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Umegaki T, Nishimoto K, Kamibayashi T. Associations of the staffing structure of intensive care units and high care units on in-hospital mortality among patients with sepsis: a cross-sectional study of Japanese nationwide claims data. BMJ Open 2024; 14:e085763. [PMID: 39079920 PMCID: PMC11293387 DOI: 10.1136/bmjopen-2024-085763] [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: 03/04/2024] [Accepted: 07/16/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE The objective was to analyse the associations of intensive care unit (ICU) and high care unit (HCU) organisational structure on in-hospital mortality among patients with sepsis in Japan's acute care hospitals. DESIGN Multicentre cross-sectional study. SETTINGS Patients with sepsis aged ≥18 years who received critical care in acute care hospitals throughout Japan between April 2018 and March 2019 were identified using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). INTERVENTIONS None. PARTICIPANTS 10 968 patients with sepsis were identified. ICUs were categorised into three groups: type 1 ICUs (fulfilling stringent staffing criteria such as experienced intensivists and high nurse-to-patient ratios), type 2 ICUs (less stringent criteria) and HCUs (least stringent criteria). PRIMARY OUTCOME MEASURE The study's primary outcome measure was in-hospital mortality. Cox proportional hazards regression analysis was performed to examine the impact of ICU/HCU groups on in-hospital mortality. RESULTS We analysed 2411 patients (178 hospitals) in the type 1 ICU group, 3653 patients (422 hospitals) in the type 2 ICU group and 4904 patients (521 hospitals) in the HCU group. When compared with the type 1 ICU group, the adjusted HRs for in-hospital mortality were 1.12 (95% CI 1.04 to 1.21) for the type 2 ICU group and 1.17 (95% CI 1.08 to 1.26) for the HCU group. CONCLUSION ICUs that fulfil more stringent staffing criteria were associated with lower in-hospital mortality among patients with sepsis than HCUs. Differences in organisational structure may have an association with outcomes in patients with sepsis, and this was observed by the NDB.
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Affiliation(s)
- Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kota Nishimoto
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
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Johnson LA, Klucher B, Jensen H, Reif R, Kalkwarf KJ, Sexton K, Kimbrough MK. A closed surgical intensive care unit organization improves cardiac surgical patient outcomes. J Thorac Dis 2024; 16:1262-1269. [PMID: 38505036 PMCID: PMC10944794 DOI: 10.21037/jtd-22-1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/19/2023] [Indexed: 03/21/2024]
Abstract
Background Intensive care unit (ICU) organization is a critical factor in optimizing patient outcomes. ICU organization can be divided into "OPEN" (O) and "CLOSED" (C) models, where the specialist or intensivist, respectively, assumes the role of primary physician. Recent studies support improved outcomes in closed ICUs, however, most of the available data is centered on ICUs generally or on subspecialty surgical patients in the setting of a subspecialized surgical intensive care unit (SICU). We examined the impact of closing a general SICU on patient outcomes following cardiac and ascending aortic surgery. Methods A retrospective cohort of patients following cardiac or ascending aortic surgery by median sternotomy was examined at a single academic medical center one year prior and one year after implementation of a closed SICU model. Patients were divided into "OPEN" (O; n=53) and "CLOSED" (C; n=73) cohorts. Results Cohorts were comparable in terms of age, race, and number of comorbid conditions. A significant difference in male gender (O: 60.4% vs. C: 76.7%, P=0.049), multiple procedure performed (O: 13.21% vs. C: 35.62%, P=0.019), and hospital readmission rates was detected (O: 39.6% vs. C: 9.6%, P=0.0003). Using a linear regression model, a closed model SICU organization decreased SICU length of stay (LOS). Using a multivariate logistic regression, being treated in a closed ICU decreased a patient's likelihood of having an ICU LOS greater than 48 hours. Conclusions Our study identified a decreased ICU LOS and hospital readmission in cardiac and ascending aortic patients in a closed general SICU despite increased procedure complexity. Further study is needed to clarify the effects on surgical complications and hospital charges.
