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Siao SF, Wang TG, Ku SC, Wei YC, Chen CCH. Inability to Sit-to-Stand in Medical ICUs Survivors: When and Why We Should Care. Crit Care Med 2024:00003246-990000000-00370. [PMID: 39258981 DOI: 10.1097/ccm.0000000000006404] [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 To investigate the prevalence and association with mortality of inability to perform sit-to-stand independently in critically ill survivors 3 months following medical ICU (MICU) discharge. DESIGN Prospective cohort study. SETTING Six MICUs at a tertiary care hospital. PATIENTS MICU survivors who could sit-to-stand independently before the index hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Inability to sit-to-stand (yes/no) was measured at four points following MICU discharge: upon ICU discharge, 1, 2, and 3 months afterward. Mortality was evaluated at 6- and 12-month post-MICU discharge. Among 194 participants, 128 (66%) had inability to sit-to-stand upon MICU discharge. Recovery occurred, with rates decreasing to 50% at 1 month, 38% at 2 months, and 36% at 3 months post-MICU discharge, plateauing at 2 months. Inability to sit-to-stand at 3 months was significantly associated with 21% mortality at 12 months and a 4.2-fold increased risk of mortality (adjusted hazard ratio, 4.2; 95% CI, 1.61-10.99), independent of age, Sequential Organ Failure Assessment score, and ICU-acquired weakness. Notably, improvement in sit-to-stand ability, even from "totally unable" to "able with assistance," correlates with reduced mortality risk. CONCLUSIONS Inability to sit-to-stand affects about 36% of MICU survivors even at 3 months post-ICU discharge, highlighting rehabilitation challenges. Revisiting sit-to-stand ability post-ICU discharge is warranted. Additionally, using sit-to-stand as a screening tool for interventions to improve return of its function and mortality is suggested.
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Affiliation(s)
- Shu-Fen Siao
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chung Wei
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Cheryl Chia-Hui Chen
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Gesser AF, Campos ML, Artismo RS, Karloh M, Matte DL. Impact of COVID-19 critical illness on functional status, fatigue symptoms, and health-related quality of life one-year after hospital discharge: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:4086-4097. [PMID: 37818936 DOI: 10.1080/09638288.2023.2266365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To estimate the prevalence and severity of impairments in functional status, fatigue, and health-related quality of life (HRQoL) among critical COVID-19 survivors one-year after hospital discharge. METHODS A systematic review was conducted following PRISMA statement and registered in PROSPERO (CRD42021258356), with searches in eight databases. Observational studies were selected. The prevalence meta-analysis of abnormalities was performed using random-effects models. Risk of bias was evaluated using the National Heart, Lung, and Blood Institute tool. RESULTS Twenty studies were included, with data collected between 12 and 13.5 months after hospital discharge and a total of 1828 participants. Of these, 71% were men, and 77.7% were intubated in the intensive care unit (ICU). Impairments and sequelae were identified in varying prevalence and degrees, with greater impact on functional capacity and physical components of fatigue and HRQoL. The prevalence of abnormalities of 32.3% [95% CI 23.9; 41.9] found in the meta-analysis is substantially high. Most studies were classified as having fair and poor quality. CONCLUSION Critical COVID-19 survivors experience impairments in functional status, fatigue, and HRQoL to varying degrees one-year after hospital discharge, particularly among patients who stayed in the ICU and on MV for a prolonged period.
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Affiliation(s)
- Ana Flávia Gesser
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Mariana Lanzoni Campos
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Regiana Santos Artismo
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Manuela Karloh
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Darlan Laurício Matte
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
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Jesus Pereira I, Santos M, Sganzerla D, Robinson CC, de Souza D, Kochhann R, Falavigna M, Azevedo L, Bozza F, Sharshar T, Goulart Rosa R, Granja C, Teixeira C. Long term cognitive dysfunction among critical care survivors: associated factors and quality of life-a multicenter cohort study. Ann Intensive Care 2024; 14:116. [PMID: 39073625 PMCID: PMC11286902 DOI: 10.1186/s13613-024-01335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/16/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVES To identify the prevalence and associated factors of cognitive dysfunction, 1 year after ICU discharge, among adult patients, and it´s relation with quality of life. METHODS Multicenter, prospective cohort study including ICUs of 10 tertiary hospitals in Brazil, between May 2014 and December 2018. The patients included were 452 adult ICU survivors (median age 60; 47.6% women) with an ICU stay greater than 72 h. RESULTS At 12 months after ICU discharge, a Montreal Cognitive Assessment (tMOCA) telephone score of less than 12 was defined as cognitive dysfunction. At 12 months, of the 452 ICU survivors who completed the cognitive evaluation 216 (47.8%) had cognitive dysfunction. In multivariable analyses, the factors associated with long-term (1-year) cognitive dysfunction were older age (Prevalence Ratio-PR = 1.44, P < 0.001), absence of higher education (PR = 2.81, P = 0.005), higher comorbidities on admission (PR = 1.089; P = 0.004) and delirium (PR = 1.13, P < 0.001). Health-related Quality of life (HRQoL), assessed by the mental and physical dimensions of the SF-12v2, was significantly better in patients without cognitive dysfunction (Mental SF-12v2 Mean difference = 2.54; CI 95%, - 4.80/- 0.28; p = 0.028 and Physical SF-12v2 Mean difference = - 2.85; CI 95%, - 5.20/- 0.50; P = 0.018). CONCLUSIONS Delirium was found to be the main modifiable predictor of long-term cognitive dysfunction in ICU survivors. Higher education consistently reduced the probability of having long-term cognitive dysfunction. Cognitive dysfunction significantly influenced patients' quality of life, leading us to emphasize the importance of cognitive reserve for long-term prognosis after ICU discharge.
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Affiliation(s)
- Isabel Jesus Pereira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
- SIM-FMUP-Simulation Center, Faculty of Medicine, University of Porto, Porto, Portugal.
- CriticalMed-Critical Care & Emergency Medicine, CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal.
