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Peng Y, Wang Q, Jin F, Tao T, Qin Q. Assessment of urine CCL2 as a potential diagnostic biomarker for acute kidney injury and septic acute kidney injury in intensive care unit patients. Ren Fail 2024; 46:2313171. [PMID: 38345000 PMCID: PMC10863526 DOI: 10.1080/0886022x.2024.2313171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
Acute kidney injury (AKI) is a prevalent and serious condition in the intensive care unit (ICU), associated with significant morbidity and mortality. Septic acute kidney injury (SAKI) contributes substantially to AKI cases in the ICU. However, current diagnostic methods have limitations, necessitating the exploration of novel biomarkers. In this study, we investigated the potential of plasma and urine CCL2 levels as diagnostic markers for AKI and SAKI in 216 ICU patients. Our findings revealed significant differences in plasma (p < 0.01) and urine CCL2 (p < 0.0001) levels between AKI and non-AKI patients in the ICU. Notably, urine CCL2 demonstrated promising predictive value for AKI, exhibiting high specificity and sensitivity (AUC = 0.8976; p < 0.0001). Furthermore, we observed higher urine CCL2 levels in SAKI compared to non-septic AKI (p < 0.001) and urine CCL2 could also differentiate SAKI from non-septic AKI (AUC = 0.7597; p < 0.0001). These results suggest that urine CCL2 levels hold promise as early biomarkers for AKI and SAKI, offering valuable insights for timely intervention and improved management of ICU patients.
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Affiliation(s)
- Yuan Peng
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Qin Wang
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Fang Jin
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Tao Tao
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Qihong Qin
- Department of Emergency, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, PR China
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Cheng H, Huang X, Yuan S, Song S, Tang Y, Ling Y, Tan S, Wang Z, Zhou F, Lyu J. Can admission Braden skin score predict delirium in older adults in the intensive care unit? Results from a multicenter study. J Clin Nurs 2024; 33:2209-2225. [PMID: 38071493 DOI: 10.1111/jocn.16962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 04/23/2024]
Abstract
AIMS AND OBJECTIVES To investigate whether a low Braden Skin Score (BSS), reflecting an increased risk of pressure injury, could predict the risk of delirium in older patients in the intensive care unit (ICU). BACKGROUND Delirium, a common acute encephalopathy syndrome in older ICU patients, is associated with prolonged hospital stay, long-term cognitive impairment and increased mortality. However, few studies have explored the relationship between BSS and delirium. DESIGN Multicenter cohort study. METHODS The study included 24,123 older adults from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and 1090 older adults from the eICU Collaborative Research Database (eICU-CRD), all of whom had a record of BSS on admission to the ICU. We used structured query language to extract relevant data from the electronic health records. Delirium, the primary outcome, was primarily diagnosed by the Confusion Assessment Method for the ICU or the Intensive Care Delirium Screening Checklist. Logistic regression models were used to validate the association between BSS and outcome. A STROBE checklist was the reporting guide for this study. RESULTS The median age within the MIMIC-IV and eICU-CRD databases was approximately 77 and 75 years, respectively, with 11,195 (46.4%) and 524 (48.1%) being female. The median BSS at enrollment in both databases was 15 (interquartile range: 13, 17). Multivariate logistic regression showed a negative association between BSS on ICU admission and the prevalence of delirium. Similar patterns were found in the eICU-CRD database. CONCLUSIONS This study found a significant negative relationship between ICU admission BSS and the prevalence of delirium in older patients. RELEVANCE TO CLINICAL PRACTICE The BSS, which is simple and accessible, may reflect the health and frailty of older patients. It is recommended that BSS assessment be included as an essential component of delirium management strategies for older patients in the ICU. NO PATIENT OR PUBLIC CONTRIBUTION This is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study.
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Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaxuan Huang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, China
| | - Yonglan Tang
- School of Nursing, Jinan University, Guangzhou, China
| | - Yitong Ling
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shanyuan Tan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
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Ma Y, Zhang H, Bai J, Zhu J. EEG Characteristics Before and After Dexmedetomidine Treatment in Severe Patients: A Prospective Study. Clin EEG Neurosci 2024; 55:384-390. [PMID: 36540002 DOI: 10.1177/15500594221144570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Bedside electroencephalography (EEG) can monitor the changes in brain function in critical patients. Light sedation is recommended in intensive care unit (ICU) patients, but sedation might confuse the EEG readings. There are few studies on the changes of EEG in severe patients with dexmedetomidine. This study aimed to explore the EEG characteristics before and after dexmedetomidine in severe patients in the ICU. Methods. This prospective study enrolled severe patients with sepsis who needed light sedation, we sedated the patients with dexmedetomidine. EEG was recorded for at least 60 min using a quantitative EEG (qEEG) bedside monitor. Amplitude-EEG (aEEG), relative spectral energy, alpha variation, and spectral entropy were recorded and compared before/after dexmedetomidine. Results. Sixty-three participants were enrolled. The relative spectral energy and alpha variation were not different before and after the use of dexmedetomidine (P > .05). The amplitude of the upper and lower boundaries in aEEG and spectral entropy were significantly lower after light sedation with dexmedetomidine compared with before (P < .05). When grouped according to the Glasgow Coma Scale (GCS), the amplitude of qEEG in participants with moderate GCS decreased significantly(P < .05), but not in mild or severe GCS. Conclusion. Relative spectral energy and alpha variation derived from qEEG could be used to evaluate the state of brain function even under light sedation with dexmedetomidine in severe patients during their ICU stay.
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Affiliation(s)
- Yujie Ma
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hongbin Zhang
- 942nd Hospital of Chinese People's Liberation Army Joint Service Support Force, Yinchuan, Ningxia, China
| | - Jijia Bai
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jinyuan Zhu
- General Hospital of Ningxia Medical University, Yinchuan, China
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Cohen M, Banerjee D. Biomarkers in Sepsis: A Current Review of New Technologies. J Intensive Care Med 2024; 39:399-405. [PMID: 37593782 DOI: 10.1177/08850666231194535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Sepsis syndromes have been recognized since antiquity yet still pose significant challenges to modern medicine. One of the biggest challenges lies in the heterogeneity of triggers and its protean clinical manifestations, as well as its rapidly progressive and lethal nature. Thus, there is a critical need for biomarkers that can quickly and accurately detect sepsis onset and predict treatment response. In this review, we will briefly describe the current consensus definitions of sepsis and the ideal features of a biomarker. We will then delve into currently available and in-development markers of pathogens, hosts, and their interactions that together comprise the sepsis syndrome.
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Affiliation(s)
- Maya Cohen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert/Brown Medical School, Providence, RI, USA
| | - Debasree Banerjee
- Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert/Brown Medical School, Providence, RI, USA
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Ryll MJ, Zodl A, Weingarten TN, Rabinstein AA, Warner DO, Schroeder DR, Sprung J. Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism. J Intensive Care Med 2024; 39:455-464. [PMID: 37964551 PMCID: PMC10935623 DOI: 10.1177/08850666231212875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) predict mortality for patients with PE. We compared PESI/sPESI to the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) in predicting mortality in patients with PE admitted to the intensive care unit (ICU). Additionally, we assessed the performance of a novel ICU-sPESI score created by adding three clinical variables associated with acuity of PE presentation (intubation, confusion [altered mental status], use of vasoactive infusions) to sPESI. MATERIALS AND METHODS Using the eICU Collaborative Research Database from 2014 to 2015, we conducted a large retrospective cohort study of adult patients admitted to the ICU with a primary diagnosis of PE. We calculated APACHE-IV, PESI, sPESI, and ICU-sPESI scores and compared their performance for predicting in-hospital mortality using area under the receiver operating characteristic (AUROC) curve. Score thresholds for >99% negative predictive values (NPV) were calculated for each score. Survival was estimated using the Kaplan-Meier method. RESULTS We included 1424 PE cases. In-hospital mortality was 6.3% [95% CI: 5.1%-7.6%]. AUROC for APACHE-IV, PESI, and sPESI were 0.870, 0.848, and 0.777, respectively. APACHE-IV and PESI outperformed sPESI (P < 0.01 for both comparisons), while APACHE-IV and PESI demonstrated similar performance (P = 0.322). The ICU-sPESI performance was similar to APACHE-IV and PESI (AUROC = 0.847; AUROC comparison: APACHE-IV vs ICU-sPESI: P = 0.396; PESI vs ICU-sPESI: P = 0.945). Hospital mortality for ICU-sPESI scores 0-2 was 1.1%, and for scores 3, 4, 5, 6, and ≥7 was 8.6%, 11.7%, 29.2%, 37.5%, and 76.9%, respectively. Score thresholds for >99% NPV were ≤48 for APACHE-IV, ≤115 for PESI, and 0 points for sPESI and ICU-sPESI. CONCLUSIONS By accounting for severity of PE presentation, our newly proposed ICU-sPESI score provided improved PE mortality prediction compared to the original sPESI score and offered excellent discrimination of mortality risk.
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Affiliation(s)
- Martin J. Ryll
- Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Aurelia Zodl
- Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Toby N. Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Darrell R. Schroeder
- Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Bahl A, Mielke N, Gibson SM, George J. The use of procedural kits may reduce unscheduled central line dressing changes: A matched pre-post intervention study. J Infect Prev 2024; 25:73-81. [PMID: 38584709 PMCID: PMC10998547 DOI: 10.1177/17571774241232063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/25/2024] [Indexed: 04/09/2024] Open
Abstract
Background Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. Objective The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. Methods This pre-post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). Results The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) (p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention (p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day (p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day (p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Discussion Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.
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Affiliation(s)
- Amit Bahl
- William Beaumont Hospitals Corp, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Julie George
- William Beaumont Hospitals Corp, Royal Oak, MI, USA
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Dağcan N, Özden D, Gürol Arslan G. Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model. Nurs Crit Care 2024; 29:512-520. [PMID: 37527978 DOI: 10.1111/nicc.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes. AIM This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM). STUDY DESIGN A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM. RESULTS The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain). CONCLUSIONS The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated. RELEVANCE TO CLINICAL PRACTICE Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.