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Affiliation(s)
- Lauren A. Johnson
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brianna Klucher
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca Reif
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle J. Kalkwarf
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Pharmaceutical Evaluation and Policy (PEP), Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mary Katherine Kimbrough
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Rashid S, Joubert I, Semple P. Groote Schuur Hospital neurosurgical intensive care unit: A 2-year review of admission characteristics. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:e1217. [PMID: 38357695 PMCID: PMC10866205 DOI: 10.7196/sajcc.2023.v39i3.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background At Groote Schuur Hospital (GSH), the neurosurgical intensive care unit (NsICU) is a 6-bed unit headed by a specialist neurosurgeon with extensive experience in neurocritical care, working in close collaboration with intensivists from the Division of Critical Care. There is currently no detailed analysis of the demographics, diagnosis and management of patients admitted to the NsICU at GSH. Objectives To provide a detailed descriptive analysis of the demographics, diagnosis and management of patients admitted to the NsICU at GSH from 1 January 2020 to 31 December 2021. Methods A retrospective descriptive analysis was done of patients who received treatment in the NsICU from 1 January 2020 to 31 December 2021. Results A total of 685 patients were admitted to the unit over a 2-year period, with a male preponderance (68.2%). The average age was 42.5 (standard deviation (SD) 17.2) years. The most common neurosurgical diagnoses were traumatic brain injuries (39.6%), brain tumours (22.6%) and aneurysmal subarachnoid haemorrhages (9.9%). Emergency admissions comprised 76.6% of the total and 86.7% of patients were admitted postoperatively. Three hundred and seventy-two patients (54.3%) required mechanical ventilation, 132 (19.3%) required both an intracranial pressure (ICP) monitor and brain tissue oxygenation monitor, 86 (12.5%) needed placement of an external ventricular drain, 50 (7.3%) needed placement of a tracheostomy tube and 16 (2.3%) needed placement of an ICP monitor only. The average duration of stay was 5.5 (1.3) days and NsICU mortality over 2 years was 11.1%. Conclusion The NsICU at GSH manages predominantly male trauma patients and a significant number of admitted patients require specialised invasive intracranial monitoring. Contribution of the study This is the first in-depth analysis of patients managed in a dedicated neurosurgical intensive care unit in South Africa. The work defines the patient population, neurosurgical pathologies and service level requirements that would likely be encountered by teams building a similar service.
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Affiliation(s)
- S Rashid
- Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University
of Cape Town, South Africa
| | - P Semple
- Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
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Henson CP, Weaver SM. Systems of Care Delivery and Optimization in the Intensive Care Unit. Anesthesiol Clin 2023; 41:863-873. [PMID: 37838389 DOI: 10.1016/j.anclin.2023.06.006] [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] [Indexed: 10/16/2023]
Abstract
As the volume and complexity of patients requiring intensive care grows, so do the barriers and challenges to the delivery of that care. This article summarizes these challenges, outlines strategies used to overcome them, and presents new developments and concepts within the care of the ICU patient.
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Affiliation(s)
- Christopher Patrick Henson
- Division of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South - MCE 3161, Nashville, TN 37232, USA.
| | - Sheena M Weaver
- Division of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South - MCE 3161, Nashville, TN 37232, USA
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Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Cardiac intensive care unit: where we are in 2023. Front Cardiovasc Med 2023; 10:1201414. [PMID: 38075954 PMCID: PMC10704904 DOI: 10.3389/fcvm.2023.1201414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024] Open
Abstract
Cardiac intensive care has been a constantly evolving area of research and innovation since the beginning of the 21st century. The story began in 1961 with Desmond Julian's pioneering creation of a coronary intensive care unit to improve the prognosis of patients with myocardial infarction, considered the major cause of death in the world. These units have continued to progress over time, with the introduction of new therapeutic means such as fibrinolysis, invasive hemodynamic monitoring using the Swan-Ganz catheter, and mechanical circulatory assistance, with significant advances in percutaneous interventional coronary and structural procedures. Since acute cardiovascular disease is not limited to the management of acute coronary syndromes and includes other emergencies such as severe arrhythmias, acute heart failure, cardiogenic shock, high-risk pulmonary embolism, severe conduction disorders, and post-implantation monitoring of percutaneous valves, as well as other non-cardiac emergencies, such as septic shock, severe respiratory failure, severe renal failure and the management of cardiac arrest after resuscitation, the conversion of coronary intensive care units into cardiac intensive care units represented an important priority. Today, the cardiac intensive care units (CICU) concept is widely adopted by most healthcare systems, whatever the country's level of development. The main aim of these units remains to improve the overall morbidity and mortality of acute cardiovascular diseases, but also to manage other non-cardiac disorders, such as sepsis and respiratory failure. This diversity of tasks and responsibilities has enabled us to classify these CICUs according to several levels, depending on a variety of parameters, principally the level of care delivered, the staff assigned, the equipment and technologies available, the type of research projects carried out, and the type of connections and networking developed. The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have detailed this organization in guidelines published initially in 2005 and updated in 2018, with the aim of harmonizing the structure, organization, and care offered by the various CICUs. In this state-of-the-art report, we review the history of the CICUs from the creation of the very first unit in 1968 to the discussion of their current perspectives, with the main objective of knowing what the CICUs will have become by 2023.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
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Ono S, Shimizu K. Analysis of the Association Between the Number of Intensivists and the Use of Cardiovascular Agonists: An Ecological Study Using Data From National Databases of Japan. Cureus 2023; 15:e48912. [PMID: 38024012 PMCID: PMC10653938 DOI: 10.7759/cureus.48912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Previous studies have demonstrated a correlation between management by intensivists and a decrease in hospital stay and mortality, yet the underlying reason remains unknown. Using open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and other databses, the present study aimed to explore the relationship between inotrope and vasoconstrictor use and the number of intensivists. Materials and methods Cardiovascular agonists listed in the 2020 NDB for which the total dose was known were included for analysis. Trends in cardiovascular agonist use over six years were then graphically assessed, and a linear regression model with the use of each target drug per prefecture as the objective variable in the 2020 data was created to analyze the impact of intensivists on drug use. Results A total of 61 drugs were classified into eight groups based on their composition, and drug use in each of the 47 prefectures was tabulated. Both the rate of use and cost showed a yearly decrease for dopamine but a yearly increase for norepinephrine. Multivariable analysis indicated that the number of intensivists was only significant for dopamine, which had a coefficient of -310 (95% CI: -548 to -72, p = 0.01) but that no such trend was evident for the other drugs. Conclusions The results demonstrated that an increasing number of intensivists in each prefecture correlated with decreasing use of dopamine, possibly explaining the improved outcomes observed in closed ICUs led by intensivists. Further research is warranted to establish causality.