- Intensive Care Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Mariana Santos
- MEDCIDS-Medicina da Comunidade, Informação E Decisão Em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE-Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
| | | | | | - Denise de Souza
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Maicon Falavigna
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Institute for Health Technology Assessment, Postgraduate Program in Epidemiology, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
- Postgraduate Program in Epidemiology, UFRGS, Porto Alegre, Brazil
| | - Luis Azevedo
- MEDCIDS-Medicina da Comunidade, Informação E Decisão Em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE-Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
| | - Fernando Bozza
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Tarek Sharshar
- Anesthesia and Intensive Care Department, Institute of Psychiatry, GHU Paris Psychiatrie Et NeurosciencesSainte-Anne HospitalNeurosciences of Paris, INSERM U1266, Université Paris Cité, Pole Neuro, ParisParis, France
| | - Regis Goulart Rosa
- Department of Internal Medicine, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Brazilian Research in Intensive Care Network, São Paulo, SP, Brazil
| | - Cristina Granja
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- SIM-FMUP-Simulation Center, Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed-Critical Care & Emergency Medicine, CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
- CINTESIS@RISE-Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Anaesthesiology Department, University Hospital Center São João, Porto, Portugal
| | - Cassiano Teixeira
- Brazilian Research in Intensive Care Network, São Paulo, SP, Brazil
- Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- UFCSPA Medical School, Porto Alegre, RS, Brazil
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Diaz-Castrillon CE, Brown JA, Navid F, Serna-Gallegos D, Yousef S, Thoma F, Punu K, Zhu J, Sultan I. The impact of prolonged mechanical ventilation after acute type A aortic dissection repair. J Thorac Cardiovasc Surg 2024; 167:1672-1679.e2. [PMID: 35989122 DOI: 10.1016/j.jtcvs.2022.07.007] [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: 01/05/2022] [Revised: 06/24/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Patients with type A aortic dissection have increased resource use. The objective of this study was to describe the relationship between prolonged mechanical ventilation and longitudinal survival in patients undergoing type A aortic dissection repair. METHODS We conducted a retrospective analysis of patients with type A aortic dissection undergoing repair from 2010 to 2018; Kaplan-Meier function and adjusted Cox regression analysis were used to compare in-hospital mortality and longitudinal survival accounting for time on mechanical ventilatory support. RESULTS A total of 552 patients were included. The study population was divided into 12 hours or less (n = 291), more than 12 to 24 or less hours (n = 101), more than 24 to 48 hours or less (n = 60), and more than 48 hours (n = 100) groups. Patients within the 12 or less hours group were the youngest (60.0 vs 63.5 years vs 63.6 vs 62.8 years; P = .03) and less likely to be female (31.6% vs 43.6% vs 46.7% vs 56.0%; P < .001). On the other hand, the more than 48 hours group presented with malperfusion syndrome at admission more often (24.4% vs 29.7% vs 28.3% vs 53.0%; P < .001) and had longer cardiopulmonary and ischemic times (P < .05). In-hospital mortality was significantly higher in the more than 48 hours group (5.2% vs 6.9% vs 3.3% vs 30.0%; P < .001). Multivariable analysis demonstrated worse longitudinal survival for the 24 to 48 hours group (hazard ratio, 1.94, confidence interval, 1.10-3.43) and more than 48 hours ventilation group (hazard ratio, 2.25, confidence interval, 1.30-3.92). CONCLUSIONS The need for prolonged mechanical ventilatory support is prevalent and associated with other perioperative complications. More important, after adjusting for other covariates, prolonged mechanical ventilation is an independent factor associated with increased longitudinal mortality.
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Affiliation(s)
- Carlos E Diaz-Castrillon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Kristian Punu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Jianhui Zhu
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Birberg Thornberg U, Andersson A, Lindh M, Hellgren L, Divanoglou A, Levi R. Neurocognitive deficits in COVID-19 patients five months after discharge from hospital. Neuropsychol Rehabil 2023; 33:1599-1623. [PMID: 36239662 DOI: 10.1080/09602011.2022.2125020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/11/2022] [Indexed: 10/17/2022]
Abstract
This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region Östergötland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life.
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Affiliation(s)
- Ulrika Birberg Thornberg
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Agnes Andersson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Malin Lindh
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lovisa Hellgren
- Department of Rehabilitation Medicine, Region Jönköping County, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Richard Levi
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lin C, Chao WC, Pai KC, Yang TY, Wu CL, Chan MC. Prolonged use of neuromuscular blocking agents is associated with increased long-term mortality in mechanically ventilated medical ICU patients: a retrospective cohort study. J Intensive Care 2023; 11:55. [PMID: 37978572 PMCID: PMC10655355 DOI: 10.1186/s40560-023-00696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Neuromuscular blockade agents (NMBAs) can be used to facilitate mechanical ventilation in critically ill patients. Accumulating evidence has shown that NMBAs may be associated with intensive care unit (ICU)-acquired weakness and poor outcomes. However, the long-term impact of NMBAs on mortality is still unclear. METHODS We conducted a retrospective analysis using the 2015-2019 critical care databases at Taichung Veterans General Hospital, a referral center in central Taiwan, as well as the Taiwan nationwide death registry profile. RESULTS A total of 5709 ventilated patients were eligible for further analysis, with 63.8% of them were male. The mean age of enrolled subjects was 67.8 ± 15.8 years, and the one-year mortality was 48.3% (2755/5709). Compared with the survivors, the non-survivors had a higher age (70.4 ± 14.9 vs 65.4 ± 16.3, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (28.0 ± 6.2 vs 24.7 ± 6.5, p < 0.001), a longer duration of ventilator use (12.6 ± 10.6 days vs 7.8 ± 8.5 days, p < 0.001), and were more likely to receive NMBAs for longer than 48 h (11.1% vs 7.8%, p < 0.001). After adjusting for age, sex, and relevant covariates, the use of NMBAs for longer than 48 h was found to be independently associated with an increased risk of mortality (adjusted HR: 1.261; 95% CI: 1.07-1.486). The analysis of effect modification revealed that this association was tended to be strong in patients with a Charlson Comorbidity Index of 3 or higher. CONCLUSIONS Our study demonstrated that prolonged use of NMBAs was associated with an increased risk of long-term mortality in critically ill patients requiring mechanical ventilation. Further studies are needed to validate our findings.
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Affiliation(s)
- Chun Lin
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
- Big Data Center, Chung Hsing University, Taichung, Taiwan
| | - Kai-Chih Pai
- College of Engineering, Tunghai University, Taichung, Taiwan
| | - Tsung-Ying Yang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ming-Cheng Chan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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Salton F, Confalonieri P, Meduri GU, Mondini L, Trotta L, Barbieri M, Bozzi C, Torregiani C, Lerda S, Bellan M, Confalonieri M, Ruaro B, Tavano S, Pozzan R. Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter-A Critical Review and Viewpoints. Pharmaceuticals (Basel) 2023; 16:924. [PMID: 37513836 PMCID: PMC10385094 DOI: 10.3390/ph16070924] [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: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization's recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/day for 10 days are now indicated in all COVID-19 cases who require respiratory support. However, the efficacy of the intervention depends on the timing of initiation, the dose, and other individual factors. Indeed, patients treated with similar GC protocols often experience different outcomes, which do not always correlate with the presence of comorbidities or with the severity of respiratory involvement at baseline. This prompted us to critically review the literature on the rationale, pharmacological principles, and clinical evidence that should guide GC treatment. Based on these data, the best treatment protocol probably involves an initial bolus dose to saturate the glucocorticoid receptors, followed by a continuous infusion to maintain constant plasma levels, and eventually a slow tapering to interruption. Methylprednisolone has shown the highest efficacy among different GC molecules, most likely thanks to its higher ability to penetrate the lung. Decreased tissue sensitivity to glucocorticoids is thought to be the main mechanism accounting for the lower response to the treatment in some individuals. We do not have a readily available test to identify GC resistance; therefore, to address inter-individual variability, future research should aim at investigating clinical, physiological, and laboratory markers to guide a personalized GC treatment approach.