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Affiliation(s)
- Necibe Dağcan
- Nursing Department, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
| | - Gülşah Gürol Arslan
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
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Paranhos DB, Annoni R, Schujmann DS, Fernandes LFRM. Functional Dependence Prior to ICU Admission is Associated with Worse Clinical and Functional Outcomes in Individuals with COVID-19: A Prospective Observational Study. J Intensive Care Med 2024; 39:439-446. [PMID: 37915228 DOI: 10.1177/08850666231211754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Objectives: To determine whether low functional capacity (FC) prior to intensive care unit (ICU) admission due to coronavirus disease 2019 (COVID-19) might be associated with worse clinical outcomes. To monitor FC until discharge from the ICU. To identify associations between physical outcomes and decreased FC at discharge from the ICU. Design: Prospective observational study conducted from March to August 2021. Setting: ICU for adult patients with COVID-19. Participants: Adults (≥18 years) with COVID-19. Interventions: Not applicable. Main outcome measures: Clinical and demographic data were obtained from medical records. At ICU admission, evaluation was made of FC using the Barthel index (BI), and of the level of mobility using the ICU mobility scale. At ICU discharge, FC and mobility level were reassessed, and muscle strength was measured using the Medical Research Council (MRC) scale and the handgrip test. Results: The study was performed with 108 individuals. At the initial assessment, 73.1% of the patients were functionally independent. Length of hospital stay (odds ratio [OR] = 1.05; 95%confidence interval [CI] = 1.00-1.10) and death (OR = 5.27; 95%CI = 1.37-20.28) were related to functional status prior to ICU admission. Between ICU admission and discharge, the BI evaluation indicated a functional decline of 22.5 points. Low mobility level (P = .003) and low muscle strength assessed by the MRC scale (P < .001), measured at ICU discharge, were associated with a greater decrease of FC during the ICU stay. Conclusions: Patients with COVID-19 who were functionally dependent prior to ICU admission presented worse clinical outcomes, with low functional status being associated with longer hospitalization and higher mortality. However, irrespective of the initial functionality status, the surviving individuals suffered from functional decline at ICU discharge. Greater functional decline during the ICU stay was associated with lower muscle strength and lower mobility level at ICU discharge.
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Affiliation(s)
- Darlisson B Paranhos
- Master's Program in Physiotherapy, Federal University of Triângulo Mineiro and Federal University of Uberlândia, Uberaba, Brazil
| | - Raquel Annoni
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Debora S Schujmann
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Luciane F R M Fernandes
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Solanki S, Dogra S, Gupta PK, Peters NJ, Malik MA, Mahajan JK. Randomized controlled trial to evaluate the rate of successful neonatal endotracheal intubation performed with a stylet versus without a stylet. Paediatr Anaesth 2024; 34:448-453. [PMID: 38305632 DOI: 10.1111/pan.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Neonates in intensive care units often require endotracheal intubation and mechanical ventilation. During this intubation procedure, a stylet is frequently used along with an endotracheal tube. Despite the widespread use of a stylet, it is still not known whether its use increases the intubation success rate. This study examined the association between stylet use and the intubation success rate in surgical neonates. METHODOLOGY This single-center study was conducted between December 2021 and December 2022 in the Neonatal surgical intensive care unit of a tertiary care center in Northern India. Infants were randomized to have the endotracheal intubation procedure performed using either an endotracheal tube alone or with a stylet. The primary outcome of the study was to assess the successful first-attempt neonatal endotracheal intubation rate with and without using a stylet. Apart from the rate of successful intubation, the duration of the intubation and complications during the intubation procedures as measured by bradycardia, desaturation episodes, and local trauma were also recorded. Both groups were thus compared on above mentioned outcomes. RESULTS The total number of neonates enrolled were 200, and the overall success rate (81% in the stylet group vs. 73% in the non-stylet group) was not statistically significant. Intubation time was however less, when stylet was used (16.2 ± 4.3 vs. 17.5 ± 5.0 s, p = .046). When the endotracheal tube size was 3 or less, the success rate was substantially higher in the stylet group (80%) than the non-stylet group (63%), p = .03. No statistical difference was recorded for bleeding and local trauma, though the esophageal intubation rate was higher when intubation was attempted without the stylet. CONCLUSION Endotracheal intubation using a stylet did not significantly improve the success rate of the procedure, however, intubation time significantly varied between groups and in different conditions. The rigidity and curvature provided by the stylet may facilitate the process of intubation when smaller caliber endotracheal tubes are used.
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Affiliation(s)
| | - Shivani Dogra
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - Pramod K Gupta
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - Nitin J Peters
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - Muneer A Malik
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - J K Mahajan
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
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Sui W, Gong X, Zhuang Y. Impact of knowledge, attitudes and self-reported practices of nurses on early mobilization of mechanically ventilated patients in the ICU. Nurs Crit Care 2024; 29:573-583. [PMID: 38410092 DOI: 10.1111/nicc.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Many ICUs worldwide are striving to integrate early mobilization as part of critical care rehabilitation. However, ICU nurses, who are essential contributors to the early mobilization of critically ill patients, still lack comprehensive surveys assessing their knowledge, beliefs, and practices regarding the early mobilization of mechanically ventilated patients. AIM To analyse the knowledge, attitudes, and practices of intensive care unit (ICU) nurses regarding the early mobilization of mechanically ventilated patients and to explore the effects of these practices. STUDY DESIGN A multicentre cross-sectional study. ICU nurses in five tertiary hospitals in Zhejiang Province, China, were selected by convenience sampling and invited to complete an online questionnaire between 1 June 2021 and 15 June 2021. Sociodemographic data and the knowledge, attitudes, and practices of ICU nurses regarding early mobilization. RESULTS A total of 296 valid questionnaires were collected, for a response rate of approximately 77.5%. The average scores for knowledge, attitudes, and practices of ICU nurses regarding the early mobilization of mechanically ventilated patients were 42.7 ± 7.4, 34.3 ± 6.5, and 47.1 ± 6.5, respectively, which were good scores. Quantile regressions showed that at the 25% and 50% quartiles, increases in knowledge and attitude scores resulted in increases in practice scores (p < .001); however, at the 75% quartile, increases in knowledge scores did not result in practice score increases (t = 0.000, p = .999); moreover, there was still a 0.5-point increase in practice scores per 1-point increase in attitude scores (t = 0.500, p < .001). CONCLUSIONS The knowledge, attitudes, and self-reported practices of ICU nurses were good, although there is room for improvement. Considering that the influence of attitudes on practice improvement is more important than knowledge, ICU managers should promote knowledge transformation, strengthen attitudes, and adopt comprehensive measures to promote the early mobilization of mechanically ventilated patients in the ICU. RELEVANCE TO CLINICAL PRACTICE To optimize the early mobilization of mechanically ventilated patients in the ICU, introducing multipronged support strategies based on the knowledge and attitudes of ICU nurses is recommended to promote the implementation of such practices.
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Affiliation(s)
- Weijing Sui
- Nursing Department, Sir Run Run Shaw Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Xiaoyan Gong
- Nursing Department, Sir Run Run Shaw Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Yiyu Zhuang
- Nursing Department, Sir Run Run Shaw Hospital School of Medicine Zhejiang University, Hangzhou, China
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11
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Knutsen K, Solbakken R, Gallagher S, Müller RT, Normann B. Patients' experiences with early rehabilitation in intensive care units: A qualitative study about aspects that influence their participation. J Adv Nurs 2024; 80:1984-1996. [PMID: 37962126 DOI: 10.1111/jan.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
AIM To explore patients' experiences with early rehabilitation in the intensive care unit and what they perceive to influence their participation. DESIGN A qualitative design anchored in phenomenological and hermeneutical traditions utilizing in-depth interviews. METHODS Thirteen patients were interviewed from 5 to 29 weeks following discharge from three units, in January-December 2022. Analysed using systematic text condensation and the pattern theory of self. Reporting adhered to consolidated criteria for reporting qualitative research. RESULTS Interviews described four main categories: (1) A foreign body, how the participants experienced their dysfunctional and different looking bodies. (2) From crisis to reorientation, the transformation the participants experienced from a state of crisis to acceptance and the ability to look forwards, indicating how bodily dysfunctions are interlinked to breakdowns of the patients' selves and the reorganization process. (3) Diverse expectations regarding activity: ambiguous expectations communicated by the nurses. (4) Nurse-patient: a powerful interaction, highlighting the essential significance of positive expectations and tailored bodily and verbal interaction for rebuilding the patient's outwards orientation. CONCLUSION Outwards orientation and reorganization of the self through a reduction in bodily dysfunctions, strengthening the patients' acceptance of the situation, providing tailored expectations and hands-on and verbal interaction appear to be fundamental aspects of patient participation in early rehabilitation. IMPLICATIONS Insights into patients' perceptions show how dysfunctional bodies cloud individuals' perceptual fields, causing inwards orientation and negative thoughts concerning themselves, their capabilities, environment and future. This knowledge can improve nurses' ability to tailor care to promote optimal recovery for patients. PATIENT OR PUBLIC CONTRIBUTION User representative contributed to the design of the study.
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Affiliation(s)
- Karina Knutsen
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
| | - Rita Solbakken
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
| | - Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, Tennessee, USA
- Faculties of Law, School of Liberal Arts, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Britt Normann
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital, Bodø, Norway
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12
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van der Wal LI, Grim CCA, Del Prado MR, van Westerloo DJ, Schultz MJ, Helmerhorst HJF, de Vries MC, de Jonge E. Perspectives of ICU Patients on Deferred Consent in the Context of Post-ICU Quality of Life: A Substudy of a Randomized Clinical Trial. Crit Care Med 2024; 52:694-703. [PMID: 38180043 PMCID: PMC11008447 DOI: 10.1097/ccm.0000000000006184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Deferred consent enables research to be conducted in the ICU when patients are unable to provide consent themselves, and there is insufficient time to obtain consent from surrogates before commencing (trial) treatment. The aim of this study was to evaluate how former ICU patients reflect on their participation in a study with deferred consent and examine whether their opinions are influenced by the quality of life (QoL) following hospital discharge. DESIGN Survey study by questionnaire. SETTING Eight ICUs in The Netherlands. PATIENTS Former ICU patients who participated in the ICONIC trial, a multicenter randomized clinical trial that evaluated oxygenation targets in mechanically ventilated ICU patients. INTERVENTIONS Participants enrolled in the ICONIC trial in one of the eight participating centers in The Netherlands received a questionnaire 6 months after randomization. The questionnaire included 12 close-ended questions on their opinion about the deferred consent procedure. QoL was measured using the EQ-5D-5L questionnaire. By calculating the EQ-5D index, patients were divided into four QoL quartiles, where Q1 reflects the lowest and Q4 is the highest. MEASUREMENTS AND MAIN RESULTS Of 362 participants who were contacted, 197 responded (54%). More than half of the respondents (59%) were unaware of their participation in the ICONIC study. In total 61% were content with the deferred consent procedure, 1% were not content, 25% neutral, 9% did not know, and 9% answered "other." Those with a higher QoL were more likely to be content ( p = 0.02). In all QoL groups, the legal representative was the most often preferred individual to provide consent. CONCLUSIONS Former ICU patients who participated in the ICONIC study often did not remember their participation but were predominantly positive regarding the use of deferred consent. Those with a higher QoL were most likely to be content.