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Affiliation(s)
- Shohei Ono
- Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, JPN
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Chander S, Kumari R, Sadarat F, Luhana S. The Evolution and Future of Intensive Care Management in the Era of Telecritical Care and Artificial Intelligence. Curr Probl Cardiol 2023; 48:101805. [PMID: 37209793 DOI: 10.1016/j.cpcardiol.2023.101805] [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: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Critical care practice has been embodied in the healthcare system since the institutionalization of intensive care units (ICUs) in the late '50s. Over time, this sector has experienced many changes and improvements in providing immediate and dedicated healthcare as patients requiring intensive care are often frail and critically ill with high mortality and morbidity rates. These changes were aided by innovations in diagnostic, therapeutic, and monitoring technologies, as well as the implementation of evidence-based guidelines and organizational structures within the ICU. In this review, we examine these changes in intensive care management over the past 40 years and their impact on the quality of care available to patients. Moreover, the current state of intensive care management is characterized by a multidisciplinary approach and the use of innovative technologies and research databases. Advancements such as telecritical care and artificial intelligence are being increasingly explored, especially since the COVID-19 pandemic, to reduce the length of hospitalization and ICU mortality. With these advancements in intensive care and ever-changing patient needs, critical care experts, hospital managers, and policymakers must also explore appropriate organizational structures and future enhancements within the ICU.
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Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York, NY.
| | - Roopa Kumari
- Department of Internal Medicine, Mount Sinai Morningside and West, New York, NY
| | - Fnu Sadarat
- Department of Internal Medicine, University of Buffalo, NY, USA
| | - Sindhu Luhana
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Oh TK, Kim S, Song IA. Intensivist coverage and critically ill COVID-19 patient outcomes: a population-based cohort study. J Intensive Care 2023; 11:19. [PMID: 37173766 PMCID: PMC10177723 DOI: 10.1186/s40560-023-00668-1] [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: 03/17/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Trained intensivist staffing improves survival outcomes in critically ill patients at intensive care units. However, the impact on outcomes of critically ill patients with coronavirus disease 2019 has not yet been evaluated. We aimed to investigate whether trained intensivists affect outcomes among critically ill coronavirus disease 2019 patients in South Korean intensive care units. METHODS Using a nationwide registration database in South Korea, we included adult patients admitted to the intensive care unit from October 8, 2020, to December 31, 2021, with a main diagnosis of coronavirus disease 2019. Critically ill patients admitted to intensive care units that employed trained intensivists were included in the intensivist group, whereas all other critically ill patients were assigned to the non-intensivist group. RESULTS A total of 13,103 critically ill patients were included, with 2653 (20.2%) patients in the intensivist group and 10,450 (79.8%) patients in the non-intensivist group. In the covariate-adjusted multivariable logistic regression model, the intensivist group exhibited 28% lower in-hospital mortality than that of the non-intensivist group (odds ratio: 0.72; 95% confidence interval: 0.62, 0.83; P < 0.001). CONCLUSIONS Trained intensivist coverage was associated with lower in-hospital mortality among critically ill coronavirus disease 2019 patients who required intensive care unit admission in South Korea.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Saeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea.