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Affiliation(s)
- Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gianfranco Umberto Meduri
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Torregiani
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- Business School, University of Milano, 20149 Milano, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- A.O.U. Maggiore della Carità, 28100 Novara, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging 2023; 18:93-112. [PMID: 36714685 PMCID: PMC9879046 DOI: 10.2147/cia.s365968] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 01/23/2023] Open
Abstract
There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.
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Affiliation(s)
- Lucille B Brunker
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina S Boncyk
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly F Rengel
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher G Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
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9
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Martin GL, Atramont A, Mazars M, Tajahmady A, Agamaliyev E, Singer M, Leone M, Legrand M. Days Spent at Home and Mortality After Critical Illness: A Cluster Analysis Using Nationwide Data. Chest 2022; 163:826-842. [PMID: 36257472 PMCID: PMC10107061 DOI: 10.1016/j.chest.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. RESEARCH QUESTION What are the days spent at home and health care trajectories during the year after surviving critical illness? STUDY DESIGN AND METHODS Data were extracted on adult survivors spending at least 2 nights in a French ICU during 2018 who were treated with invasive mechanical ventilation or vasopressors or inotropes. Trauma, burn, organ transplant, stroke, and neurosurgical patients were excluded. Stays at home, death, and hospitalizations were reported before and after ICU stay, using state sequence analysis. An unsupervised clustering method was performed to identify cohorts based on post-ICU trajectories. RESULTS Of 77,132 ICU survivors, 89% returned home. In the year after discharge, these patients spent a median of 330 (interquartile range [IQR], 283-349) days at home. At 1 year, 77% of patients were still at home and 17% had died. Fifty-one percent had been re-hospitalized, and 10% required a further ICU admission. Forty-eight percent used rehabilitation facilities, and 5.7%, hospital at home. Three clusters of patients with distinct post-ICU trajectories were identified. Patients in cluster 1 (68% of total) survived and spent most of the year at home (338 [323-354] days). Patients in cluster 2 (18%) had more complex trajectories, but most could return home (91%), spending 242 (174-277) days at home. Patients in cluster 3 (14%) died, with only 37% returning home for 45 (15-90) days. INTERPRETATION Many patients had complex health care trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge were observed between clusters, which represents an important patient-centered outcome.
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Affiliation(s)
| | | | | | | | | | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Marc Leone
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesia and Intensive Care Unit, Hospital Nord, Marseille, France; Société Française d'Anesthésie et de Réanimation (SFAR), Paris, France
| | - Matthieu Legrand
- Société Française d'Anesthésie et de Réanimation (SFAR), Paris, France; Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF, San Francisco, CA; INI-CRCT network, Nancy, France.
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10
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Ahmad SR, Tarabochia AD, Budahn L, Lemahieu AM, Anderson B, Vashistha K, Karnatovskaia L, Gajic O. Feasibility of Extracting Meaningful Patient Centered Outcomes From the Electronic Health Record Following Critical Illness in the Elderly. Front Med (Lausanne) 2022; 9:826169. [PMID: 35733861 PMCID: PMC9207323 DOI: 10.3389/fmed.2022.826169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Meaningful patient centered outcomes of critical illness such as functional status, cognition and mental health are studied using validated measurement tools that may often be impractical outside the research setting. The Electronic health record (EHR) contains a plethora of information pertaining to these domains. We sought to determine how feasible and reliable it is to assess meaningful patient centered outcomes from the EHR. Methods Two independent investigators reviewed EHR of a random sample of ICU patients looking at documented assessments of trajectory of functional status, cognition, and mental health. Cohen's kappa was used to measure agreement between 2 reviewers. Post ICU health in these domains 12 month after admission was compared to pre- ICU health in the 12 months prior to assess qualitatively whether a patient's condition was “better,” “unchanged” or “worse.” Days alive and out of hospital/health care facility was a secondary outcome. Results Thirty six of the 41 randomly selected patients (88%) survived critical illness. EHR contained sufficient information to determine the difference in health status before and after critical illness in most survivors (86%). Decline in functional status (36%), cognition (11%), and mental health (11%) following ICU admission was observed compared to premorbid baseline. Agreement between reviewers was excellent (kappa ranging from 0.966 to 1). Eighteen patients (44%) remained home after discharge from hospital and rehabilitation during the 12- month follow up. Conclusion We demonstrated the feasibility and reliability of assessing the trajectory of changes in functional status, cognition, and selected mental health outcomes from EHR of critically ill patients. If validated in a larger, representative sample, these outcomes could be used alongside survival in quality improvement studies and pragmatic clinical trials.
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Affiliation(s)
- Sumera R. Ahmad
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Sumera R. Ahmad
| | - Alex D. Tarabochia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Luann Budahn
- Anesthesia and Critical Care Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Allison M. Lemahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Brenda Anderson
- Anesthesia and Critical Care Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Kirtivardhan Vashistha
- Department of Infectious Disease, Multi-disciplinary Epidemiology and Translational Research in Intensive Care Research Group, Mayo Clinic, Rochester, MN, United States
| | | | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
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11
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Young DL, Fritz JM, Kean J, Thackeray A, Johnson JK, Dummer D, Passek S, Stilphen M, Beck D, Havrilla S, Hoyer EH, Friedman M, Daley K, Marcus RL. Key Data Elements for Longitudinal Tracking of Physical Function: A Modified Delphi Consensus Study. Phys Ther 2022; 102:6497841. [PMID: 35079819 DOI: 10.1093/ptj/pzab279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/02/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. METHODS A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. RESULTS Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are "administrative" and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. CONCLUSION A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. IMPACT Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA.,Department of Population Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Danica Dummer
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Sandra Passek
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Stilphen
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donna Beck
- Johns Hopkins Home Health Services, Baltimore, Maryland, USA
| | | | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kelly Daley
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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12
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Hashem MD, Hopkins RO, Colantuoni E, Dinglas VD, Sinha P, Aronson Friedman L, Morris PE, Jackson JC, Hough CL, Calfee CS, Needham DM. Six-month and 12-month patient outcomes based on inflammatory subphenotypes in sepsis-associated ARDS: secondary analysis of SAILS-ALTOS trial. Thorax 2022; 77:22-30. [PMID: 34112703 PMCID: PMC8660939 DOI: 10.1136/thoraxjnl-2020-216613] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Prior acute respiratory distress syndrome (ARDS) trials have identified hypoinflammatory and hyperinflammatory subphenotypes, with distinct differences in short-term outcomes. It is unknown if such differences extend beyond 90 days or are associated with physical, mental health or cognitive outcomes. METHODS 568 patients in the multicentre Statins for Acutely Injured Lungs from Sepsis trial of rosuvastatin versus placebo were included and assigned a subphenotype. Among 6-month and 12-month survivors (N=232 and 219, respectively, representing 243 unique survivors), subphenotype status was evaluated for association with a range of patient-reported outcomes (eg, mental health symptoms, quality of life). Patient subsets also were evaluated with performance-based tests of physical function (eg, 6 min walk test) and cognition. FINDINGS The hyperinflammatory versus hypoinflammatory subphenotype had lower overall 12-month cumulative survival (58% vs 72%, p<0.01); however, there was no significant difference in survival beyond 90 days (86% vs 89%, p=0.70). Most survivors had impairment across the range of outcomes, with little difference between subphenotypes at 6-month and 12-month assessments. For instance, at 6 months, in comparing the hypoinflammatory versus hyperinflammatory subphenotypes, respectively, the median (IQR) patient-reported SF-36 mental health domain score was 47 (33-56) vs 44 (35-56) (p=0.99), and the per cent predicted 6 min walk distance was 66% (48%, 80%) vs 66% (49%, 79%) (p=0.76). INTERPRETATION Comparing the hyperinflammatory versus hypoinflammatory ARDS subphenotype, there was no significant difference in survival beyond 90 days and no consistent findings of important differences in 6-month or 12-month physical, cognitive and mental health outcomes. These findings, when considered with prior results, suggest that inflammatory subphenotypes largely reflect the acute phase of illness and its short-term impact.