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Affiliation(s)
- L Imeen van der Wal
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Chloe C A Grim
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michael R Del Prado
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - David J van Westerloo
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hendrik J F Helmerhorst
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
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13
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Saghafi F, Hardy J, Leigh MC, Hillege S. Intensive care as a specialty of choice for registered nurses: A descriptive phenomenological study. Nurs Crit Care 2024; 29:536-544. [PMID: 37587726 DOI: 10.1111/nicc.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/18/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care. AIM To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit. STUDY DESIGN This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two). FINDINGS Findings related to factors influencing the participants' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment. CONCLUSIONS This paper highlights that the registered nurse's perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit. RELEVANCE TO CLINICAL PRACTICE The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing.
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Affiliation(s)
- Farida Saghafi
- School of Nursing, College of Health and Medicine, University of Tasmania, Alexandria, New South Wales, Australia
| | - Jennifer Hardy
- School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Maria Cynthia Leigh
- School of Nursing, Midwifery and Paramedicine (NSW/ACT), Australian Catholic University, North Sydney, New South Wales, Australia
| | - Sharon Hillege
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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14
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Oxenbøll Collet M, Albertsen H, Egerod I. Patient and family engagement in Danish intensive care units: A national survey. Nurs Crit Care 2024; 29:614-621. [PMID: 37402590 DOI: 10.1111/nicc.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Patient and family engagement in the intensive care unit increases the quality of care and patient safety. AIM The aim of our study was to describe current practice and experiences of contemporary patient and family engagement in the intensive care unit at the individual level, the organizational level, and in the research process according to critical care nurses. DESIGN/METHOD We conducted a national qualitative survey of intensive care units in Denmark from 5th May-5th June 2021. Questionnaires were piloted and sent to intensive care nurse specialists and research nurses at 41 intensive care units, allowing one respondent per unit. All respondents were provided with written information about the study by email, and by activating the survey link, they accepted participation. RESULTS Thirty-two nurses responded to the invitation, 24 completed and 8 partially completed the survey, yielding a response rate of 78%. At the individual level, 27 respondents stated that they involved patients and 25 said they involved family in daily treatment and care. At the organizational level, 28 intensive care units had an overall strategy or guideline for patient and family engagement, and 4 units had established a PFE panel. And, finally, 11 units engaged patients and families in the research process. CONCLUSIONS Our survey suggested that patient and family engagement was implemented to some degree at the individual level, organizational level, and in the research process, but only 4 units had established a PFE panel at the organizational level, which is key to engagement. RELEVANCE TO CLINICAL PRACTICE Patient engagement increases when patients are more awake, and family engagement increases when patients are unable to participate. Engagement increases when patient and family engagement panels are implemented.
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Affiliation(s)
- Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helle Albertsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Imbriaco G, Capitano M, Rocchi M, Suhan A, Tacci A, Monesi A, Sebastiani S, Samolsky Dekel BG. Relationship between noise levels and intensive care patients' clinical complexity: An observational simulation study. Nurs Crit Care 2024; 29:555-563. [PMID: 37265028 DOI: 10.1111/nicc.12934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Noise pollution in intensive care units is a relevant problem, associated with psychological and physiological consequences for patients and healthcare staff. Sources of noise pollution include medical equipment, alarms, communication tools, staff activities, and conversations. AIMS To explore the cumulative effects of noise caused by an increasing number and type of medical devices in an intensive care setting on simulated patients with increasing clinical complexity. Secondly, to measure medical device alarms and nursing activities' sound levels, evaluating their role as potentially disruptive noises. STUDY DESIGN Observational simulation study (reported according to the STROBE checklist). Using an electronic sound meter, the sound levels of an intensive care room in seven simulated clinical scenarios were measured on a single day (09 March 2022), each featuring increasing numbers of devices, hypothetically corresponding to augmented patients' clinical complexity. Secondly, noise levels of medical device alarms and specific nursing activities performed at a distance of three meters from the sound meter were analysed. RESULTS The empty room's mean baseline noise level was 37.8 (±0.7) dBA; among the simulated scenarios, noise ranged between 45.3 (±1.0) and 53.5 (±1.5) dBA. Alarms ranged between 76.4 and 81.3 dBA, while nursing tasks (closing a drawer, opening a saline bag overwrap, or sterile packages) and speaking were all over 80 dBA. The noisiest activity was opening a sterile package (98 dBA). CONCLUSION An increased number of medical devices, an expression of patients' higher clinical complexity, is not a significant cause of increased noise. Some specific nursing activities and conversations produce higher noise levels than medical devices and alarms. This study's findings suggest further research to assess the relationships between these factors and to encourage adequate noise reduction strategies. RELEVANCE TO CLINICAL PRACTICE Excessive noise level in the intensive care unit is a clinical issue that negatively affects patients' and healthcare providers' well-being. The increase in baseline room noise from medical devices is generally limited. Typical nursing tasks and conversations produce higher noise levels than medical devices and alarms. These findings could be helpful to raise awareness among healthcare professionals to recognize noise sources. The noisiest components of the environment can be modified by staff behaviour, promoting noise reduction strategies and improving the critical care environment.
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Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est, Prehospital Emergency Dispatch Center, Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Martina Capitano
- Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Margherita Rocchi
- Intensive Care Unit, Nuovo San Giovanni di Dio hospital, AUSL Toscana Centro, Florence, Italy
| | - Aglaia Suhan
- Medical Department (COVID-19), Madre Teresa di Calcutta hospital, Padova, Italy
| | - Alice Tacci
- Neonatal Intensive Care Unit, Maggiore Hospital, AOU Parma, Parma, Italy
| | - Alessandro Monesi
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- Intensive Care Unit, Maggiore hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Stefano Sebastiani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Boaz Gedaliahu Samolsky Dekel
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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16
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Pan JM, Guo Y, Jiang FF, Xu R, Zhang X, Cai WK, Yin SJ, Wang P, Huang YH, Zhang XS, Li YH, Cai L, He GH. Effect of Histamine H2 Receptor Antagonists on All-Cause Mortality in Critically Ill Patients With Essential Hypertension: A Retrospective Cohort Study. J Clin Pharmacol 2024. [PMID: 38659369 DOI: 10.1002/jcph.2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Previous studies found that histamine H2 receptor antagonists (H2RAs) had blood pressure lowering and cardioprotective effects, but the impact of H2RAs on the survival outcomes of critically ill patients with essential hypertension is still unclear. The aim of this study was to investigate the association of H2RAs exposure with all-cause mortality in patients with essential hypertension based on Medical Information Mart for Intensive Care III database. A total of 17,739 patients were included, involving 8482 H2RAs users and 9257 non-H2RAs users. Propensity score matching (PSM) was performed to improve balance between 2 groups that were exposed to H2RAs or not. Kaplan-Meier survival curves were used to compare the cumulative survival rates and multivariable Cox regression models were performed to evaluate the association between H2RAs exposure and all-cause mortality. After 1:1 PSM, 4416 pairs of patients were enrolled. The results revealed potentially significant association between H2RAs exposure and decreased 30-day, 90-day, and 1-year mortalities in multivariate analyses (HR = 0.783, 95% CI: 0.696-0.882 for 30-day; HR = 0.860, 95% CI: 0.778-0.950 for 90-day; and HR = 0.883, 95% CI: 0.811-0.961 for 1-year mortality, respectively). Covariate effect analyses showed that the use of H2RAs was more beneficial in essential hypertension patients with age ≥ 60, BMI ≥ 25 kg/m2, coronary arteriosclerosis, stroke, and acute kidney failure, respectively. In conclusion, H2RAs exposure was related to lower mortalities in critically ill patients with essential hypertension, which provided novel potential strategy for the use of H2RAs in essential hypertension patients.
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Affiliation(s)
- Jian-Mei Pan
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Yu Guo
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Fang-Fang Jiang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Ran Xu
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Xin Zhang
- Department of Respiratory, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Wen-Ke Cai
- Department of Cardiothoracic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Sun-Jun Yin
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Ping Wang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yan-Hua Huang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Xue-Sha Zhang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Yi-Hua Li
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Liao Cai
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Gong-Hao He
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Vincent MN, Jaggers J, Fiske C, Phillips EJ, Stollings JL. Amikacin SDRIFE on the basis of neomycin cross-reactivity managed with desensitization and treating through. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00239-4. [PMID: 38648976 DOI: 10.1016/j.anai.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Affiliation(s)
| | - Jordon Jaggers
- Department of Pharmacology, Vanderbilt University School of Medicine; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center; Institute for Immunology & Infectious Disease, Murdoch University.
| | - Christina Fiske
- Department of Pharmacology, Vanderbilt University School of Medicine; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center; Institute for Immunology & Infectious Disease, Murdoch University.
| | - Elizabeth J Phillips
- Department of Pharmacology, Vanderbilt University School of Medicine; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center; Institute for Immunology & Infectious Disease, Murdoch University.
| | - Joanna L Stollings
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.
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18
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Endo K, Mizuno K, Yoshida S, Kawakami K. Association Between Arterial Pulse Waveform Analysis and Mortality in Patients With Septic Shock: A Retrospective Cohort Study Using Japanese Diagnosis Procedure Combination Data. J Intensive Care Med 2024:8850666241246215. [PMID: 38634171 DOI: 10.1177/08850666241246215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Purpose: Specialized pressure transducers for arterial pulse waveform analysis (S-APWA) devices are dedicated kits connected to an arterial pressure catheter that monitors hemodynamic parameters, such as cardiac output, pulse pressure variation, and stroke volume variation, less invasively. While the association between the use of S-APWA devices and clinical outcomes in perioperative patients has been previously evaluated, its assessment in patients with septic shock remains inadequate. Materials and Methods: This retrospective cohort study utilized a nationwide Diagnosis Procedure Combination database in Japan. Adult patients with septic shock admitted to the intensive care unit (ICU) with arterial pressure catheter placement on the admission day from August 2012 to February 2021 were included. Hospitalizations meeting the eligibility criteria were categorized into groups based on S-APWA device usage. The primary outcome, evaluated using Cox regression analysis, was 30-day all-cause mortality in the propensity score overlap-weighted population. Secondary outcomes included in-hospital mortality, ICU duration, and overall hospital stay. Results: Among 5130 eligible hospitalizations, 643 were in the S-APWA group and 4487 were in the conventional pressure transducer group. Cox regression analysis within the propensity score overlap-weighted population showed no significant difference in 30-day mortality (adjusted hazard ratio: 0.94; 95% confidence interval: 0.9-1.38; P = .58). Logistic regression analysis indicated no significant differences in the in-hospital mortality. While the S-APWA group had prolonged ICU stays, no significant difference in the overall hospital stay was observed according to linear regression analyses. Conclusions: Our study found no significant association between S-APWA use and 30-day mortality in patients with septic shock. These findings offer insights into optimizing monitoring systems in ICUs.
