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Bode CM, Kristensen SB, Olsen HT, Cornwall CD, Roberg L, Monsson O, Krøigård T, Toft P, Beier CP. Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors. Neurocrit Care 2024; 40:1025-1035. [PMID: 37940836 PMCID: PMC11147838 DOI: 10.1007/s12028-023-01868-1] [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: 06/21/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Postictal encephalopathy is well known after status epilepticus (SE), but its prognostic impact and triggers are unknown. Here, we aimed to establish risk factors for the development of postictal encephalopathy and to study its impact on survival after discharge. METHODS This retrospective cohort study comprised adult patients diagnosed with first nonanoxic SE at Odense University Hospital between January 2008 and December 2017. Patients with ongoing SE at discharge or unknown treatment success were excluded. Postictal symptoms of encephalopathy were estimated retrospectively using the West Haven Criteria (WHC). WHC grade was determined for postictal day 1 to 14 or until the patient died or was discharged from the hospital. Cumulative postictal WHC during 14 days after SE-cessation was used to quantify postictal encephalopathy. Clinical characteristics, patient demographics, electroencephalographic and imaging features, and details on intensive care treatment were assessed from medical records. RESULTS Of all eligible patients (n = 232), 198 (85.3%) had at least WHC grade 2 postictal encephalopathy that lasted for > 14 days in 24.5% of the surviving patients. WHC grade at discharge was strongly associated with poor long-term survival (p < 0.001). Postictal encephalopathy was not associated with nonconvulsive SE, postictal changes on magnetic resonance imaging, or distinct ictal patterns on electroencephalography. Although duration of SE and treatment in the intensive care unit showed an association with cumulative postictal WHC grade, they were not independently associated with the degree of encephalopathy when controlling for confounders. In a linear regression model, etiology, duration of sedation, age, and premorbid modified Rankin Scale were significant and consistent predictors for higher cumulative postictal WHC grade. Exploratory analyses showed an association of a cumulative midazolam dosage (mg/kg/h) with higher cumulative postictal WHC grade. DISCUSSION In this cohort, postictal encephalopathy after SE was common and associated with poor long-term survival. Seizure characteristics were not independently associated with postictal encephalopathy; the underlying etiology, long (high-dose midazolam) sedation, high age, and poor premorbid condition were the major risk factors for its development.
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Affiliation(s)
- Clara Marie Bode
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Simon Bruun Kristensen
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | | | - Camilla Dyremose Cornwall
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Roberg
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Olav Monsson
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Thomas Krøigård
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Neurophysiology, Odense University Hospital, Odense, Denmark
| | - Palle Toft
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
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Frei AI, Wagner AS, Baumann SM, Grzonka P, Berger S, Hunziker S, Rüegg S, Marsch S, Sutter R. Concurrence of seizures and peri-ictal delirium in the critically ill - its frequency, associated characteristics, and outcomes. J Neurol 2024; 271:231-240. [PMID: 37676299 PMCID: PMC10769924 DOI: 10.1007/s00415-023-11944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND To assess the frequency, clinical features, and outcome of peri-ictal delirium in adult patients experiencing seizures during intensive care. METHODS This observational study was conducted at a Swiss intensive care unit from 2015 to 2020. Patients aged ≥ 18 years with seizures were categorized as peri-ictal delirious (Intensive Care Delirium Screening Checklist [i.e., ICDSC] ≥ 4) or not (i.e., ICDSC < 4) within 24 h of seizures. The frequency of peri-ictal delirium and in-hospital death were defined as the primary endpoints. Illness severity and treatment characteristics between delirious and non-delirious patients were secondary endpoints. Logistic regression was used to compare in-hospital death and differences regarding clinical characteristics between delirious and non-delirious patients. RESULTS 48% of 200 patients had peri-ictal delirium for a median of 3 days. Delirious patients were older (median age 69 vs. 62 years, p = 0.002), had lower Simplified Acute Physiology Scores II (SAPS II; median 43 vs. 54, p = 0.013), received neuroleptics more frequently (31 vs. 5%, p < 0.001), were mechanically ventilated less often (56% vs. 73%, p = 0.013) and shorter (median 3 vs. 5 days, p = 0.011), and had decreased odds for in-hospital death with delirium (OR = 0.41, 95% CI 0.20-0.84) in multivariable analyses. CONCLUSIONS Delirium emerged in every second patient experiencing seizures and was associated with lower SAPS II, shorter mechanical ventilation, and better outcomes, contradicting assumptions that altered cerebral function, from seizures and delirium, are linked to unfavorable outcomes.