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Affiliation(s)
- Mohamed D Hashem
- Department of Medicine, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins University - Bloomberg School of Public Health, Baltimore, Maryland, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pratik Sinha
- Division of Critical Care, Department of Anesthesia, Washington University in St Louis, Saint Louis, Missouri, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter E Morris
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - James C Jackson
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS Center), Nashville, Tennessee, USA
- Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco Department of Medicine, San Francisco, California, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Puengel T, Weber B, Wirtz TH, Buendgens L, Loosen SH, Geisler L, Özdirik B, Karim H, Jhaisha SA, Brozat JF, Hohlstein P, Eisert A, Yagmur E, Trautwein C, Tacke F, Koch A. Low Serum Levels of Soluble Receptor Activator of Nuclear Factor κ B Ligand (sRANKL) Are Associated with Metabolic Dysregulation and Predict Long-Term Mortality in Critically Ill Patients. Diagnostics (Basel) 2021; 12:diagnostics12010062. [PMID: 35054232 PMCID: PMC8774641 DOI: 10.3390/diagnostics12010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 01/23/2023] Open
Abstract
Soluble receptor activator of nuclear factor κ B ligand (sRANKL) is a member of the tumor necrosis factor receptor superfamily, and therefore, involved in various inflammatory processes. The role of sRANKL in the course of bone remodeling via activation of osteoclasts as well as chronic disease progression has been described extensively. However, the potential functional importance of sRANKL in critically ill or septic patients remained unknown. Therefore, we measured sRANKL serum concentrations in 303 critically ill patients, including 203 patients with sepsis and 100 with non-sepsis critical illness. Results were compared to 99 healthy controls. Strikingly, in critically ill patients sRANKL serum levels were significantly decreased at intensive care unit (ICU) admission (p = 0.011) without differences between sepsis and non-sepsis patients. Inline, sRANKL was correlated with markers of metabolic dysregulation, such as pre-existing diabetes and various adipokines (e.g., adiponectin, leptin receptor). Importantly, overall mortality of critically ill patients in a three-year follow-up was significantly associated with decreased sRANKL serum concentrations at ICU admission (p = 0.038). Therefore, our study suggests sRANKL as a biomarker in critically ill patients which is associated with poor prognosis and overall survival beyond ICU stay.
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Affiliation(s)
- Tobias Puengel
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
- Correspondence:
| | - Beate Weber
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Theresa H. Wirtz
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Lukas Buendgens
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Sven H. Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Lukas Geisler
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Burcin Özdirik
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Hamesch Karim
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Samira Abu Jhaisha
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Jonathan F. Brozat
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Philipp Hohlstein
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH-University Hospital Aachen, 52074 Aachen, Germany;
- Institute of Clinical Pharmacology, RWTH-University Hospital Aachen, 52074 Aachen, Germany
| | - Eray Yagmur
- Institute of Laboratory Medicine, Western Palatinate Hospital, 67655 Kaiserslautern, Germany;
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
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14
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Jaywant A, Vanderlind WM, Alexopoulos GS, Fridman CB, Perlis RH, Gunning FM. Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19. Neuropsychopharmacology 2021; 46:2235-2240. [PMID: 33589778 PMCID: PMC7884062 DOI: 10.1038/s41386-021-00978-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation. Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - W Michael Vanderlind
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, US
| | - Chaya B Fridman
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - Roy H Perlis
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, US
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US.
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US.
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, US.
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15
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Thackeray M, Mohebbi M, Orford N, Kotowicz MA, Pasco JA. Lean mass as a risk factor for intensive care unit admission: an observational study. Crit Care 2021; 25:364. [PMID: 34663393 PMCID: PMC8525013 DOI: 10.1186/s13054-021-03788-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Intensive care unit (ICU) survivors have reduced physical function likely due to skeletal muscle wasting and weakness acquired during critical illness. However, the contribution of pre-morbid muscle mass has not been elucidated. We aimed to examine the association between pre-ICU muscle mass and ICU admission risk. Secondary outcomes include the relationship between muscle mass and ICU outcomes. METHODS ICU admissions between June 1, 1998, and February 1, 2019, were identified among participants of Geelong Osteoporosis Study (GOS), a population-based cohort study. Cox proportional hazard regression models estimated hazard ratios (HR) for ICU admission across T-score strata and continuous values of DXA-derived lean mass measures of skeletal mass index (SMI, lean mass/body mass %) and appendicular lean mass corrected for height (ALM/h2, kg/m2). Multivariable regression was used to determine the relationship between lean mass and ICU outcomes. RESULTS One hundred and eighty-six of 3126 participants enrolled in GOS were admitted to the ICU during the follow-up period. In adjusted models, lean mass was not predictive of ICU admission (SMI: HR 0.99 95%CI 0.97-1.01, p = 0.32; ALM/h2: HR 1.11 95%CI 0.94-1.31, p = 0.23), while greater appendicular lean mass was related to reduced 28-day mortality (ALM/h2 adjOR: 0.25, 95%CI 0.10-0.63, p = 0.003, SMI adjOR: 0.91, 95%CI 0.82-1.02, p = 0.09). CONCLUSION Lean mass was not associated with ICU admission in this population-based cohort study; however, greater appendicular lean mass was associated with reduced mortality. This suggests pre-ICU muscle status may not predict development of critical illness but is associated with better survival after critical illness occurs.
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Affiliation(s)
- Matthew Thackeray
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia.
- Barwon Health, Geelong, Australia.
| | - Mohammadreza Mohebbi
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Australia
| | - Neil Orford
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, Australia
| | - Mark A Kotowicz
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, Australia
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16
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Meduri GU, Rochwerg B. POINT: Should Corticosteroids Be Routine Treatment in Early ARDS? Yes. Chest 2021; 159:25-29. [PMID: 33422200 DOI: 10.1016/j.chest.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/19/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Gianfranco Umberto Meduri
- Departments of Medicine, Pulmonary, Critical Care, and Sleep Medicine Service, Memphis Veterans Affairs Medical Center, Memphis, TN.
