Care, North District Hospital, Hong Kong, China
| | - Kai Man Chan
- Intensive Care Unit, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Oi Fung Mok
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Man Yee To
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Sze Yuen Yau
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Carmen Chan
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Ella Lei
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
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Paul N, Grunow JJ, Weiß B, Spies C. [Enhanced Recovery after Intensive Care-ERIC]. Anaesthesist 2020; 69:937-939. [PMID: 33026507 PMCID: PMC7716892 DOI: 10.1007/s00101-020-00863-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- N Paul
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - J J Grunow
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - B Weiß
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - C Spies
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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47
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Chapman LB, Kopp KE, Petty MG, Hartwig JLA, Pendleton KM, Langer K, Meiers SJ. Benefits of collaborative patient care rounds in the intensive care unit. Intensive Crit Care Nurs 2020; 63:102974. [PMID: 33262010 DOI: 10.1016/j.iccn.2020.102974] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Improving care of critically ill patients requires using an interprofessional care model and care standardisation. OBJECTIVES Determine whether collaborative patient care rounds in the intensive care unit increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration. METHODS Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration. RESULTS Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001). CONCLUSION This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.
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Affiliation(s)
- Leah B Chapman
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States; University of Minnesota Medical Center, Minneapolis, MN, United States.
| | - Kathleen E Kopp
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States; University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Michael G Petty
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Jodi L A Hartwig
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Kathryn M Pendleton
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kimberly Langer
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States
| | - Sonia J Meiers
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States
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48
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Telemedicine in the intensive care unit: A vehicle to improve quality of care? J Crit Care 2020; 61:241-246. [PMID: 33220577 DOI: 10.1016/j.jcrc.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/03/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
The high demand for intensive care, which is predicted to further increase in the future, is contrasted by a shortage of trained intensivists and specialized nurses. Telemedicine has been heralded as a promising solution. Yet, there is considerable heterogeneity in tele-critical care when it comes to measurable effects. However, the focus has been on telemedical solutions substituting on-site intensivist functions, and outcome measures have primarily been mortality and length of stay. In a new model of telemedicine for the ICU, telemedicine could be used to increase adherence to best practice guidelines and indicators of process quality. Further, indicators of process quality, functional outcomes and quality of life measures should be incorporated in the evaluation of outcomes, as patients frequently value those higher than mere survival.
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Epidemiological trends of surgical admissions to the intensive care unit in the United States. J Trauma Acute Care Surg 2020; 89:279-288. [PMID: 32384370 DOI: 10.1097/ta.0000000000002768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs. METHODS We performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes. RESULTS We evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period. CONCLUSION Temporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training. LEVEL OF EVIDENCE Economic/decision, level IV.Epidemiologic, level IV.
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50
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Gosling AF, Hammer M, Grabitz S, Wachtendorf LJ, Katsiampoura A, Murugappan KR, Sehgal S, Khabbaz KR, Mahmood F, Eikermann M. Development of an Instrument for Preoperative Prediction of Adverse Discharge in Patients Scheduled for Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:482-489. [PMID: 32893054 DOI: 10.1053/j.jvca.2020.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Inability of home discharge occurs in nearly a third of patients undergoing cardiac surgery and is associated with increased mortality. The authors aimed to evaluate the incidence and risk factors for adverse discharge disposition (ADD) after cardiac surgery and develop a prediction tool for preoperative risk assessment. DESIGN This retrospective cohort study included adult patients undergoing cardiac surgery between 2010 and 2018. The primary outcome was ADD, defined as in-hospital mortality, discharge to a skilled nursing facility, or transfer to a long-term care hospital. The authors created a prediction tool using stepwise backward logistic regression and used 5-fold and leave-one-out cross-validation. SETTING University hospital network. PARTICIPANTS Adult patients living at home prior to surgery, who underwent coronary artery bypass grafting and/or valve procedures at the authors' institution. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 3,760 patients were included in the final study cohort. The observed rate of ADD was 33.3%. The prediction model showed good discrimination and accuracy, with C-statistic of 0.78 (95% confidence interval [CI] 0.76-0.79) and unmodified Brier score of 0.177 (reliability 0.001). The final model comprised 14 predictors. Patients who experienced ADD were more likely to be older, of female sex, to have had higher length of hospital stay prior to surgery, and to have undergone emergency surgery. CONCLUSIONS The authors present an instrument for prediction of loss of the ability to live independently in patients undergoing cardiac surgery. The authors' score may be useful in identifying high-risk patients such that earlier coordination of care can be initiated in this vulnerable patient population.
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Affiliation(s)
- Andre F Gosling
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Maximilian Hammer
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stephanie Grabitz
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Luca J Wachtendorf
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Anastasia Katsiampoura
- Department of Anesthesiology, Critical Care and Pain Medicine, St. Elizabeth's Medical Center, Tufts Medical School, Brighton, MA
| | - Kadhiresan R Murugappan
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sankalp Sehgal
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Matthias Eikermann
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Universitaet Duisburg Essen, Medizinische Fakultaet, Essen, Germany.
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