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Affiliation(s)
- Koji Endo
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Reis Gomes VM, Pires MC, Delfino Pereira P, Schwarzbold AV, Gomes AGDR, Pessoa BP, Cimini CCR, Rios DRA, Anschau F, Nascimento FJM, Grizende GMS, Vietta GG, Batista JDL, Ruschel KB, Carneiro M, Reis MA, Bicalho MAC, Porto PF, Dos Reis PP, Araújo SF, Nobre V, Marcolino MS. AB 2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units. Respir Med 2024:107635. [PMID: 38641122 DOI: 10.1016/j.rmed.2024.107635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS It is a retrospective observational study, including consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from 09/2021 to 07/2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS From 558 patients, median age was 69 years (IQR 58-78), 56.3% were men, 19.7% required mechanical ventilation (MV), and 44.8% died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95% CI 0.744 to 0.819), good overall performance (Brier score=0.191) and an excellent calibration (slope=1.063, intercept=0.015, p-value=0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS The AB2CO score is a fast and easy tool to be used upon ICU admission.
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Affiliation(s)
- Virginia Mara Reis Gomes
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Magda Carvalho Pires
- Statistics Department, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.
| | - Polianna Delfino Pereira
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.
| | | | | | - Bruno Porto Pessoa
- Hospital Julia Kubitschek. R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil.
| | | | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor. Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | | | | | | | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS). R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Medical School, Federal University of Fronteira Sul, Rod. SC 484 - Km 02, Chapecó, Brazil; Hospital Regional do Oeste. R. Florianópolis, 1448 E, Chapecó, Brazil.
| | | | - Marcelo Carneiro
- Hospital Santa Cruz. R. Fernando Abott, 174, Santa Cruz do Sul, Brazil.
| | - Marco Aurélio Reis
- Hospital Risoleta Tolentino Neves. R. das Gabirobas, 01, Belo Horizonte, Brazil.
| | - Maria Aparecida Camargos Bicalho
- Fundação Hospitalar do Estado de Minas Gerais - FHEMIG. Cidade Administrativa de Minas Gerais, Edifício Gerais - 13º andar, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil.
| | - Paula Fonseca Porto
- Hospital Metropolitano Odilon Behrens. R. Formiga, 50, Belo Horizonte, Brazil.
| | | | | | - Vandack Nobre
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Milena Soriano Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil.
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20
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Freudiger K, Verweij L, Naef R. Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study. J Fam Nurs 2024:10748407241234262. [PMID: 38622871 DOI: 10.1177/10748407241234262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.
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Affiliation(s)
| | - Lotte Verweij
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
| | - Rahel Naef
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
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21
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Siddiqi N, Lammers D, Hu P, Stonko D, DuBose J, Hurst S, Hashmi Z, Morrison J, Betzold R. Comparison of Contralateral vs Ipsilateral Vein Graft for Traumatic Vascular Injury Repair: A Cohort From PROOVIT. Am Surg 2024:31348241246167. [PMID: 38621410 DOI: 10.1177/00031348241246167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Traumatic injury leading to arterial damage has traditionally been repaired using autologous vein graft from the contralateral limb. This often requires a secondary surgical site and the potential of prolonged operative time for patients. We sought to assess the use of ipsilateral vs contralateral vein grafts in patients who experienced traumatic extremity vascular injury. A multicenter database was queried to identify arterial injuries requiring operative intervention with vein grafting. The primary outcome of interest was need for operative reintervention. Secondary outcomes included risk of thrombosis, infection, and intensive care unit length of stay. 358 patients (320 contralateral and 38 ipsilateral) were included in the analysis. The ipsilateral vein cohort did not display a statistically significant decrease in need for reoperation when compared to the contralateral group (11% vs 23%; OR 0.41, 95% CI -0.07-1.3; P = .14). Contralateral repair was associated with longer median intensive care unit (ICU) LOS (4.3 vs 3.1 days; P < .01).
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Affiliation(s)
- Noreen Siddiqi
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Daniel Lammers
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Parker Hu
- Department of Surgery, Chippenham Hospital, Richmond, VA, USA
| | - David Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph DuBose
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Stuart Hurst
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Zain Hashmi
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Jonathan Morrison
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Richard Betzold
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
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22
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Gao J, Zhu Y, Wang W, Wang Z, Dong G, Tang W, Wang H, Wang Y, Harrison EM, Ma L. A comprehensive benchmark for COVID-19 predictive modeling using electronic health records in intensive care. Patterns (N Y) 2024; 5:100951. [PMID: 38645764 PMCID: PMC11026964 DOI: 10.1016/j.patter.2024.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 04/23/2024]
Abstract
The COVID-19 pandemic highlighted the need for predictive deep-learning models in health care. However, practical prediction task design, fair comparison, and model selection for clinical applications remain a challenge. To address this, we introduce and evaluate two new prediction tasks-outcome-specific length-of-stay and early-mortality prediction for COVID-19 patients in intensive care-which better reflect clinical realities. We developed evaluation metrics, model adaptation designs, and open-source data preprocessing pipelines for these tasks while also evaluating 18 predictive models, including clinical scoring methods and traditional machine-learning, basic deep-learning, and advanced deep-learning models, tailored for electronic health record (EHR) data. Benchmarking results from two real-world COVID-19 EHR datasets are provided, and all results and trained models have been released on an online platform for use by clinicians and researchers. Our efforts contribute to the advancement of deep-learning and machine-learning research in pandemic predictive modeling.
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Affiliation(s)
- Junyi Gao
- Centre for Medical Informatics, University of Edinburgh, EH16 4UX Edinburgh, UK
- Health Data Research UK, NW1 2BE London, UK
| | | | | | | | - Guiying Dong
- Peking University People’s Hospital, Beijing 100044, China
| | - Wen Tang
- Peking University Third Hospital, Beijing 100191, China
| | - Hao Wang
- Peking University, Beijing 100871, China
| | - Yasha Wang
- Peking University, Beijing 100871, China
| | - Ewen M. Harrison
- Centre for Medical Informatics, University of Edinburgh, EH16 4UX Edinburgh, UK
| | - Liantao Ma
- Peking University, Beijing 100871, China
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23
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Nguyen C, Singh G, Rubio K, Mclemore K, Kuschner W. Parenteral Nutrition in the Critically Ill Adult: A Narrative Review. J Intensive Care Med 2024:8850666241246748. [PMID: 38602149 DOI: 10.1177/08850666241246748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Malnutrition in adult intensive care unit patients is associated with poor clinical outcomes. Providing adequate nutritional support to the critically ill adult should be an important goal for the intensivist. This narrative review aims to delineate the role of parenteral nutrition (PN) in meeting nutritional goals. We examined the data regarding the safety and efficacy of PN compared to enteral nutrition. In addition, we describe practical considerations for the use of PN in the ICU including patient nutritional risk stratification, nutrient composition selection for PN, route of PN administration, and biochemical monitoring.
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Affiliation(s)
- Christopher Nguyen
- Pulmonary, Critical Care and Sleep Medicine Section, Veterans Affairs Palo Alto Health Care System, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gaurav Singh
- Pulmonary, Critical Care and Sleep Medicine Section, Veterans Affairs Palo Alto Health Care System, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Karen Rubio
- Department of Intensive Care Medicine, Kaiser Oakland Medical Center, Oakland, CA, USA
| | - Karen Mclemore
- Department of Intensive Care Medicine, Kaiser Oakland Medical Center, Oakland, CA, USA
| | - Ware Kuschner
- Pulmonary, Critical Care and Sleep Medicine Section, Veterans Affairs Palo Alto Health Care System, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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24
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Bogucki A, John I, Zinkiewicz Ł, Jachura M, Jaworski D, Suwała K, Chrost H, Wlodarski M, Kałużny J, Campbell D, Bakken P, Pandya S, Chrapkiewicz R, Manohar SG. Machine learning approach for ambient-light-corrected parameters and the Pupil Reactivity score in smartphone-based pupillometry. Front Neurol 2024; 15:1363190. [PMID: 38654735 PMCID: PMC11037402 DOI: 10.3389/fneur.2024.1363190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The pupillary light reflex (PLR) is the constriction of the pupil in response to light. The PLR in response to a pulse of light follows a complex waveform that can be characterized by several parameters. It is a sensitive marker of acute neurological deterioration, but is also sensitive to the background illumination in the environment in which it is measured. To detect a pathological change in the PLR, it is therefore necessary to separate the contributions of neuro-ophthalmic factors from ambient illumination. Illumination varies over several orders of magnitude and is difficult to control due to diurnal, seasonal, and location variations. Methods and results We assessed the sensitivity of seven PLR parameters to differences in ambient light, using a smartphone-based pupillometer (AI Pupillometer, Solvemed Inc.). Nine subjects underwent 345 measurements in ambient conditions ranging from complete darkness (<5 lx) to bright lighting (≲10,000 lx). Lighting most strongly affected the initial pupil size, constriction amplitude, and velocity. Nonlinear models were fitted to find the correction function that maximally stabilized PLR parameters across different ambient light levels. Next, we demonstrated that the lighting-corrected parameters still discriminated reactive from unreactive pupils. Ten patients underwent PLR testing in an ophthalmology outpatient clinic setting following the administration of tropicamide eye drops, which rendered the pupils unreactive. The parameters corrected for lighting were combined as predictors in a machine learning model to produce a scalar value, the Pupil Reactivity (PuRe) score, which quantifies Pupil Reactivity on a scale 0-5 (0, non-reactive pupil; 0-3, abnormal/"sluggish" response; 3-5, normal/brisk response). The score discriminated unreactive pupils with 100% accuracy and was stable under changes in ambient illumination across four orders of magnitude. Discussion This is the first time that a correction method has been proposed to effectively mitigate the confounding influence of ambient light on PLR measurements, which could improve the reliability of pupillometric parameters both in pre-hospital and inpatient care settings. In particular, the PuRe score offers a robust measure of Pupil Reactivity directly applicable to clinical practice. Importantly, the formulae behind the score are openly available for the benefit of the clinical research community.