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
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Mohankumar N, Rajagopal L, Nieto JJ. Optimal control for co-infection with COVID-19-Associated Pulmonary Aspergillosis in ICU patients with environmental contamination. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:9861-9875. [PMID: 37322914 DOI: 10.3934/mbe.2023432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In this paper, we propose a mathematical model for COVID-19-Associated Pulmonary Aspergillosis (CAPA) co-infection, that enables the study of relationship between prevention and treatment. The next generation matrix is employed to find the reproduction number. We enhanced the co-infection model by incorporating time-dependent controls as interventions based on Pontryagin's maximum principle in obtaining the necessary conditions for optimal control. Finally, we perform numerical experiments with different control groups to assess the elimination of infection. In numerical results, transmission prevention control, treatment controls, and environmental disinfection control provide the best chance of preventing the spread of diseases more rapidly than any other combination of controls.
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Affiliation(s)
- Nandhini Mohankumar
- Department of Mathematics, Coimbatore Institute of Technology, Tamilnadu, India
| | - Lavanya Rajagopal
- Department of Mathematics, Coimbatore Institute of Technology, Tamilnadu, India
| | - Juan J Nieto
- CITMAga, Departamento de Estatística, Análise Matemática e Optimización, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Closed Collaborative Surgical Intensive Care Unit Modeling and Its Association With Trauma Patient Outcomes. J Surg Res 2023; 283:494-499. [PMID: 36436285 DOI: 10.1016/j.jss.2022.11.015] [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: 03/02/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The optimization of intensive care unit (ICU) care impacts clinical outcomes and resource utilization. In 2017, our surgical ICU (SICU) adopted a "closed-collaborative" model. The aim of this study is to compare patient outcomes in the closed-collaborative model versus the previous open model in a cohort of trauma surgical patients admitted to our adult level 1 trauma center. METHODS A retrospective review of trauma patients in the SICU from August 1, 2015 to July 31, 2019 was performed. Patients were divided into those admitted prior to August 1, 2017 (the "open" cohort) and those admitted after August 1, 2017 (the "closed-collaborative" cohort). Demographic variables and clinical outcomes were analyzed. Trauma severity was assessed using injury severity score (ISS). RESULTS We identified 1669 patients (O: 895; C: 774). While no differences in demographics were observed, the closed-collaborative cohort had a higher overall ISS (O: 21.5 ± 12.14; C: 25.10 ± 2.72; P < 0.0001). There were no significant differences between the two cohorts in the incidence of strokes (O: 1.90%; C: 2.58%, P = 0.3435), pulmonary embolism (O: 0.78%; C: 0.65%; P = 0.7427), sepsis (O: 5.25%; C: 7.49%; P = 0.0599), median ICU charges (O: $7784.50; C: $8986.53; P = 0.5286), mortality (O: 11.40%; C: 13.18%; P = 0.2678), or ICU length of stay (LOS) (O: 4.85 ± 6.23; C: 4.37 ± 4.94; P = 0.0795). CONCLUSIONS Patients in the closed-collaborative cohort had similar clinical outcomes despite having a sicker cohort of patients. We hypothesize that the closed-collaborative ICU model was able to maintain equivalent outcomes due to the dedicated multidisciplinary critical care team caring for these patients. Further research is warranted to determine the optimal model of ICU care for trauma patients.
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Oh TK, Song IA. Trained intensivist coverage and survival outcomes in critically ill patients: a nationwide cohort study in South Korea. Ann Intensive Care 2023; 13:4. [PMID: 36637567 PMCID: PMC9839899 DOI: 10.1186/s13613-023-01100-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/07/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The difference in survival outcomes between closed and open intensive care unit (ICU) designs with respect to trained intensivist coverage remains unknown. We aimed to investigate whether trained intensivist coverage is associated with mortality in critically ill patients admitted to the ICU in South Korea. METHODS This population-based cohort study used nationwide registration data from South Korea. This study enrolled all adult patients admitted to the ICU between January 1, 2016, and December 31, 2019. Patients, who were admitted ICU in a hospital that employed trained intensivists, were designated as the intensivist group. RESULTS This study included 1,147,493 critically ill patients admitted to the ICU. The intensivist and non-intensivist groups consisted of 484,004 (42.2%) and 663,489 (57.8%) patients, respectively. Mixed effect logistic regression revealed a 22% lower in-hospital mortality rate (odds ratio: 0.78. 95% confidence interval: 0.74, 0.81; P < 0.001) than that in the non-intensivist group. Mixed effect Cox regression revealed a 15% lower 1-year mortality rate (hazard ratio: 0.85. 95% confidence interval: 0.83, 0.89; P < 0.001) in the intensivist group than that in the non-intensivist group. Moreover, the in-hospital mortality was significantly lower in the intensivist group than that in the non-intensivist group, irrespective of age, Charlson comorbidity index, surgery or non-surgery associated admission, and invasive treatment during ICU stay. CONCLUSIONS A closed ICU design with trained intensivist coverage was associated with lower in-hospital and 1-year mortality rates. Our results suggest that hospitals should employ trained intensivists to improve both short-term and long-term survival outcomes of critically ill patients.