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Affiliation(s)
- Anja I Frei
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Anna S Wagner
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Sira M Baumann
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Sebastian Berger
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Faculty, University of Basel, Basel, Switzerland
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
- Medical Faculty, University of Basel, Basel, Switzerland.
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Rodrigues JAM, Lenardt MH, Cechinel C, Cruz EDDA, Tsunoda AT, Kuznier TP. Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study. Rev Esc Enferm USP 2023; 57:e20230156. [PMID: 38100603 PMCID: PMC10723772 DOI: 10.1590/1980-220x-reeusp-2023-0156en] [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: 05/30/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To analyze the relationship between hospitalization and the occurrence of delirium in older adults with physical frailty. METHOD Cross-sectional study carried out in a public hospital in southern Brazil. Hospitalized older adults aged ≥ 60 years participated. Sociodemographic and clinical data were collected, physical frailty phenotype tests were performed and the Confusion Assessment Method was used. Descriptive analyzes were carried out and odds ratio values were estimated for the frailty and delirium variables. RESULTS Of the 320 older adults evaluated, 21.14% presented delirium, 49% were identified as pre-frail and 36.2% as frail. Of those affected by delirium, 71.6% were classified as frail and 28.3% as pre-frail (p < 0.001). An association was observed between the occurrence of delirium and frailty (OR 1.22; 95% CI 1.07 to 1.38), age ≥ 80 years (OR 1.14; 95% CI 1.01 to 1.32), epilepsy (OR 1.38; 95% CI 1.09 to 1.76), dementia (OR 1.58; 95% CI 1.37 to 1.82), and history of stroke (OR 1.14; 95% CI 1.03 to 1.26). CONCLUSION There was a high frequency of pre-frail and frail older adults, and the occurrence of delirium in frail was significantly higher. Special attention should be paid to frail older adults to prevent the occurrence of delirium during hospitalization.
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Affiliation(s)
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem, Curitiba, PR, Brazil
| | - Clovis Cechinel
- Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem, Curitiba, PR, Brazil
| | | | - Audrey Tieko Tsunoda
- Pontifícia Universidade Católica do Paraná, Programa de Pós-graduação em Tecnologias em Saúde, Curitiba, PR, Brazil
| | - Tatiane Prette Kuznier
- Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem, Curitiba, PR, Brazil
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Alvarez V, Novy J, Beuchat I, Rossetti AO. Letter to the editor regarding "early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study". Epilepsia 2023; 64:2530-2531. [PMID: 37376780 DOI: 10.1111/epi.17705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Vincent Alvarez
- Department of Neurology, Neurocentre, Hôpital du Valais, Sion, Switzerland
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Jan Novy
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Isabelle Beuchat
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
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De Stefano P, Baumann SM, Grzonka P, Sarbu OE, De Marchis GM, Hunziker S, Rüegg S, Kleinschmidt A, Quintard H, Marsch S, Seeck M, Sutter R. Early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study. Epilepsia 2023; 64:1493-1506. [PMID: 37032415 DOI: 10.1111/epi.17614] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE This study was undertaken to investigate the efficacy, tolerability, and outcome of different timing of anesthesia in adult patients with status epilepticus (SE). METHODS Patients with anesthesia for SE from 2015 to 2021 at two Swiss academic medical centers were categorized as anesthetized as recommended third-line treatment, earlier (as first- or second-line treatment), and delayed (later as third-line treatment). Associations between timing of anesthesia and in-hospital outcomes were estimated by logistic regression. RESULTS Of 762 patients, 246 received anesthesia; 21% were anesthetized as recommended, 55% earlier, and 24% delayed. Propofol was preferably used for earlier (86% vs. 55.5% for recommended/delayed anesthesia) and midazolam for later anesthesia (17.2% vs. 15.9% for earlier anesthesia). Earlier anesthesia was statistically significantly associated with fewer infections (17% vs. 32.7%), shorter median SE duration (.5 vs. 1.5 days), and more returns to premorbid neurologic function (52.9% vs. 35.5%). Multivariable analyses revealed decreasing odds for return to premorbid function with every additional nonanesthetic antiseizure medication given prior to anesthesia (odds ratio [OR] = .71, 95% confidence interval [CI] = .53-.94) independent of confounders. Subgroup analyses revealed decreased odds for return to premorbid function with increasing delay of anesthesia independent of the Status Epilepticus Severity Score (STESS; STESS = 1-2: OR = .45, 95% CI = .27-.74; STESS > 2: OR = .53, 95% CI = .34-.85), especially in patients without potentially fatal etiology (OR = .5, 95% CI = .35-.73) and in patients experiencing motor symptoms (OR = .67, 95% CI = .48-.93). SIGNIFICANCE In this SE cohort, anesthetics were administered as recommended third-line therapy in only every fifth patient and earlier in every second. Increasing delay of anesthesia was associated with decreased odds for return to premorbid function, especially in patients with motor symptoms and no potentially fatal etiology.