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Affiliation(s)
| | - Ivo John
- Solvemed Inc., Lewes, DE, United States
| | | | | | - Damian Jaworski
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Karolina Suwała
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | | | - Jakub Kałużny
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Doug Campbell
- Space Medicine Group, International Institute for Astronautical Sciences, Boulder, CO, United States
| | - Paul Bakken
- Space Medicine Group, International Institute for Astronautical Sciences, Boulder, CO, United States
| | - Shawna Pandya
- Space Medicine Group, International Institute for Astronautical Sciences, Boulder, CO, United States
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25
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Yu J, Zhang K, Chen T, Lin R, Chen Q, Chen C, Tong M, Chen J, Yu J, Lou Y, Xu P, Zhong C, Chen Q, Sun K, Liu L, Cao L, Zheng C, Wang P, Chen Q, Yang Q, Chen W, Wang X, Yan Z, Zhang X, Cui W, Chen L, Zhang Z, Zhang G. Temporal patterns of organ dysfunction in COVID-19 patients hospitalized in the intensive care unit: A group-based multitrajectory modelling analysis. Int J Infect Dis 2024:107045. [PMID: 38604470 DOI: 10.1016/j.ijid.2024.107045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The course of organ dysfunction (OD) in Corona Virus Disease 2019 (COVID-19) patients is unknown. Herein, we analyse the temporal patterns of OD in intensive care unit-admitted COVID-19 patients. METHODS Sequential organ failure assessment scores were evaluated daily within 2 weeks of admission to determine the temporal trajectory of OD using group-based multitrajectory modelling (GBMTM). RESULTS 392 patients were enrolled with a 28-day mortality rate of 53.6%. GBMTM identified four distinct trajectories. Group 1 (mild OD, n=64), with a median APACHE II score of 13 (IQR 9-21), had an early resolution of OD and a low mortality rate. Group 2 (moderate OD, n=140), with a median APACHE II score of 18 (IQR 13-22), had a 28-day mortality rate of 30.0%. Group 3 (severe OD, n=117), with a median APACHR II score of 20 (IQR 13-27), had a deterioration trend of respiratory dysfunction and a 28-day mortality rate of 69.2%. Group 4 (extremely severe OD, n=71), with a median APACHE II score of 20 (IQR 17-27), had a significant and sustained OD affecting all organ systems and a 28-day mortality rate of 97.2%. CONCLUSIONS Four distinct trajectories of OD were identified, and respiratory dysfunction trajectory could predict nonpulmonary OD trajectories and patient prognosis.
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Affiliation(s)
- Jiafei Yu
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Department of Critical Care Medicine, People's Hospital of Haiyan, Zhejiang 314399, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Tianqi Chen
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Ronghai Lin
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China
| | - Qijiang Chen
- Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315699, China
| | - Chensong Chen
- Intensive Care Unit, Xiangshan First People's Hospital Medical and Health Group, Zhejiang, 315700, China
| | - Minfeng Tong
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Jianping Chen
- Department of Emergency Medicine, Dongyang People' Hospital of Wenzhou Medical university, Zhejiang, 322100, China
| | - Jianhua Yu
- Department of Critical Care Medicine, Longquan People's Hospital, Zhejiang, 323700, China
| | - Yuhang Lou
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Panpan Xu
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China
| | - Chao Zhong
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315699, China
| | - Qianfeng Chen
- Intensive Care Unit, Xiangshan First People's Hospital Medical and Health Group, Zhejiang, 315700, China
| | - Kangwei Sun
- Department of Emergency Medicine, Dongyang People' Hospital of Wenzhou Medical university, Zhejiang, 322100, China
| | - Liyuan Liu
- Department of Critical Care Medicine, Longquan People's Hospital, Zhejiang, 323700, China
| | - Lanxin Cao
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Cheng Zheng
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China
| | - Ping Wang
- Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315699, China
| | - Qitao Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Qianqian Yang
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Weiting Chen
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Department of Emergency and Intensive Care Unit, The First People's Hospital of Linhai, Taizhou, Zhejiang 317000, China
| | - Xiaofang Wang
- Department of Cardiovascular Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Zuxi Yan
- Department of Critical Care Medicine, People's Hospital of Haiyan, Zhejiang 314399, China
| | - Xuefeng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Jiaxing College School of Medicine, Jiaxing 314031, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Lin Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Key Laboratory of Multiple Organ Failure (Zhejiang University), Ministry of Education, Hangzhou 310009, China.
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26
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Snow TAC, Waller AV, Loye R, Ryckaert F, Cesar A, Saleem N, Roy R, Whittle J, Al-Hindawi A, Das A, Singer M, Brealey D, Arulkumaran N. Early dynamic changes to monocytes following major surgery are associated with subsequent infections. Front Immunol 2024; 15:1352556. [PMID: 38655251 PMCID: PMC11035723 DOI: 10.3389/fimmu.2024.1352556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background Post-operative infections are a common cause of morbidity following major surgery. Little is understood about how major surgery perturbs immune function leading to heightened risk of subsequent infection. Through analysis of paired blood samples obtained immediately before and 24 h following surgery, we evaluated changes in circulating immune cell phenotype and function across the first 24 h, to identify early immune changes associated with subsequent infection. Methods We conducted a prospective observational study of adult patients undergoing major elective gastrointestinal, gynecological, or maxillofacial surgery requiring planned admission to the post-anesthetic care unit. Patients were followed up to hospital discharge or death. Outcome data collected included mortality, length of stay, unplanned intensive care unit admission, and post-operative infections (using the standardized endpoints in perioperative medicine-core outcome measures for perioperative and anesthetic care criteria). Peripheral blood mononuclear cells were isolated prior to and 24 h following surgery from which cellular immune traits including activation and functional status were assessed by multi-parameter flow cytometry and serum immune analytes compared by enzyme-linked immunosorbent assay (ELISA). Results Forty-eight patients were recruited, 26 (54%) of whom developed a post-operative infection. We observed reduced baseline pre- and post-operative monocyte CXCR4 and CD80 expression (chemokine receptors and co-stimulation markers, respectively) in patients who subsequently developed an infection as well as a profound and selective post-operative increase in CD4+ lymphocyte IL-7 receptor expression in the infection group only. Higher post-operative monocyte count was significantly associated with the development of post-operative infection (false discovery rate < 1%; adjusted p-value = 0.001) with an area under the receiver operating characteristic curve of 0.84 (p < 0.0001). Conclusion Lower monocyte chemotaxis markers, higher post-operative circulating monocyte counts, and reduced co-stimulatory signals are associated with subsequent post-operative infections. Identifying the underlying mechanisms and therapeutics to reverse defects in immune cell function requires further exploration.
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Affiliation(s)
| | - Alessia V. Waller
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Richard Loye
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Francis Ryckaert
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Antonio Cesar
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Naveed Saleem
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Rudra Roy
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - John Whittle
- Centre for Anaesthesia, Critical Care & Pain Medicine, University College London, London, United Kingdom
| | - Ahmed Al-Hindawi
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Abhishek Das
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - David Brealey
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
- National Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Nishkantha Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
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27
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Çaklovica Küçükkaya I, Orhun G, Atahan Çağatay A, Kalaycı S, Esen F, Şahin F, Ağaçfidan A, Erturan Z. Comparison of Candida colonization in intensive care unit patients with and without COVID-19: First prospective cohort study from Turkey. Med Mycol 2024:myae035. [PMID: 38592959 DOI: 10.1093/mmy/myae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Candida species are the primary cause of fungal infections in intensive care units (ICUs). Despite the increasing prevalence of Candida-related infections, monitoring the progression of these infections from colonization in COVID-19 ICU patients lacks sufficient information. This study aims prospectively to compare 62 COVID-19 and 60 non-COVID-19 ICU patients from admission to discharge in terms of colonization development, rates, isolated Candida species, risk factors, and Candida infections during hospitalization. A total of 1464 samples collected at specific time intervals from various body sites [mouth, skin (axilla), rectal, and urine]. All samples were inoculated onto CHROMagar Candida and CHROMagar Candida Plus media, with isolates identified using MALDI-TOF MS. COVID-19 patients exhibited significantly higher colonization rates in oral, rectal, and urine samples compared to non-COVID-19 patients, (p<0.05). Among the Candida species, non-albicans Candida was more frequently detected in COVID-19 patients, particularly in oral (75.8%-25%; p<0.001) and rectal regions (74.19%-46.66%; p< 0.05). Colonization with mixed Candida species was also more prevalent in the oropharyngeal region (p<0.05). Mechanical ventilation and corticosteroid use emerged as elevated risk factors among COVID-19 patients (p<0.05). Despite the colonization prevalence, both COVID-19-positive and negative patients exhibited low incidences of Candida infections, with rates of 9.67% (n=6/62) and 6.67% (n=3/60), respectively. Consequently, although Candida colonization rates were higher in COVID-19 ICU patients, there was no significant difference in Candida infection development compared to the non-COVID-19 group. However, the elevated rate of non-albicans Candida isolates highlights potential future infections, particularly given their intrinsic resistance in prophylactic or empirical treatments if needed. Additionally, the high rate of mixed colonization emphasizes the importance of using chromogenic media for routine evaluation.