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Affiliation(s)
- Tak Kyu Oh
- grid.412480.b0000 0004 0647 3378Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620 South Korea ,grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - In-Ae Song
- grid.412480.b0000 0004 0647 3378Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620 South Korea ,grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
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Abstract
UNLABELLED PICU patients who experience critical illness events, such as intubation, are at high risk for morbidity and mortality. Little is known about the impact of these events, which require significant resources, on outcomes in other patients. Therefore, we aimed to assess the association between critical events in PICU patients and the risk of similar events in neighboring patients over the next 6 hours. DESIGN Retrospective observational cohort study. SETTING Quaternary care PICU at the University of Chicago. PATIENTS All children admitted to the PICU between 2012 and 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was a critical event defined as the initiation of invasive ventilation, initiating vasoactive medications, cardiac arrest, or death. The exposure was the occurrence of a critical event among other patients in the PICU within the preceding 6 hours. Discrete-time survival analysis using fixed 6-hour blocks beginning at the time of PICU admission was used to model the risk of experiencing a critical event in the PICU when an event occurred in the prior 6 hours. There were 13,628 admissions, of which 1,886 (14%) had a critical event. The initiation of mechanical ventilation was the most frequent event (n = 1585; 59%). In the fully adjusted analysis, there was a decreased risk of critical events (odds ratio, 0.82; 95% CI, 0.70-0.96) in the 6 hours following exposure to a critical event. This association was not present when considering longer intervals and was more pronounced in patients younger than 6 years old when compared with patients 7 years and older. CONCLUSION Critical events in PICU patients are associated with decreased risk of similar events in neighboring patients. Further studies targeted toward exploring the mechanism behind this effect as well as identification of other nonpatient factors that adversely affect outcomes in children are warranted.
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Oh TK, Cho M, Song IA. Impact of trained intensivist coverage on survival outcomes after in-hospital cardiopulmonary resuscitation: A nationwide cohort study in South Korea. Resuscitation 2022; 178:69-77. [PMID: 35870558 DOI: 10.1016/j.resuscitation.2022.07.022] [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: 06/10/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 10/17/2022]
Abstract
AIM We aimed to investigate whether trained intensivist coverage affects survival outcomes following in-hospital cardiopulmonary resuscitation (ICPR) for in-hospital cardiac arrest (IHCA). METHODS All adult patients who received ICPR for IHCA between January 1, 2016 and December 31, 2019 in South Korea were included. Patients who received ICPR in hospitals with trained intensivist coverage for ICU staffing were defined as the intensivist group, whereas other patients were considered the non-intensivist group. RESULTS In total 68,286 adult patients (36,025 [52.8%] in the intensivist group and 32,261 [47.2%] in the non-intensivist group) were included in the analysis. After propensity score (PS) matching 40,988 patients (20,494 in each group) were included. In logistic regression after PS matching, the intensivist group showed a 17% (odds ratio: 1.17; 95% confidence interval [CI]: 1.12-1.22; P < 0.001) higher live discharge rate after ICPR than the non-intensivist group. In Cox regression after PS matching, the 6-month and the 1-year mortality rates in the intensivist group after ICPR were 11% (hazard ratio [HR]: 0.89; 95% CI: 0.87-0.91; P < 0.001) and 10% (HR: 0.90; 95% CI: 0.88-0.92; P < 0.001) lower than those in the non-intensivist group, respectively. In Kaplan-Meir estimation the median survival time after ICPR in the intensivist group was 12.0 days (95% CI: 11.6-12.4) while that in the non-intensivist group was 8.0 days (95% CI: 7.7-8.3). CONCLUSIONS Trained intensivist coverage in the ICU was associated with improvements in both short and long-term survival outcomes after ICPR for IHCA.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Mincheul Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
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Hashimoto M, Asai S, Umezawa K, Kohara K, Miyazawa M, Suzuki Y, Miyachi H. Impact of ward pharmacist-led antimicrobial stewardship in intensive care units. J Chemother 2022:1-10. [PMID: 35748502 DOI: 10.1080/1120009x.2022.2087652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Various outcomes of mortality, medical costs, and antimicrobial usage result from antimicrobial stewardship (AS) programmes. Here, we clarified the effects of AS implementation by a well-trained pharmacist in an open intensive care unit (open ICU) through a retrospective, comparative study of 5123 open ICU patients of Tokai University Hospital. The 12 months before and after AS implementation were considered the control and study periods, respectively. After AS implementation, the number of AS cases increased significantly. The period until the implementation of therapeutic drug monitoring was significantly shortened, and antimicrobial drug usage increased significantly. The methicillin-resistant Staphylococcus aureus (MRSA) detection rate decreased significantly. Earlier and more frequent AS implementation could enhance treatment effects, possibly decreasing the MRSA incidence. Despite active AS implementation, antimicrobial drug usage did not necessarily decrease. ICU pharmacists with experience in AS should take on leadership roles and implement active AS strategies in open ICU settings.