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton
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17
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Higgins AM, Neto AS, Bailey M, Barrett J, Bellomo R, Cooper DJ, Gabbe BJ, Linke N, Myles PS, Paton M, Philpot S, Shulman M, Young M, Hodgson CL. Predictors of death and new disability after critical illness: a multicentre prospective cohort study. Intensive Care Med 2021; 47:772-781. [PMID: 34089063 DOI: 10.1007/s00134-021-06438-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to determine the prevalence and predictors of death or new disability following critical illness. METHODS Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. RESULTS Of 628 patients with the primary outcome available (median age of 62 [49-71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01-1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01-1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89-8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32-4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07-12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07-0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72-0.80). CONCLUSION Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
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Affiliation(s)
- A M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - A Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - J Barrett
- Intensive Care Unit, Epworth Healthcare, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - R Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - D J Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - B J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - N Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - P S Myles
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia
| | - M Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Physiotherapy, Monash Health, Melbourne, VIC, Australia
| | - S Philpot
- Intensive Care Unit, Cabrini Health, Melbourne, VIC, Australia
| | - M Shulman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia
| | - M Young
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - C L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. .,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
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18
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A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project. Crit Care Med 2021; 48:e1164-e1170. [PMID: 33003081 DOI: 10.1097/ccm.0000000000004579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care. DESIGN Population health quality improvement comparative study with retrospective data analysis. SETTING A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs. PATIENTS ICU survivors. INTERVENTIONS Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process. MEASUREMENTS AND MAIN RESULTS Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed. CONCLUSIONS Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.
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19
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Hauschildt KE, Seigworth C, Kamphuis LA, Hough CL, Moss M, McPeake JM, Harrod M, Iwashyna TJ. Patients' Adaptations After Acute Respiratory Distress Syndrome: A Qualitative Study. Am J Crit Care 2021; 30:221-229. [PMID: 34161982 DOI: 10.4037/ajcc2021825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients' adaptations to these problems after hospitalization may identify opportunities to improve recovery. OBJECTIVES To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS. METHODS Semistructured interviews were conducted after hospitalization in patients with ARDS who had received mechanical ventilation. This was an ancillary study to a multicenter randomized controlled trial. Consecutive surviving patients who spoke English, consented to follow-up, and had been randomized between November 12, 2017, and April 5, 2018 were interviewed 9 to 16 months after that. RESULTS Forty-six of 79 eligible patients (58%) participated (mean [range] age, 55 [20-84] years). All patients reported using strategies to address physical, emotional, or cognitive problems after hospitalization. For physical and cognitive problems, patients reported accommodative strategies for adapting to new disabilities and recuperative strategies for recovering previous ability. For emotional issues, no clear distinction between accommodative and recuperative strategies emerged. Social support and previous familiarity with the health care system helped patients generate and use many strategies. Thirty-one of 46 patients reported at least 1 persistent problem for which they had no acceptable adaptation. CONCLUSIONS Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.
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Affiliation(s)
- Katrina E. Hauschildt
- Katrina E. Hauschildt is an advanced fellow in health services research at the Veterans Affairs Center for Clinical Management Research and a research associate in the Pulmonary and Critical Care Division at the University of Michigan, Ann Arbor
| | - Claire Seigworth
- Claire Seigworth is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan
| | - Lee A. Kamphuis
- Lee A. Kamphuis is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan
| | - Catherine L. Hough
- Catherine L. Hough is a professor of medicine and chief of the Division of Pulmonary and Critical Care Medicine at the Oregon Health & Science University in Portland
| | - Marc Moss
- Marc Moss is the Roger S. Mitchell Professor of Medicine and division head of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Joanne M. McPeake
- Joanne M. McPeake is a nurse consultant, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom, a senior honorary clinical lecturer at the University of Glasgow School of Medicine, Dentistry & Nursing, Glasgow, and a THIS Institute research fellow at the University of Cambridge
| | - Molly Harrod
- Molly Harrod is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan
| | - Theodore J. Iwashyna
- Theodore J. Iwashyna is the co-director of the research core at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, and the Alpheus W. Tucker, MD, Collegiate Professor of Internal Medicine at the University of Michigan, Ann Arbor
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20
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Sonneville R, Mazighi M, Bresson D, Crassard I, Crozier S, de Montmollin E, Degos V, Faugeras F, Gayat E, Josse L, Lamy C, Magalhaes E, Maldjian A, Ruckly S, Servan J, Vassel P, Vigué B, Timsit JF, Woimant F. Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study. Neurocrit Care 2021; 32:624-629. [PMID: 32026446 DOI: 10.1007/s12028-019-00907-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Care pathways and long-term outcomes of acute stroke patients requiring mechanical ventilation have not been thoroughly studied. METHODS AND RESULTS Stroke Prognosis in Intensive Care (SPICE) is a prospective multicenter cohort study which will be conducted in 34 intensive care units (ICUs) in the Paris, France area. Patients will be eligible if they meet all of the following inclusion criteria: (1) age of 18 years or older; (2) acute stroke (i.e., ischemic stroke, intracranial hemorrhage, or subarachnoid hemorrhage) diagnosed on neuroimaging; (3) ICU admission within 7 days before or after stroke onset; and (4) need for mechanical ventilation for a duration of at least 24 h. Patients will be excluded if they meet any of the following: (1) stroke of traumatic origin; (2) refusal to participate; and (3) privation of liberty by administrative or judicial decision. The primary endpoint is poor functional outcome at 1 year, defined by a score of 4 to 6 on the modified Rankin scale (mRS), indicating severe disability or death. Main secondary endpoints will include decisions to withhold or withdraw care, mRS scores at 3 and 6 months, and health-related quality of life at 1 year. CONCLUSIONS The SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation. TRIAL REGISTRATION NCT03335995.