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Affiliation(s)
| | - Günseli Orhun
- Department of Anaesthesiology and Reanimation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Atahan Çağatay
- Department of Infectious Diseases and Clinical Microbiology Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sadık Kalaycı
- Genetics and Bioengineering Department, Faculty of Engineering Yeditepe University, Istanbul, Turkey
| | - Figen Esen
- Department of Anaesthesiology and Reanimation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fikrettin Şahin
- Genetics and Bioengineering Department, Faculty of Engineering Yeditepe University, Istanbul, Turkey
| | - Ali Ağaçfidan
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zayre Erturan
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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28
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Danesh V, Tellson A, Boehm LM, Stevens AB, Ogola GO, Shrestha A, Cho J, Jimenez EJ, Arroliga AC. Exploring the Association of Metabolic Syndrome with In-Hospital Survival of Older Patients Hospitalized with COVID-19: Beyond Chronological Age. J Gen Intern Med 2024:10.1007/s11606-024-08744-4. [PMID: 38587729 DOI: 10.1007/s11606-024-08744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Despite the variability and complexity of geriatric conditions, few COVID-19 reports of clinical characteristic prognostication provide data specific to oldest-old adults (over age 85), and instead generally report broadly as 65 and older. OBJECTIVE To examine metabolic syndrome criteria in adults across 25 hospitals with variation in chronological age. DESIGN AND PARTICIPANTS This cohort study examined 39,564 hospitalizations of patients aged 18 or older with COVID-19 who received inpatient care between March 13, 2020, and February 28, 2022. EXPOSURE ICU admission and/or in-hospital mortality. MAIN MEASURES Metabolic syndrome criteria and patient demographics were examined as risk factors. The main outcomes were admission to ICU and hospital mortality. KEY RESULTS Oldest old patients (≥ 85 years) hospitalized with COVID-19 accounted for 7.0% (2758/39,564) of all adult hospitalizations. They had shorter ICU length of stay, similar overall hospitalization duration, and higher rates of discharge destinations providing healthcare services (i.e., home health, skilled nursing facility) compared to independent care. Chronic conditions varied by age group, with lower proportions of diabetes and uncontrolled diabetes in the oldest-old cohort compared with young-old (65-74 years) and middle-old (75-84 years) groups. Evaluations of the effect of metabolic syndrome and patient demographics (i.e., age, sex, race) on ICU admission demonstrate minimal change in the magnitude of effect for metabolic syndrome on ICU admission across the different models. CONCLUSIONS Metabolic syndrome measures are important individual predictors of COVID-19 outcomes. Building on prior examinations that metabolic syndrome is associated with death and ARDS across all ages, this analysis supports that metabolic syndrome criteria may be more relevant than chronological age as risk factors for poor outcomes attributed to COVID-19.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Alaina Tellson
- Nursing Research, Baylor Scott & White Health, Dallas, TX, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan B Stevens
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gerald O Ogola
- Biostatistics, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Anisha Shrestha
- Data Core, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Jinmyoung Cho
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Alejandro C Arroliga
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Baylor Scott & White Health, Dallas, TX, USA
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29
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Shetty AS, Hoegger MJ, Das KK. Post-contrast abdominal magnetic resonance imaging of critically ill patients using compressed sensing free-breathing golden radial angle imaging. Diagn Interv Radiol 2024; 0:0-0. [PMID: 38578150 DOI: 10.4274/dir.2024.232646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Obtaining diagnostic-quality magnetic resonance imaging (MRI) of the abdomen in critically ill patients can be difficult due to challenges with breath-holding and the inability to follow technologist instructions. Protocols that harness advances in commercially available MRI techniques provide a potential solution, particularly using the golden radial angle sparse parallel (GRASP) technique for dynamic post-contrast T1-weighted imaging. The GRASP technique uses a combination of free-breathing, a stack-of-stars radial acquisition, and compressed sensing reconstruction acquired over several minutes to produce motion-free images at time points defined by the user; these include the non-contrast, arterial, venous, and delayed images, which are typical of abdominal MRI protocols. The three cases discussed herein illustrate the use of this technique in providing both exquisite image quality and diagnostic value in the care of critically ill patients with hepatopancreaticobiliary diseases. Our work aims to raise awareness of this technique and its utility in imaging patients who cannot hold their breath for dynamic T1-weighted post-contrast imaging.
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Affiliation(s)
- Anup S Shetty
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, United States
| | - Mark J Hoegger
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, United States
| | - Koushik K Das
- Washington University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, St. Louis, United States
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30
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Gokdemir GŞ, Gokdemir MT, Araç S, Yokuş B. Prognostic significance of the chemerin level in coronavirus disease 2019 patients. Medicine (Baltimore) 2024; 103:e37743. [PMID: 38579052 PMCID: PMC10994447 DOI: 10.1097/md.0000000000037743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
Increased serum chemerin levels have been reported in several inflammatory diseases. Few studies have investigated the relationship between chemerin and clinical features of COVID-19. Thus, chemerin may modulate the development and progression of COVID-19. We compared the serum chemerin concentration between patients with and without SARS-CoV-2 infection and its association with the severity and prognosis of COVID-19 pneumonia. This is a prospective, single-center, cross-sectional study. We enrolled COVID-19 patients who presented to our tertiary hospital and healthy controls. The COVID-19 patients were conducted and the dates of symptom onset were recorded. After admission to the hospital and stabilization, blood samples were obtained for routine hemogram, biochemistry, and chemerin. The chemerin level was 37.93 ± 17.3 ng/mL in patients followed in the ICU, 29.41 ± 12.79 ng/mL in inpatients, 30.48 ± 10.86 ng/mL in outpatients, and 25.12 ± 9.82 ng/mL in healthy controls. The difference between patients treated in the ICU and healthy controls was significant (P < .001). The high-sensitivity C-reactive protein (hs-CRP), ferritin, procalcitonin (PCT), and D-dimer levels were significantly higher in the intensive care unit (ICU) group (P < .001). Moreover, the chemerin level of patients who died was significantly higher than that of those who survived (P < .001). The chemerin level was increased in COVID-19 patients and also increased with increasing disease severity. The chemerin level was higher in the COVID-19 patients than healthy controls and was significantly higher in patients who died compared to those who did not.
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Affiliation(s)
- Gül Şahika Gokdemir
- Faculty of Medicine, Physiology Department, Mardin Artuklu University, Mardin, Turkey
| | - Mehmet Tahir Gokdemir
- Faculty of Medicine, Emergency Department, Mardin Artuklu University, Mardin, Turkey
| | - Songül Araç
- Emergency Department, University of Health Science, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Beran Yokuş
- Faculty of Veterinary, Biochemistry Department, Dicle University, Diyarbakir, Turkey
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Arslan K, Ates S. The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures. Nurs Crit Care 2024. [PMID: 38576118 DOI: 10.1111/nicc.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. AIM This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. METHODOLOGY This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. RESULTS In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). CONCLUSION The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. RELEVANCE FOR CLINICAL PRACTICE This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.
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Affiliation(s)
- Kubra Arslan
- S.B.Ü. Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Sebahat Ates
- Department of Nursing, Faculty of Health Sciences, Uskudar University, İstanbul, Turkey
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Dugan C, Weightman S, Palmer V, Schulz L, Aneman A. The impact of frailty and rapid response team activation on patients admitted to the intensive care unit: A case-control matched, observational, single-centre cohort study. Acta Anaesthesiol Scand 2024. [PMID: 38576212 DOI: 10.1111/aas.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/01/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Frailty is a multi-dimensional syndrome associated with mortality and adverse outcomes in patients admitted to the intensive care unit (ICU). Further investigation is warranted to explore the interplay among factors such as frailty, clinical deterioration triggering a medical emergency team (MET) review, and outcomes following admission to the ICU. METHODS Single-centre, retrospective observational case-control study of adult patients (>18 years) admitted to a medical-surgical ICU with (cases) or without (controls) a preceding MET review between 4 h and 14 days prior. Matching was performed for age, ICU admission diagnosis, Acute Physiology and Chronic Health Evaluation III (APACHE III) score and the 8-point Clinical Frailty Scale (CFS). Cox proportional hazard regression modelling was performed to determine associations with 30-day mortality after admission to ICU. RESULTS A total of 2314 matched admissions were analysed. Compared to non-frail patients (CFS 1-4), mortality was higher in all frail patients (CFS 5-8), at 31% vs. 13%, and in frail patients admitted after MET review at 33%. After adjusting for age, APACHE, antecedent MET review and CFS in the Cox regression, mortality hazard ratio increased by 26% per CFS point and by 3% per APACHE III point, while a MET review was not an independent predictor. Limitations of medical treatment occurred in 30% of frail patients, either with or without a MET antecedent, and this was five times higher compared to non-frail patients. CONCLUSION Frail patients admitted to ICU have a high short-term mortality. An antecedent MET event was associated with increased mortality but did not independently predict short-term survival when adjusting for confounding factors. The intrinsic significance of frailty should be primarily considered during MET review of frail patients. This study suggests that routine frailty assessment of hospitalised patients would be helpful to set goals of care when admission to ICU could be considered.
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Affiliation(s)
- Christopher Dugan
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Weightman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Vanessa Palmer
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Luis Schulz
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Anders Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Faculty of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Endo H, Okamoto H, Hashimoto S, Miyata H. Association Between In-hospital Mortality and the Institutional Factors of Intensive Care Units with a Focus on the Intensivist- to-bed Ratio: A Retrospective Cohort Study. J Intensive Care Med 2024:8850666241245645. [PMID: 38567432 DOI: 10.1177/08850666241245645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Purpose: To elucidate the relationship between in-hospital mortality and the institutional factors of intensive care units (ICUs), with a focus on the intensivist-to-bed ratio. Methods: A retrospective cohort study was conducted using a Japanese ICU database, including adult patients admitted between April 1, 2020 and March 31, 2021. We used a multilevel logistic regression model to investigate the associations between in-hospital mortality and the following institutional factors: the intensivist-to-bed ratios on weekdays or over weekends/holidays, different work shifts, hospital-to-ICU-bed ratio, annual-ICU-admission-to-bed ratio, type of hospital, and the presence of other medical staff. Results: The study population comprised 46 503 patients admitted to 65 ICUs. The in-hospital mortality rate was 8.1%. The median numbers of ICU beds and intensivists were 12 (interquartile range [IQR] 8-14) and 4 (IQR 2-9), respectively. In-hospital mortality decreased significantly as the intensivist-to-bed ratio at 10 am on weekdays increased: the average contrast indicated a 20% (95% confidence interval [CI]: 1%-38%) reduction when the ratio increased from 0 to 0.5, and a 38% (95% CI: 9%-67%) reduction when the ratio increased from 0 to 1. The other institutional factors did not present a significant effect. Conclusions: The intensivist-to-bed ratio at 10 am on weekdays had a significant effect on in-hospital mortality. Further investigation is needed to understand the processes leading to improved outcomes.