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Affiliation(s)
- Masayoshi Hashimoto
- Department of Pharmacy, Tokai University Hospital, Isehara, Japan.,Division of Infection control, Tokai University Hospital, Isehara, Japan
| | - Satomi Asai
- Division of Infection control, Tokai University Hospital, Isehara, Japan.,Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kazuo Umezawa
- Division of Infection control, Tokai University Hospital, Isehara, Japan.,Department of Emergency and Critical Care, Tokai University School of Medicine, Isehara, Japan
| | - Kento Kohara
- Department of Pharmacy, Tokai University Hospital, Isehara, Japan
| | - Miki Miyazawa
- Division of Infection control, Tokai University Hospital, Isehara, Japan
| | - Yuji Suzuki
- Department of Pharmacy, Tokai University Hospital, Isehara, Japan
| | - Hayato Miyachi
- Division of Infection control, Tokai University Hospital, Isehara, Japan.,Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Japan
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Ko SJ, Cho J, Choi SM, Park YS, Lee CH, Yoo CG, Lee J, Lee SM. Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit. PLoS One 2021; 16:e0259092. [PMID: 34705879 PMCID: PMC8550369 DOI: 10.1371/journal.pone.0259092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. However, the benefits of a closed unit model have not been extensively compared to those of a mandatory critical care consultation model. METHODS This retrospective before-after study included patients admitted to the medical ICU. Anthropometric data, admission reason, Acute Physiology and Chronic Health Evaluation II score, Eastern Cooperative Oncology Group grade, survival status, length of stay (LOS) in the ICU, duration of mechanical ventilator care, and occurrence of ventilator-associated pneumonia (VAP) were recorded. The staffing model of the medical ICU was changed from a mandatory critical care consultation model to a closed unit model in September 2017, and indices before and after the conversion were compared. RESULTS A total of 1,526 patients were included in the analysis. The mean age was 64.5 years, and 954 (62.5%) patients were men. The mean LOS in the ICU among survivors was shorter in the closed unit model than in the mandatory critical care consultation model by multiple regression analysis (5.5 vs. 6.7 days; p = 0.005). Central venous catheter insertion (38.5% vs. 51.9%; p < 0.001) and VAP (3.5% vs. 8.6%; p < 0.001) were less frequent in the closed unit model group than in the mandatory critical care consultation model group. After adjusting for confounders, the closed unit model group had decreased ICU mortality (adjusted odds ratio 0.65; p < 0.001) and shortened LOS in the ICU compared to the mandatory critical care consultation model group. CONCLUSION The closed unit model was superior to the mandatory critical care consultation model in terms of ICU mortality and LOS among ICU survivors.
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Affiliation(s)
- Sung Jun Ko
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail: (JL); (SML)
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail: (JL); (SML)
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Vahedian-Azimi A, Rahimibashar F, Ashtari S, Guest PC, Sahebkar A. Comparison of the clinical features in open and closed format intensive care units: A systematic review and meta-analysis. Anaesth Crit Care Pain Med 2021; 40:100950. [PMID: 34555538 DOI: 10.1016/j.accpm.2021.100950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/29/2021] [Accepted: 06/06/2021] [Indexed: 01/09/2023]
Abstract
IMPORTANCE The difference in clinical outcomes between closed and open designs of intensive care units (ICUs) is still an open question. OBJECTIVE We conducted a systematic review and meta-analysis to compare total mortality, hospital and ICU length of stay (LOS) and mortality as primary outcomes, and severity of illness based on physiological variables, organ failure assessment, age, duration of mechanical ventilation and ventilator-associated pneumonia frequency as secondary outcomes in closed and open ICUs. EVIDENCE REVIEW Medline, PubMed, Scopus, Web of Science, Cochrane database, Iran-doc and Elm-net according to the MeSH terms were searched from 1988 to October 2019. The standardised mean difference (SMD), relative risk (RR) with 95% confidence interval (CI) were applied to display summary statistics of primary and secondary outcomes. FINDINGS A total of 90 studies with 444,042 participants were analysed. ICU mortality (RR: 1.16, CI: 1.07-1.27, p < 0.001), hospital mortality (RR: 1.12, CI: 1.03-1.22, p = 0.010) and ICU LOS (SMD: 0.43, CI: 0.01-0.85, p = 0.040) were significantly higher in open ICUs. Total mortality (RR: 0.91, CI: 0.77-1.08, p = 0.28) and hospital LOS (SMD: 1.14, CI: 1.31-3.59, p = 0.36) showed no significant difference between the two types of ICU. The secondary outcome measures were also comparable between the two ICU formats (p > 0.05). CONCLUSIONS AND RELEVANCE The results demonstrated superiority of closed versus open ICUs in hospital and ICU mortality rates and ICU LOS, with no difference in total mortality, hospital LOS or severity of illness parameters. The superiority of the closed ICU format may be a result of the intensivist-led patient care and should therefore be implemented by clinicians to decrease ICU mortality rates and LOS for critically ill patients.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Centre, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimibashar
- Anaesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sara Ashtari
- Gastroenterology and Liver Diseases Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paul C Guest
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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17
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Luo W, Xing R, Wang C. The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days. BMC Infect Dis 2021; 21:684. [PMID: 34266399 PMCID: PMC8280627 DOI: 10.1186/s12879-021-06383-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen. MV may result in ventilator-associated pneumonia (VAP) in ICU patients. This study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients. METHODS Totally, 8182 patients who aged ≥18 years and received mechanical ventilation (MV) in ICU from Medical Information Mart for Intensive Care III (MIMIC III) database were involved in this study. All subjects were divided into the VAP group (n = 537) and the non-VAP group (n = 7626) based on the occurrence of VAP. Clinical data of all participants were collected. The effect of VAP on the prognosis of ICU patients was explored by binary logistic regression analysis. RESULTS The results delineated that the 90-day mortality of VAP patients in ICU was 33.33% and 180-day mortality was 37.62%. The 90-day and 180-day mortality rates were higher in the VAP group than in the non-VAP group. After adjusting the confounders including age, ethnicity, heart failure, septicemia, simplified acute physiology score II (SAPSII) score, sequential organ failure assessment (SOFA) score, serum lactate, white blood cell (WBC), length of ICU stay, length of hospital stay, length of ventilation, antibiotic treatment, Pseudomonas aeruginosa (P.aeruginosa), methicillin-resistant Staphylococcus aureus (MRSA), other pathogens, the risk of 90-day and 180-day mortalities in VAP patients were 1.465 times (OR = 1.465, 95%CI: 1.188-1.807, P < 0.001) and 1.635 times (OR = 1.635, 95%CI: 1.333-2.005, P < 0.001) higher than those in non-VAP patients, respectively. CONCLUSIONS Our study revealed that ICU patients with VAP had poorer prognosis than those without VAP. The results of this study might offer a deeper insight into preventing the occurrence of VAP.
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Affiliation(s)
- Wenjuan Luo
- Department of Critical Care Medicine, Guangdong Second Provincial General Hospital, No.466 Xingang Middle Road, Guangzhou, 510000, Guangdong, China.
| | - Rui Xing
- Department of Critical Care Medicine, Guangdong Second Provincial General Hospital, No.466 Xingang Middle Road, Guangzhou, 510000, Guangdong, China
| | - Canmin Wang
- Department of Critical Care Medicine, Guangdong Second Provincial General Hospital, No.466 Xingang Middle Road, Guangzhou, 510000, Guangdong, China
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Nagata I, Abe T, Ogura H, Kushimoto S, Fujishima S, Gando S. Intensive care unit model and in-hospital mortality among patients with severe sepsis and septic shock: A secondary analysis of a multicenter prospective observational study. Medicine (Baltimore) 2021; 100:e26132. [PMID: 34032762 PMCID: PMC8154476 DOI: 10.1097/md.0000000000026132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
We aimed to determine the association between the intensive care unit (ICU) model and in-hospital mortality of patients with severe sepsis and septic shock.This was a secondary analysis of a multicenter prospective observational study conducted in 59 ICUs in Japan from January 2016 to March 2017. We included adult patients (aged ≥16 years) with severe sepsis and septic shock based on the sepsis-2 criteria who were admitted to an ICU with a 1:2 nurse-to-patient ratio per shift. Patients were categorized into open or closed ICU groups, according to the ICU model. The primary outcome was in-hospital mortality.A total of 1018 patients from 45 ICUs were included in this study. Patients in the closed ICU group had a higher severity score and higher organ failure incidence than those in the open ICU group. The compliance rate for the sepsis care 3-h bundle was higher in the closed ICU group than in the open ICU group. In-hospital mortality was not significantly different between the closed and open ICU groups in a multilevel logistic regression analysis (odds ratio = 0.83, 95% confidence interval; 0.52-1.32, P = .43) and propensity score matching analysis (closed ICU, 21.2%; open ICU, 25.7%, P = .22).In-hospital mortality between the closed and open ICU groups was not significantly different after adjusting for ICU structure and compliance with the sepsis care bundle.