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Affiliation(s)
- R Sonneville
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France. .,APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
| | - M Mazighi
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.,Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Neuroradiology, Rothschild Hospital, Paris, France
| | - D Bresson
- Department of Neurosurgery, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - I Crassard
- Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Agence Régionale de Santé, Paris, France
| | - S Crozier
- Department of Neurology, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E de Montmollin
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - V Degos
- Department of Critical Care, Anesthesia and Perioperative Medicine, Pitié-Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris-Sorbonne University, Paris, France.,GRC ARPE, Sorbonne University, Paris, France
| | - F Faugeras
- Department of Neurology, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, EQuipe E01 Neuropsychologie Interventionnelle, 94000, Créteil, France
| | - E Gayat
- Department of Anesthesiology and Critical Care, DMU Parabol, APHP Nord, Université de Paris, Paris, France.,UMR-S 942, Inserm, MASCOT, Paris, France
| | - L Josse
- Department of Rehabilitation Medicine, Fernand Widal University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - C Lamy
- Department of Neurology, Saint Anne Hospital, Paris, France.,INSERM U1266, Université Paris Descartes, Paris, France
| | - E Magalhaes
- Department of Intensive Care Medicine, Sud Francilien Hospital, Corbeil, France
| | - A Maldjian
- Department of Rehabilitation Medicine, 317 Lostihuel Braz, 56250, Sulniac, France
| | - S Ruckly
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - J Servan
- Department of Neurology, André Mignot Hospital, Le Chesnay, France
| | - P Vassel
- Department of Rehabilitation Medicine, Le Parc, Pontault-Combault, France
| | - B Vigué
- Department of Anesthesiology and Critical Care, Kremlin Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-F Timsit
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - F Woimant
- Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Agence Régionale de Santé, Paris, France
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21
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Collet MO, Egerod I, Thomsen T, Wetterslev J, Lange T, Ebdrup BH, Perner A. Risk factors for long-term cognitive impairment in ICU survivors: A multicenter, prospective cohort study. Acta Anaesthesiol Scand 2021; 65:92-99. [PMID: 32852053 DOI: 10.1111/aas.13692] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/16/2020] [Accepted: 08/16/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE To describe the incidence of and risk factors for impaired cognitive function in intensive care unit (ICU) survivors. We hypothesized that age, severity of illness, and days in coma, delirium, mechanical ventilation in the ICU would be associated with impaired cognitive function. METHODS We included all adults, alive 6 months after acute admission to one of the 24 Danish ICUs participating in the AID-ICU cohort study. Trained professionals assessed cognitive function in patients' homes or in outpatient clinics using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) 6 months after ICU admission. Potential risk factors for cognitive impairment were analyzed with linear regression models. RESULTS In total, 237 ICU patients were alive 6 months after ICU admission and did not meet the exclusion criteria. A total of 106 patients completed the cognitive assessment. The median RBANS global cognitive score was 76 (interquartile range, 62-91), and 52% had a global cognitive score 1.5 SD below the normative mean and 36% displayed a global cognitive score 2 SD below the normative mean, similar to that of Alzheimer's disease. Higher age was associated with poorer RBANS global cognitive score (estimate -0.35 [95% confidence interval -0.63 to -0.07] per year). CONCLUSIONS In this multicenter study of adult ICU survivors, cognitive impairment was frequent and severe in those assessed at 6 months. Higher age was a risk factor for cognitive impairment, but events related to the ICU stay were not associated with poorer cognitive performance at 6 months.
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Affiliation(s)
- Marie O. Collet
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
| | - Ingrid Egerod
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
| | - Thordis Thomsen
- Herlev ACES – Herlev Anaesthesia Critical and Emergency Care Science Unit Department of Anaesthesia Copenhagen University Hospital Herlev‐Gentofte Herlev Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit Centre for Clinical Intervention Research Copenhagen University Hospital Denmark
| | - Theis Lange
- Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Bjørn H. Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) Mental Health Centre Glostrup Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
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22
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Hajeb M, Singh TD, Sakusic A, Graff-Radford J, Gajic O, Rabinstein AA. Functional outcome after critical illness in older patients: a population-based study. Neurol Res 2020; 43:103-109. [PMID: 33012281 DOI: 10.1080/01616412.2020.1831302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the prevalence of disability among ICU survivors one year after admission, and which factors influence functional outcome. METHODS We examined consecutive patients enrolled in the population-based Mayo Clinic Olmsted Study of Aging and then admitted to medical or surgical adult ICUs at Mayo Clinic, Rochester between January 1, 2006, and December 31, 2014 to determine one-year functional outcomes. RESULTS 831cases were included. Mean age was 84 years (IQR 79-88). 569 (68.5%) patients were alive one year after ICU admission. Of them, 546 patients had functional assessment at one year and 367 (67.2%) had good functional outcome. On multivariable analysis, poor one-year functional outcome (death or disability) was more common among women, older patients, and patients with baseline cognitive impairment (mild cognitive impairment or dementia), higher Carlson scores, and longer ICU stay (all P <.01). After excluding deceased patients, these associations remained unchanged. In addition, 120 (32.3%) of 372 patients who had post-ICU cognitive evaluation experienced cognitive decline after the ICU admission. CONCLUSIONS On a population-based cohort of older, predominantly elderly patients, approximately two-thirds of survivors maintained or regained good functional status 1 year after ICU hospitalization. However, older age, female sex, greater comorbidities, abnormal baseline cognition, and longer ICU stay were associated with poor functional recovery and cognitive decline was common.
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Affiliation(s)
- Mania Hajeb
- Departments of Neurology, Mayo Clinic , Rochester, MN, USA
| | - Tarun D Singh
- Departments of Neurology, Mayo Clinic , Rochester, MN, USA
| | - Amra Sakusic
- University Clinical Center Tuzla, Bosnia and Herzegovina; and Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic , Rochester, MN, USA
| | | | - Ognjen Gajic
- Pulmonary Medicine and Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic , Rochester, MN, USA
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23
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Son YJ, Song HS, Seo EJ. Gender Differences Regarding the Impact of Change in Cognitive Function on the Functional Status of Intensive Care Unit Survivors: A Prospective Cohort Study. J Nurs Scholarsh 2020; 52:406-415. [PMID: 32583935 DOI: 10.1111/jnu.12568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to identify gender differences with regard to the impact of change in cognitive function on functional status 3 months after receiving critical care. DESIGN AND METHODS This prospective cohort study investigated 152 intensive care unit (ICU) patients. Their functional status and cognitive function were assessed using the validated Korean version of the Modified Barthel Index and Mini-Mental State Examination, respectively. Hierarchical regression was used to evaluate the impact of change in cognitive function on functional status in ICU survivors by gender. FINDINGS The proportion of women suffering from consistent cognitive impairment was significantly higher than that of men. Women had a rate of improvement to normal cognitive function within 3 months after discharge that was higher than that of men. Functional status 3 months after discharge was significantly lower for patients whose cognitive impairment was consistent than that for those whose cognitive function was normal. The impact of change in cognitive function on men (R2 change = .28) was greater than that on women (R2 change = .13). CONCLUSIONS Persistent cognitive impairment after critical illness had a negative effect on functional status in ICU survivors. Importantly, the negative impact of consistent cognitive impairment was greater in men than in women. CLINICAL RELEVANCE Early careful assessment of functional and cognitive status after critical illness is warranted. Strategies addressing the gender-specific characteristics related to cognitive improvement should also be developed.