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Affiliation(s)
- Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroshi Okamoto
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Satoru Hashimoto
- Non Profit Organization, ICU Collaboration Network, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
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Ramos-Rincón JM, Pinargote-Celorio H, González-de-la-Aleja P, Sánchez-Payá J, Reus S, Rodríguez-Díaz JC, Merino E. Impact of influenza related hospitalization in Spain: characteristics and risk factor of mortality during five influenza seasons (2016 to 2021). Front Public Health 2024; 12:1360372. [PMID: 38628848 PMCID: PMC11018950 DOI: 10.3389/fpubh.2024.1360372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
Background Estimating the global influenza burden in terms of hospitalization and death is important for optimizing prevention policies. Identifying risk factors for mortality allows for the design of strategies tailored to groups at the highest risk. This study aims to (a) describe the clinical characteristics of hospitalizations with a diagnosis of influenza over five flu seasons (2016-2017 to 2020-2021), (b) assess the associated morbidity (hospitalization rates and ICU admissions rate), mortality and cost of influenza hospitalizations in different age groups and (c) analyze the risk factors for mortality. Methods This retrospective study included all hospital admissions with a diagnosis of influenza in Spain for five influenza seasons. Data were extracted from the Spanish National Surveillance System for Hospital Data from 1 July 2016 to 30 June 2021. We identified cases coded as having influenza as a primary or secondary diagnosis (International Classification of Diseases, 10th revision, J09-J11). The hospitalization rate was calculated relative to the general population. Independent predictors of mortality were identified using multivariable logistic regression. Results Over the five seasons, there were 127,160 hospitalizations with a diagnosis of influenza. The mean influenza hospitalization rate varied from 5/100,000 in 2020-2021 (COVID-19 pandemic) to 92.9/100,000 in 2017-2018. The proportion of influenza hospitalizations with ICU admission was 7.4% and was highest in people aged 40-59 years (13.9%). The case fatality rate was 5.8% overall and 9.4% in those aged 80 years or older. Median length of stay was 5 days (and 6 days in the oldest age group). In the multivariable analysis, independent risk factors for mortality were male sex (odds ratio [OR] 1.14, 95% confidence interval [95% CI] 1.08-1.20), age (<5 years: OR 1; 5-19 years: OR 2.02, 95%CI 1.17-3.49; 20-39 years: OR 4.11, 95% CI 2.67-6.32; 40-59 years: OR 8.15, 95% CI 5.60-11.87; 60-79 years: OR 15.10, 95% CI 10.44-21.84; ≥80 years: OR 33.41, 95% CI 23.10-48.34), neurological disorder (OR 1.97, 95% CI 1.83-2.11), heart failure (OR 1.85, 95% CI 1.74-1.96), chronic kidney disease (OR 1.33, 95% CI 1.25-1.41), chronic liver disease (OR 2.95, 95% CI 2.68-3.27), cancer (OR 1.85, 95% CI 1.48-2.24), coinfection with SARS-CoV2 (OR 3.17, 95% CI 2.34-4.28), influenza pneumonia (OR 1.76, 95% CI 1.66-1.86) and admission to intensive care (OR 7.81, 95% CI 7.31-8.36). Conclusion Influenza entails a major public health burden. People aged over 60-and especially those over 80-show the longest hospital stays. Age is also the most significant risk factor for mortality, along with certain associated comorbidities.
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Affiliation(s)
- José-Manuel Ramos-Rincón
- Internal Medicine Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Héctor Pinargote-Celorio
- Unit of Infectious Diseases, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pilar González-de-la-Aleja
- Unit of Infectious Diseases, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Preventive Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sergio Reus
- Unit of Infectious Diseases, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Juan-Carlos Rodríguez-Díaz
- Microbiology Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unit of Infectious Diseases, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Kanitkar T, Bakewell N, Dissanayake O, Symonds M, Rimmer S, Adlakha A, Lipman MCI, Bhagani S, Agarwal B, Sabin CA, Miller RF. Improving 1-Year Mortality Following Intensive Care Unit Admission in Adults with HIV: A 20-Year Observational Study. J Intensive Care Med 2024:8850666241241480. [PMID: 38563646 DOI: 10.1177/08850666241241480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Despite widespread use of combination antiretroviral therapy, people with HIV (PWH) continue to have an increased risk of admission to and mortality in the intensive care unit (ICU). Mortality risk after hospital discharge is not well described. Using retrospective data on adult PWH (≥18 years) admitted to ICU from 2000-2019 in an HIV-referral centre, we describe trends in 1-year mortality after ICU admission. METHODS One-year mortality was calculated from index ICU admission to date of death; with follow-up right-censored at day 365 for people remaining alive at 1 year, or day 7 after ICU discharge if lost-to-follow-up after hospital discharge. Cox regression was used to describe the association with calendar year before and after adjustment for patient characteristics (age, sex, Acute Physiology and Chronic Health Evaluation II [APACHE II] score, CD4+ T-cell count, and recent HIV diagnosis) at ICU admission. Analyses were additionally restricted to those discharged alive from ICU using a left-truncated design, with further adjustment for respiratory failure at ICU admission in these analyses. RESULTS Two hundred and twenty-one PWH were admitted to ICU (72% male, median [interquartile range] age 45 [38-53] years) of whom 108 died within 1-year (cumulative 1-year survival: 50%). Overall, the hazard of 1-year mortality was decreased by 10% per year (crude hazard ratio (HR): 0.90 (95% confidence interval: 0.87-0.93)); the association was reduced to 7% per year (adjusted HR: 0.93 (0.89-0.98)) after adjustment. Conclusions were similar among the subset of 136 patients discharged alive (unadjusted: 0.91 (0.84-0.98); adjusted 0.92 (0.84, 1.02)). CONCLUSIONS Between 2000 and 2019, 1-year mortality after ICU admission declined at this ICU. Our findings highlight the need for multi-centre studies and the importance of continued engagement in care after hospital discharge among PWH.
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Affiliation(s)
- Tanmay Kanitkar
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Nicholas Bakewell
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Oshani Dissanayake
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Maggie Symonds
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Stephanie Rimmer
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Amit Adlakha
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Marc C I Lipman
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, Division of Medicine, University College London, London, UK
- Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Sanjay Bhagani
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Banwari Agarwal
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Robert F Miller
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
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Eickholtz A, Mormol J, Kelley J, Mangione M, Pounders S, Groseclose R, Lypka M, Gibson C, Chapman A, Chadwick C, Krech L. The Effect of COVID-19 on Rib Fracture Patients in Michigan. Am Surg 2024:31348241241634. [PMID: 38565216 DOI: 10.1177/00031348241241634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study aims to compare outcomes of rib fracture patients with and without COVID-19 in Michigan. Data from the Michigan Trauma Quality Improvement Program (MTQIP) identified adults hospitalized from January 1, 2020, to October 31, 2022, with at least one rib fracture and a completed COVID-19 test on admission. Patients were propensity score matched 1:1 using 20 variables. The primary outcome was hospital length of stay (LOS). Secondary outcomes were mortality, ventilator days, intensive care unit (ICU) LOS, pneumonia, and ventilator-assisted pneumonia (VAP). 13,305 total patients were identified. 232 patients matched into both the COVID+ and COVID- groups. COVID was associated with increased LOS (7 days vs. 5 days, P < 0.001). There were no significant differences between the two groups when evaluating secondary outcomes. Our study indicates that although COVID-19 infection is associated with increased LOS, COVID may not contribute to additional morbidity or mortality in traumatic rib fracture patients.
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Affiliation(s)
- Allie Eickholtz
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Jeremy Mormol
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Jesse Kelley
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Madi Mangione
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Steffen Pounders
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Ryan Groseclose
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Matthew Lypka
- Scholarly Activity and Scientific Support, Corewell Health, Grand Rapids, MI, USA
| | - Charles Gibson
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Alistair Chapman
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Cathryn Chadwick
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Laura Krech
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
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Jensen S, Gallagher R, Sing R, Torres Fajardo R. Causes and Timing of Unplanned ICU Admissions Among Trauma Patients at a Level 1 Trauma Center. Am Surg 2024:31348241241659. [PMID: 38563045 DOI: 10.1177/00031348241241659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Unexpected ICU admissions are a key quality metric in trauma care. The purpose of this study is to identify the most common causes of unplanned ICU admissions among trauma patients at an ACS-verified level 1 trauma center. METHODS A retrospective review was conducted of all trauma patients with unplanned admission to the ICU at a level 1 trauma center between 2019 and 2021. Unplanned ICU admissions were categorized into (1) "bounce-backs," patients previously admitted to the ICU and (2) "upgrades," patients who had not previously been cared for in the ICU. RESULTS Of 300 unexpected ICU transfers, bounce-backs accounted for 69% and upgrades 31%. The most common injuries were traumatic brain injuries (40%) and rib fractures (41.3%). In-hospital mortality rate was 10% and did not significantly differ between bounce-backs and upgrades (12 vs 5%, P = .92). Respiratory distress was the most common cause of transfer (41.1%), followed by neurologic (29.6%) and cardiovascular decline (21.2%). Patients were on average 928 mL fluid positive 72 hours prior to transfer (t > 0, P < .0001), and 295 mL fluid positive in the 24 hours prior to transfer (t > 0, P .0003). Patients transferred for respiratory distress were no more fluid over-balanced than those transferred for other reasons. CONCLUSION We found a large percent of unplanned transfers occurring within 48 hours of admission or transfer out of the ICU suggesting under-triage as a leading cause of bounce-backs and upgrades. Respiratory distress was the leading cause of transfer. These findings highlight opportunities for targeted interventions.
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Affiliation(s)
- Stephanie Jensen
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Robert Gallagher
- School of Medicine, Des Moines University Medical School, West Des Moines, IA, USA
| | - Ronald Sing
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Gahramani S, Mahmoudi M, Nouri, Valiee S. Factors associated with the quality of dying and death and missed nursing care. Int J Palliat Nurs 2024; 30:190-198. [PMID: 38630644 DOI: 10.12968/ijpn.2024.30.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Patients in intensive care units need full nursing care due to the high mortality rate. However, some aspects of nursing care can be forgotten. AIMS To investigate the quality of death and dying and its association with aspects of missed nursing care, alongside the overall perception of nurses in intensive care units about factors associated with missed nursing care. METHODS This cross-sectional study used a census sampling method of 105 nurses working in intensive care units. In order to collect data, the Quality of Dying and Death Questionnaire (QODD), missed nursing care (MISSCARE survey) and factors associated with missed nursing care questionnaire were used. Data analysis was performed by using SPSS 16. FINDINGS The quality of death and dying, as perceived by nurses, was found to be lower than the average (Range score: 0 to 100). The range of missed nursing care was average (Range of score: 24 to 96) and the most noticeable reason for this missed nursing care was the shortage of nursing staff. CONCLUSION Managers should ensure that nurses provide complete nursing care for terminally ill patients in intensive care units and eliminate factors that lead to aspects of nursing care being missed, such as staffing levels, material resources and communication between staff members.