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Affiliation(s)
- Pia De Stefano
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Sira M Baumann
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Oana E Sarbu
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical faculty of the University of Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
| | - Andreas Kleinschmidt
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical faculty of the University of Geneva, Geneva, Switzerland
| | - Hervé Quintard
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- Medical faculty of the University of Geneva, Geneva, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical faculty of the University of Geneva, Geneva, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
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Sun PYW, Fanning J, Peeler A, Shou B, Lindsley J, Caturegli G, Whitman G, Cha S, Kim BS, Cho SM. Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation. Front Med (Lausanne) 2023; 10:1172063. [PMID: 37305142 PMCID: PMC10248255 DOI: 10.3389/fmed.2023.1172063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Background Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with COVID-19 acute respiratory distress syndrome (ARDS). We aim to assess the characteristics of delirium and describe its association with sedation and in-hospital mortality. Methods We retrospectively reviewed adult patients on VV-ECMO for severe COVID-19 ARDS in the Johns Hopkins Hospital ECMO registry in 2020-2021. Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU) when patients scored-3 or above on the Richmond Agitation-Sedation Scale (RASS). Primary outcomes were delirium prevalence and duration in the proportion of days on VV-ECMO. Results Of 47 patients (median age = 51), 6 were in a persistent coma and 40 of the remaining 41 patients (98%) had ICU delirium. Delirium in the survivors (n = 21) and non-survivors (n = 26) was first detected at a similar time point (VV-ECMO day 9.5(5,14) vs. 8.5(5,21), p = 0.56) with similar total delirium days on VV-ECMO (9.5[3.3, 16.8] vs. 9.0[4.3, 28.3] days, p = 0.43). Non-survivors had numerically lower RASS scores on VV-ECMO days (-3.72[-4.42, -2.96] vs. -3.10[-3.91, -2.21], p = 0.06) and significantly prolonged delirium-unassessable days on VV-ECMO with a RASS of -4/-5 (23.0[16.3, 38.3] vs. 17.0(6,23), p = 0.03), and total VV-ECMO days (44.5[20.5, 74.3] vs. 27.0[21, 38], p = 0.04). The proportion of delirium-present days correlated with RASS (r = 0.64, p < 0.001), the proportions of days on VV-ECMO with a neuromuscular blocker (r = -0.59, p = 0.001), and with delirium-unassessable exams (r = -0.69, p < 0.001) but not with overall ECMO duration (r = 0.01, p = 0.96). The average daily dosage of delirium-related medications on ECMO days did not differ significantly. On an exploratory multivariable logistic regression, the proportion of delirium days was not associated with mortality. Conclusion Longer duration of delirium was associated with lighter sedation and shorter paralysis, but it did not discern in-hospital mortality. Future studies should evaluate analgosedation and paralytic strategies to optimize delirium, sedation level, and outcomes.
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Affiliation(s)
- Philip Young-woo Sun
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathon Fanning
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Anna Peeler
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, United Kingdom
| | - Benjamin Shou
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John Lindsley
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Giorgio Caturegli
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Glenn Whitman
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Stephanie Cha
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Bo Soo Kim
- Department of Pulmonary Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
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Wagner AS, Baumann SM, Semmlack S, Frei AI, Rüegg S, Hunziker S, Marsch S, Sutter R. Comparing Patients With Isolated Seizures and Status Epilepticus in Intensive Care Units: An Observational Cohort Study. Neurology 2023; 100:e1763-e1775. [PMID: 36878696 PMCID: PMC10136011 DOI: 10.1212/wnl.0000000000206838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/06/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the frequency of status epilepticus (SE) among seizing critically ill adult patients and to determine clinical differences between patients with isolated seizures and patients with SE in the intensive care unit (ICU). METHODS From 2015 to 2020, all consecutive adult ICU patients at a Swiss tertiary care center with isolated seizures or SE as reported by intensivists and/or consulting neurologists were identified by screening of all digital medical, ICU, and EEG records. Patients aged <18 years and patients with myoclonus due to hypoxic-ischemic encephalopathy but without seizures on EEG were excluded. The frequency of isolated seizures, SE, and clinical characteristics at seizure onset associated with SE were the primary outcomes. Uni- and multivariable logistic regression was performed to identify associations with the emergence of SE. RESULTS Among 404 patients with seizures, 51% had SE. Compared with patients with isolated seizures, patients with SE had a lower median Charlson Comorbidity Index (CCI) (3 vs 5, p < 0.001), fewer fatal etiologies (43.6% vs 80.5%, p < 0.001), higher median Glasgow coma scores (7 