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Affiliation(s)
- Youn-Jung Son
- Lambda Alpha-at-Large, Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Hyo-Suk Song
- Assistant professor, Department of Emergency Medical Technology, Daejeon Health Institute of Technology, Daejeon, Republic of Korea
| | - Eun Ji Seo
- Assistant professor, Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, Republic of Korea
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24
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de Vries FEE, Claessen JJM, Atema JJ, van Ruler O, Boermeester MA. Immediate Closure of Abdominal Cavity with Biologic Mesh versus Temporary Abdominal Closure of Open Abdomen in Non-Trauma Emergency Patients (CLOSE-UP Study). Surg Infect (Larchmt) 2020; 21:694-703. [PMID: 32097095 DOI: 10.1089/sur.2019.289] [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] [Indexed: 01/29/2023] Open
Abstract
Background: In more than 10% of emergency laparotomies in non-trauma patients, primary fascial closure is not achievable because of excessive visceral edema, which leaves the patient with an open abdomen (OA). An OA harbors an inherent high risk of serious complications, and temporary closure devices are used to achieve delayed fascial closure. A potential new strategy in preventing OA is immediate closure during the emergency procedure with a non-crosslinked biologic mesh. Methods: This is a prospective comparative cohort feasibility study in 13 teaching hospitals in the Netherlands. Non-trauma patients who underwent emergency laparotomy in which regular sutured primary fascial closure was not achievable because of excessive intra-abdominal edema were eligible. In one cohort, Biomesh (n = 20), the abdominal cavity was immediately closed at the emergency laparotomy with a non-crosslinked biologic mesh. In a parallel cohort, Control (n = 20), the resulting OA was managed by temporary abdominal closure (TAC; inlay polyglactin [Vicryl™] mesh [n = 7]) or commercial (ABTheraTM) abdominal negative pressure therapy device (n = 13)). The primary end point was the proportion of closed abdominal cavities at 90 days. Results: At 90 days, 65% (13/20) of the abdominal cavities were closed in the Biomesh cohort versus 45% (9/20) in Controls (p = 0.204). In the Biomesh cohort, seven of 20 (35%) patients had at least one major complication versus 15 of 20 (75%) patients in the Control cohort (p = 0.011). Both the median number of intensive care unit (ICU) and mechanical ventilation days were significantly lower in the Biomesh cohort; one versus 10 (p = 0.002) and 0 versus four (p = 0.003) days, respectively. The number of abdominal reoperations was significantly lower in the Biomesh cohort (median 0 vs. two, p < 0.001; total number five vs. 44). Conclusions: If primary fascial closure cannot be achieved at the emergency laparotomy in non-trauma patients, immediate abdominal closure by use of a non-crosslinked biologic mesh prevents OA management. This results in a non-significant higher proportion of closed abdominal cavities at 90 days compared with OA management with TAC techniques, and in a significant reduction of major complications and reoperations, and a shorter ICU stay.
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Affiliation(s)
- Fleur E E de Vries
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jeroen J M Claessen
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jasper J Atema
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Oddeke van Ruler
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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25
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Kapoor MC. Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 2: Cognitive dysfunction after critical illness; potential contributors in surgery and intensive care; pathogenesis; and therapies to prevent/treat perioperative neurological dysfunction. Ann Card Anaesth 2020; 23:391-400. [PMID: 33109793 PMCID: PMC7879886 DOI: 10.4103/aca.aca_139_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Severe cognitive decline and cognitive dysfunction has been attributed to patient's stay in the cardiovascular intensive care unit. Prolonged mechanical ventilation, long duration of stay, sedation protocols, and sleep deprivation contribute to patients developing neurocognitive disorder after intensive care admission and it is associated with poor clinical outcomes. Trauma of surgery, stress of critical care, and administration of anaesthesia evoke a systemic inflammatory response and trigger neuroinflammation and oxidative stress. Anaesthetic agents modulate the function of the GABA receptors. The persistence of these effects in the postoperative period promotes development of cognitive dysfunction. A number of drugs are under investigation to restrict or prevent this cognitive decline.
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Affiliation(s)
- Mukul C Kapoor
- Department of Anaesthesia, Max Smart Super Specialty Hospital, Saket, Delhi, India
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26
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Clinical Frailty Scale Score Before ICU Admission Is Associated With Mobility Disability in Septic Patients Receiving Early Rehabilitation. Crit Care Explor 2019; 1:e0066. [PMID: 32166247 PMCID: PMC7063928 DOI: 10.1097/cce.0000000000000066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
To clarify the relationship between mobility disability at the time of discharge from the ICU and clinical factors evaluated at ICU admission in septic patients.
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27
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Understanding Macrophages in Acute Respiratory Distress Syndrome: From Pathophysiology to Precision Medicine. Crit Care Med 2019; 46:1207-1208. [PMID: 29912110 DOI: 10.1097/ccm.0000000000003175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Five-year mortality and morbidity impact of prolonged versus brief ICU stay: a propensity score matched cohort study. Thorax 2019; 74:1037-1045. [DOI: 10.1136/thoraxjnl-2018-213020] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/03/2019] [Accepted: 06/26/2019] [Indexed: 11/03/2022]
Abstract
PurposeLong-term outcomes of critical illness may be affected by duration of critical illness and intensive care. We aimed to investigate differences in mortality and morbidity after short (<8 days) and prolonged (≥8 days) intensive care unit (ICU) stay.MethodsFormer EPaNIC-trial patients were included in this preplanned prospective cohort, 5-year follow-up study. Mortality was assessed in all. For morbidity analyses, all long-stay and—for feasibility—a random sample (30%) of short-stay survivors were contacted. Primary outcomes were total and post-28-day 5-year mortality. Secondary outcomes comprised handgrip strength (HGF, %pred), 6-minute-walking distance (6MWD, %pred) and SF-36 Physical Function score (PF SF-36). One-to-one propensity-score matching of short-stay and long-stay patients was performed for nutritional strategy, demographics, comorbidities, illness severity and admission diagnosis. Multivariable regression analyses were performed to explore ICU factors possibly explaining any post-ICU observed outcome differences.ResultsAfter matching, total and post-28-day 5-year mortality were higher for long-stayers (48.2% (95%CI: 43.9% to 52.6%) and 40.8% (95%CI: 36.4% to 45.1%)) versus short-stayers (36.2% (95%CI: 32.4% to 40.0%) and 29.7% (95%CI: 26.0% to 33.5%), p<0.001). ICU risk factors comprised hypoglycaemia, use of corticosteroids, neuromuscular blocking agents, benzodiazepines, mechanical ventilation, new dialysis and the occurrence of new infection, whereas clonidine could be protective. Among 276 long-stay and 398 short-stay 5-year survivors, HGF, 6MWD and PF SF-36 were significantly lower in long-stayers (matched subset HGF: 83% (95%CI: 60% to 100%) versus 87% (95%CI: 73% to 103%), p=0.020; 6MWD: 85% (95%CI: 69% to 101%) versus 94% (95%CI: 76% to 105%), p=0.005; PF SF-36: 65 (95%CI: 35 to 90) versus 75 (95%CI: 55 to 90), p=0.002).ConclusionLonger duration of intensive care is associated with excess 5-year mortality and morbidity, partially explained by potentially modifiable ICU factors.Trail registration numberNCT00512122.