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Affiliation(s)
- Isao Nagata
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki
- Intensive Care Unit, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Toshikazu Abe
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Ibaraki
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Osaka
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Tokyo
| | - Satoshi Gando
- Intensive Care Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan
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Lyra S, Mayer L, Ou L, Chen D, Timms P, Tay A, Chan PY, Ganse B, Leonhardt S, Hoog Antink C. A Deep Learning-Based Camera Approach for Vital Sign Monitoring Using Thermography Images for ICU Patients. SENSORS (BASEL, SWITZERLAND) 2021; 21:1495. [PMID: 33670066 PMCID: PMC7926634 DOI: 10.3390/s21041495] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022]
Abstract
Infrared thermography for camera-based skin temperature measurement is increasingly used in medical practice, e.g., to detect fevers and infections, such as recently in the COVID-19 pandemic. This contactless method is a promising technology to continuously monitor the vital signs of patients in clinical environments. In this study, we investigated both skin temperature trend measurement and the extraction of respiration-related chest movements to determine the respiratory rate using low-cost hardware in combination with advanced algorithms. In addition, the frequency of medical examinations or visits to the patients was extracted. We implemented a deep learning-based algorithm for real-time vital sign extraction from thermography images. A clinical trial was conducted to record data from patients on an intensive care unit. The YOLOv4-Tiny object detector was applied to extract image regions containing vital signs (head and chest). The infrared frames were manually labeled for evaluation. Validation was performed on a hold-out test dataset of 6 patients and revealed good detector performance (0.75 intersection over union, 0.94 mean average precision). An optical flow algorithm was used to extract the respiratory rate from the chest region. The results show a mean absolute error of 2.69 bpm. We observed a computational performance of 47 fps on an NVIDIA Jetson Xavier NX module for YOLOv4-Tiny, which proves real-time capability on an embedded GPU system. In conclusion, the proposed method can perform real-time vital sign extraction on a low-cost system-on-module and may thus be a useful method for future contactless vital sign measurements.
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Affiliation(s)
- Simon Lyra
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (L.M.); (L.O.); (S.L.); (C.H.A.)
| | - Leon Mayer
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (L.M.); (L.O.); (S.L.); (C.H.A.)
| | - Liyang Ou
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (L.M.); (L.O.); (S.L.); (C.H.A.)
| | - David Chen
- Eastern Health Clinical School, Monash University Melbourne, Box Hill, VIC 3128, Australia; (D.C.); (P.T.); (A.T.); (P.Y.C.)
| | - Paddy Timms
- Eastern Health Clinical School, Monash University Melbourne, Box Hill, VIC 3128, Australia; (D.C.); (P.T.); (A.T.); (P.Y.C.)
| | - Andrew Tay
- Eastern Health Clinical School, Monash University Melbourne, Box Hill, VIC 3128, Australia; (D.C.); (P.T.); (A.T.); (P.Y.C.)
| | - Peter Y. Chan
- Eastern Health Clinical School, Monash University Melbourne, Box Hill, VIC 3128, Australia; (D.C.); (P.T.); (A.T.); (P.Y.C.)
| | - Bergita Ganse
- Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester M1 5GD, UK;
| | - Steffen Leonhardt
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (L.M.); (L.O.); (S.L.); (C.H.A.)
| | - Christoph Hoog Antink
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (L.M.); (L.O.); (S.L.); (C.H.A.)
- Biomedical Engineering, Electrical Engineering and Information Technology, TU Darmstadt, 64289 Darmstadt, Germany
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Rissanen M. Translational health technology and system schemes: enhancing the dynamics of health informatics. Health Inf Sci Syst 2020; 8:39. [PMID: 33194173 PMCID: PMC7652954 DOI: 10.1007/s13755-020-00133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
Translational health technology and design schemes reflect certain themes in systems approach and its dynamics. This paper discusses these aligned ideas in view of their value to translational design processes. The ideas embedded in these two approaches are considered in the light of critical questions associated with the development of health informatics. Health care processes for patients might be very fragmented. Synergy thinking is required in all areas of design: it is crucial to understand the theoretical frames and issues associated with focus environments, administration, and cost policy. By internalizing common nuances in these approaches, designers can ease the interaction and communication between experts from different backgrounds. Synergistic thinking aids designers in health informatics to produce more sophisticated products. Maturing in recognizing the whole aids to take into account “the very essentials” more easily. These skills are very vital in prioritizing development substances in health informatics area.
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