vs 5, p < 0.001), fever more frequently (27.5% vs 7.5%, p < 0.001), shorter median ICU and hospital stay (ICU: 4 vs 5 days, p = 0.039; hospital stay: 13 vs 15 days, p = 0.045), and recovered to premorbid function more often (36.8% vs 17%, p < 0.001). Multivariable analyses revealed decreased odds ratios (ORs) for SE with increasing CCI (OR 0.91, 95% CI 0.83-0.99), fatal etiology (OR 0.15, 95% CI 0.08-0.29), and epilepsy (OR 0.32, 95% CI 0.16-0.63). Systemic inflammation was an additional association with SE after excluding patients with seizures as the reason for ICU admission (ORfor CRP 1.01, 95% CI 1.00-1.01; ORfor fever 7.35, 95% CI 2.84-19.0). Although fatal etiologies and increasing CCI remained associated with low odds for SE after excluding anesthetized patients and hypoxic-ischemic encephalopathy, inflammation remained associated in all subgroups except patients with epilepsy. DISCUSSION Among all ICU patients with seizures, SE emerged frequently and seen in every second patient. Besides the unexpected low odds for SE with higher CCI, fatal etiology, and epilepsy, the association of inflammation with SE in the critically ill without epilepsy represents a potential treatment target and deserves further attention.
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Affiliation(s)
- Anna S Wagner
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Sira M Baumann
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Saskia Semmlack
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Anja I Frei
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Stephan Rüegg
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Sabina Hunziker
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Stephan Marsch
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Raoul Sutter
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland.
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Zhang Z, Qu H, Gong W. Multifactor Logistic Analysis to Explore the Risk Factors of Safety Risks in the Transport of Critically Ill Patients with ICU and the Improvement of Nursing Strategies. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3330667. [PMID: 35607648 PMCID: PMC9124074 DOI: 10.1155/2022/3330667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
Objective Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and the improvement of nursing strategies. Methods Two hundred critical transport patients with ICU treated in our hospital from January 2019 to April 2021 were enrolled. According to the occurrence of unsafe events in transit, the patients were assigned to the control group (165 cases without unsafe events, n = 165) and the study group (35 cases with safety incidents, n = 35). Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and to enhance nursing strategies. Results (1) General data of the subjects: among the 200 critically ill patients with ICU who needed in-hospital transport, the age ranged from 18 to 85 years with an average age of 52.48 ± 3.31, including 89 males and 111 females. There were 35 cases of gastrointestinal bleeding, 16 cases of respiratory failure, 23 cases of heart failure, 43 cases of myocardial infarction, 26 cases of cerebrovascular accident, 14 cases of ectopic pregnancy, 25 cases of severe injury, and 18 cases of mechanical ventilation. There were 35 cases in the study group with accidents and 45 cases in group B without accidents. (2) Among the 200 patients, 35 patients had complications during the transit process in the intermediate people's court, with an incidence rate of 17.5%. It included blood pressure fluctuation (n = 6), artificial airway obstruction (n = 6), decrease in blood oxygen saturation (n = 10), dyspnea (n = 5), fall pain (n = 3), elevated intracranial pressure (n = 2), and other factors (n = 3). There exhibited no significant difference in blood oxygen saturation at each time point during transport (P > 0.05). There exhibited no significant difference in SpO2 before transport. The comparison of 5 min and 10 min blood oxygen saturation during transit in the study group was lower compared to the control group (P < 0.05). (3) In a univariate analysis of safety risks for critically ill ICU patients, home escorts did not show significant differences in hospital transport for critically ill ICU patients (P > 0.05). There were significant differences in terms of age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline (P < 0.05). The results of multivariate logistic regression analysis indicated that age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline were the risk factors affecting the safe transport of critically ill patients (P < 0.05). Conclusion Age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline are the independent risk factors that affect the safe transport of emergency or ICU critically ill patients. Therefore, in order to reduce the risk of transshipment, we must enhance the safety awareness of escorts, strengthen the management and training of escorts, promote rules and regulations, and formulate dangerous plans, so as to eliminate the occurrence of unsafe factors.
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Affiliation(s)
- Zhenyu Zhang
- Department of Intensive Care Unit (Eastern), Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Hui Qu
- Department of Intensive Care Unit (Western), Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Wei Gong
- Department of Cardiac Intensive Care Unit, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
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