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Aftermath of Respiratory Failure: Recovery or Decline? Crit Care Med 2019. [PMID: 29538117 DOI: 10.1097/ccm.0000000000002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW In this review, we will discuss efforts and challenges in understanding and developing meaningful outcomes of critical care research, quality improvement and policy, which are patient-centered and goal concordant, rather than mortality alone. We shall discuss different aspects of what could constitute outcomes of critical illness as meaningful to the patients and other stakeholders, including families and providers. RECENT FINDINGS Different outcome pathways after critical illness impact the patients, families and providers in multiple ways. For patients who die, it is important to consider the experience of dying. For the increasing number of survivors of critical illness, challenges of survival have surfaced. The physical, mental and social debility that survivors experience has evolved into the entity called post-ICU syndrome. The importance of prehospital health state trajectory and the need for the outcome of critical care to be aligned with the patients' goals and preferences have been increasingly recognized. SUMMARY A theoretical framework is outlined to help understand the impact of critical care interventions on outcomes that are meaningful to patients, families and healthcare providers.
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Decreased CTRP3 Plasma Concentrations Are Associated with Sepsis and Predict Mortality in Critically Ill Patients. Diagnostics (Basel) 2019; 9:diagnostics9020063. [PMID: 31234326 PMCID: PMC6628070 DOI: 10.3390/diagnostics9020063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/08/2019] [Accepted: 06/19/2019] [Indexed: 02/06/2023] Open
Abstract
C1q/ tumor necrosis factor (TNF)-like protein 3 (CTRP3) represents a novel member of the adipokine family that exerts favorable metabolic actions in humans. However, the role of CTRP3 in critical illness and sepsis is currently unknown. Upon admission to the medical intensive care unit (ICU), we investigated CTRP3 plasma concentrations in 218 critically ill patients (145 with sepsis, 73 without sepsis). Results were compared with 66 healthy controls. CTRP3 plasma levels were significantly decreased in critically ill patients, when compared to healthy controls. In particular, low CTRP3 levels were highly associated with the presence of sepsis. CTRP3 levels were neither associated with obesity nor diabetes. In critically ill patients, CTRP3 plasma concentrations were inversely correlated with inflammatory cytokines and classical sepsis markers. Among a wide group of adipokines, CTRP3 only correlated with circulating resistin. Low CTRP3 plasma levels were associated with the overall mortality, and CTRP3 levels below 620.6 ng/mL indicated a particularly increased mortality risk in ICU patients. Our study demonstrates for the first time the role of circulating CTRP3 as a biomarker in critically ill patients that might facilitate diagnosis of sepsis as well as prognosis prediction. The association between low CTRP3 and increased inflammation warrants further pathophysiological investigations.
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Rengel KF, Hayhurst CJ, Pandharipande PP, Hughes CG. Long-term Cognitive and Functional Impairments After Critical Illness. Anesth Analg 2019; 128:772-780. [DOI: 10.1213/ane.0000000000004066] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Berry MJ, Love NJ, Files DC, Bakhru RN, Morris PE. The relationship between self-report and performance-based measures of physical function following an ICU stay. J Crit Care 2019; 51:19-23. [PMID: 30690430 DOI: 10.1016/j.jcrc.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/10/2018] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine relationships between self-report and performance-based measures of physical function in ICU patients randomized to standardized rehabilitation therapy (SRT) or usual care (UC). METHODS Physical function was assessed in 257 ICU patients using self-report (physical functioning scale of the SF-36 (SF-36 PFS)) and the functional performance inventory-short form (FPI-SF) as well as performance-based measures (Short Physical Performance Battery (SPPB)) and muscular strength (MS). Assessments were at hospital discharge, 2, 4, and 6 months. RESULTS Correlations between self-report and performance-based measures were not significantly different between the two groups. When examining the entire cohort, a significant, but weak, correlation (r = 0.286) was found between the SF-36 PFS and the SPPB. At 2 months, moderate correlations were found between self-report and performance-based measures. The SF-36 PFS and FPI were significantly correlated with the SPPB (r = 0.536 and 0.553, respectively) and muscular strength (r = 0.413 and 0.431, respectively). Similar associations were seen at 4 and 6 months in both groups. CONCLUSION Self-report and performance-based measures of physical function appear to assess different constructs at hospital discharge. Following recovery, these measures converge, but indicate different constructs are being assessed. As such, both self-report and performance-based measures of physical function should be used with ICU patients.
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Affiliation(s)
- Michael J Berry
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA.
| | - Nathan J Love
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
| | - D Clark Files
- Department of Internal Medicine, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Rita N Bakhru
- Department of Internal Medicine, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Peter E Morris
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
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Visfatin Serum Levels Predict Mortality in Critically Ill Patients. DISEASE MARKERS 2018; 2018:7315356. [PMID: 30224938 PMCID: PMC6129328 DOI: 10.1155/2018/7315356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/22/2018] [Indexed: 02/01/2023]
Abstract
The adipokine visfatin, also termed pre-B-cell colony-enhancing factor (PBEF), is mainly derived from adipose tissue but has been implicated in the regulation of innate immune responses. We hypothesized that visfatin could be a potential circulating biomarker in critical illness and sepsis. We therefore measured serum levels of visfatin in a cohort of 229 critically ill medical patients upon admission to the intensive care unit (ICU). In comparison to 53 healthy controls, visfatin levels were significantly elevated in medical ICU patients, especially in patients with sepsis. Visfatin serum concentrations were strongly associated with disease severity and organ failure but did not differ between patients with or without obesity or type 2 diabetes. Visfatin levels correlated with biomarkers of renal failure, liver dysfunction, and other adipokines (e.g., resistin, leptin, and adiponectin) in critically ill patients. High visfatin levels at ICU admission indicated an increased mortality, both at the ICU and during long-term follow-up of approximately two years. Our data therefore demonstrate that circulating visfatin is a valuable biomarker for risk and prognosis assessment in critically ill patients. Furthermore, visfatin seems to be involved in the pathogenesis of excessive systemic inflammation, supporting further research on visfatin as a therapeutic target.
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Meduri GU, Siemieniuk RAC, Ness RA, Seyler SJ. Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS. J Intensive Care 2018; 6:53. [PMID: 30155260 PMCID: PMC6109298 DOI: 10.1186/s40560-018-0321-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022] Open
Abstract
An updated meta-analysis incorporating nine randomized trials (n = 816) investigating low-to-moderate dose prolonged glucocorticoid treatment in acute respiratory distress syndrome (ARDS) show moderate-to-high quality evidence that glucocorticoid therapy is safe and reduces (i) time to endotracheal extubation, (ii) duration of hospitalization, and (iii) mortality (number to treat to save one life = 7), and increases the number of days free from (i) mechanical ventilation, (ii) intensive care unit stay, and (iii) hospitalization. Recent guideline suggests administering methylprednisolone in patients with early moderate-to-severe (1 mg/kg/day) and late persistent (2 mg/kg/day) ARDS (conditional recommendation based on moderate quality of evidence).
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Affiliation(s)
- Gianfranco Umberto Meduri
- 1Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Memphis Veterans Affairs Medical Center (111), 1030 Jefferson Avenue, Suite room #CW444, Memphis, TN 38104 USA
| | - Reed A C Siemieniuk
- 2Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada.,3Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Rachel A Ness
- 4Department of Pharmacy, Memphis Veterans Affairs Medical Center, Memphis, TN USA
| | - Samuel J Seyler
- 5Department of Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, TN USA
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