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Affiliation(s)
- Shahin Gahramani
- Students Research Committee, Kurdistan University of Medical Sciences, Iran
| | - Mokhtar Mahmoudi
- Assistant Professor, Clinical Care Research Center, Kurdistan University of Medical Sciences, Iran
| | - Nouri
- Associate Professor, Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Iran
| | - Sina Valiee
- Professor, Clinical Care Research Center; Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Iran
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Wenzel F, Whitaker IY. Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition. J Wound Care 2024; 33:271-277. [PMID: 38573900 DOI: 10.12968/jowc.2024.33.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.
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Affiliation(s)
- Fernanda Wenzel
- Hospital e Maternidade Escola Mario de Moraes Altenfelder Silva, São Paulo, SP, Brazil
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Ang L, Lin YK, Schroeder LF, Huang Y, DeGeorge CA, Arnold P, Akanbi F, Knotts S, DuBois E, Desbrough N, Qu Y, Freeman R, Esfandiari NH, Pop-Busui R, Gianchandani R. Feasibility and Performance of Continuous Glucose Monitoring to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit. J Diabetes Sci Technol 2024:19322968241241005. [PMID: 38563491 DOI: 10.1177/19322968241241005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND We evaluated the feasibility of real-time continuous glucose monitoring (CGM) for titrating continuous intravenous insulin infusion (CII) to manage hyperglycemia in postoperative individuals in the cardiovascular intensive care unit and assessed their accuracy, nursing acceptance, and postoperative individual satisfaction. METHODS Dexcom G6 CGM devices were applied to 59 postsurgical patients with hyperglycemia receiving CII. A hybrid approach combining CGM with periodic point-of-care blood glucose (POC-BG) tests with two phases (initial-ongoing) of validation was used to determine CGM accuracy. Mean and median absolute relative differences and Clarke Error Grid were plotted to evaluate the CGM accuracy. Surveys of nurses and patients on the use of CGMs experience were conducted and results were analyzed. RESULTS In this cohort (mean age 64, 32% female, 32% with diabetes) with 864 paired POC-BG and CGM values analyzed, mean and median absolute relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.7% of paired CGM and POC-BG were in Zones A and B of the Clarke Error Grid. Responses from nurses reported CGMs being very or quite convenient (n = 28; 93%) and it was favored over POC-BG testing (n = 28; 93%). Majority of patients (n = 42; 93%) reported their care process using CGM as being good or very good. CONCLUSION This pilot study demonstrates the feasibility, accuracy, and nursing convenience of adopting CGM via a hybrid approach for insulin titration in postoperative settings. These findings provide robust rationale for larger confirmatory studies to evaluate the benefit of CGM in postoperative care to improve workflow, enhance health outcomes, and cost-effectiveness.
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Affiliation(s)
- Lynn Ang
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yu Kuei Lin
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lee F Schroeder
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Yiyuan Huang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Christina A DeGeorge
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Patrick Arnold
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Folake Akanbi
- Division of Endocrinology and Metabolism, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Sharon Knotts
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth DuBois
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Desbrough
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yunyan Qu
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Regi Freeman
- Michigan Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Roma Gianchandani
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, Division of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Chang YL, Hsieh MJ, Pan CI, Shang ST, Tsai YF. Development and validation of a delirium care critical-thinking scale for intensive care unit nurses: A mixed-method study. J Clin Nurs 2024; 33:1387-1397. [PMID: 38240043 DOI: 10.1111/jocn.16997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/30/2023] [Accepted: 01/07/2024] [Indexed: 03/08/2024]
Abstract
AIM AND OBJECTIVES To develop a Delirium Care Critical-Thinking Scale for nurses caring for patients in the intensive care unit and examine the scale's psychometric properties. BACKGROUND There is a tool to evaluate nurses' critical thinking skills to determine nursing competency when delirium care is required. DESIGN This cross-sectional, mixed-methods study. METHODS The Delphi method was applied for collection and analysis of data during conceptualization and item generation of the tool (Phase I). Item analysis, assessment of validity and reliability of the scale (Phase II) involved 318 nurses recruited by convenience sampling from nine adult intensive care units in medicine and surgery at one medical centre. Confirmatory factor analysis assessed construct validity. Internal consistency and 2-week test-retest stability measured reliability. A Critical Thinking Disposition Inventory Scale examined concurrent validity. RESULTS After three rounds, the Delphi method resulted in 31 scale items. Item analysis demonstrated construct reliability ranged from 9.23 to 16.18. Confirmatory factor analysis eliminated one item and extracted five factors: applying knowledge, confirming the problem and accuracy of information, reasoning logically, choosing appropriate strategies and remaining open-minded. Average variance extracted values of all factors indicated good convergent validity. Cronbach's α for internal consistency was .96 with good test-retest reliability. The correlation coefficient for concurrent validity was .301. CONCLUSION The new Delirium Care Critical-Thinking Scale for intensive care nurses was demonstrated to be a reliable and valid tool for evaluating their ability to assess patients with delirium. RELEVANCE TO CLINICAL PRACTICE This new scale could be used to assess outcomes of education interventions and the effectiveness of nursing care quality involving patients with delirium in intensive and critical care units. REPORTING METHOD The COSMIN checklist was used as the reporting guideline for this study. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Yu-Ling Chang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Department of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-I Pan
- Department of Nursing, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shu-Ting Shang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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AlJohi A, Alohali A, Alsaeed S, Sakkijah HM, Obeid DA. Outcome of pregnant women admitted to critical care unit with confirmed severe COVID-19: A center experience. Saudi Med J 2024; 45:379-386. [PMID: 38657988 DOI: 10.15537/smj.2024.45.4.20240022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To explore the traits and risk factors of pregnant women admitted to intensive care units (ICUs) with COVID-19. Moreover, the study classifies outcomes based on differing levels of required respiratory support during their intensive care stay. METHODS This retrospective and descriptive study included all pregnant women with COVID-19 admitted to the adult critical care unit at a specialized tertiary hospital in Riyadh, Saudi Arabia. Between January 2020 and December 2022. A total of 38 pregnant women were identified and were eligible for our study. RESULTS The mean age of the patients was 32.9 (19-45) years, and the average Acute Physiology and Chronic Health Evaluation IV (APACHI IV) score was 49.9 (21-106). Approximately 60.5% of the patients suffered from superimposed infections during their ICU stay. Approximately 81.6% patients were delivered by C-section, 33 of the newborns survived, and 5 died. The crude mortality rate among pregnant women in our cohort was 15.8%. Patients treated with high-flow nasal cannula (HFNC) were mostly discharged or delivered normally, while the mechanical ventilation (MV) and extracorporeal membrane oxygenation groups mostly underwent C-sections. Most of the surviving newborns were on HFNC and MV. Patients with multiple infections had the longest ICU stay and had the highest risk of death. CONCLUSION The results of this study highlight the characteristics of pregnant women admitted to the ICU at a specialized tertiary healthcare center in Saudi Arabia. The APACHI IV scores accurately predicted patient's mortality, duration of MV, and length of ICU stay. In our study, we shared our experience of managing severe COVID-19 infections in pregnant patients.
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Affiliation(s)
- Amani AlJohi
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Alohali
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Saffanah Alsaeed
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Hussam M Sakkijah
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Dalia A Obeid
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Aghamohammadi D, Shakouri SK, Jahanpanah N, Dolatkhah N. Effects of adjuvant ozone autohemotherapy combined with routine treatment on clinical and paraclinical features of mechanically ventilated COVID-19 patients in the intensive care unit: a pilot randomized controlled trial. Med Gas Res 2024; 14:67-74. [PMID: 37929510 DOI: 10.4103/2045-9912.385439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Until the availability of an effective and practical vaccine, there is a serious need to recognize alternative treatments for coronavirus disease 2019 (COVID-19). This study aimed to determine whether major ozonated autohemotherapy (MOAH) can improve the clinical and paraclinical parameters in critically-ill patients with COVID-19 requiring mechanical ventilation. In this controlled trial, we enrolled 40 critically ill COVID-19 patients receiving invasive mechanical ventilation. The enrolled patients were then randomized into the MOAH and control groups. The patients in the MOAH group received MOAH three times per week (10 times in total) in addition to routine treatment and standard critical supportive care. Patients in the control group were only given regular treatment and standard critical supportive care. The patients in the MOAH group had more days of breathing with no aid than those in the control group. Moreover, the length of stay in the intensive-care unit was significantly lower in the MOAH group than in the control group. MOAH resulted in higher ventilation-free days and less intensive-care unit stay compared with the control treatment. In COVID-19 patients undergoing mechanical ventilation, MOAH with routine treatment resulted in more ventilator-free days and less intensive-care unit stay compared with the standard therapy.
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Affiliation(s)
- Dawood Aghamohammadi
- Palliative Care Medicine Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Kazem Shakouri
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Jahanpanah
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Daughtrey HR, Lee J, Boothroyd DB, Burnside GM, Shaw RJ, Anand KJS, Sanders LM. Stress Symptoms Among Children and Their Parents After ICU Hospitalization. J Intensive Care Med 2024; 39:328-335. [PMID: 37743757 DOI: 10.1177/08850666231201836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective: Child survival after intensive care unit (ICU) hospitalization has increased, yet many children experience acute stress that may precipitate mental/behavioral health comorbidities. Parents report stress after their child's hospitalization. Little is known about the individual and family characteristics that may moderate intergenerational relationships of acute stress. Design: Following ICU admission at a large academic medical center, a prospective cross-sectional cohort study assessed the associations between intergenerational characteristics and acute stress among children and families. Patients: Parent-child dyads (N = 88) were recruited from the pediatric ICU and pediatric cardiovascular ICU (CVICU) following ICU discharge. Eligible children were between 8 and 18 years old with ICU stays longer than 24 hours. Children with developmental delays were excluded. Caregivers were proficient in English or Spanish. Surveys were collected before hospital discharge. Measurements/Main Results: The primary outcome was "child stress" defined as a score≥17, measured by the Children's Revised Impact of Events Scale (CRIES-8). "Parent stress" was defined as an elevated composite score on the Stanford Acute Stress Reaction Questionnaire. We used validated scales to assess the child's clinical and family social characteristics. Acute stress was identified in 34 (39.8%) children and 50 (56.8%) parents. In multivariate linear regression analyses adjusting for social characteristics, parent stress was associated with increased risk of child stress (adjusted odds ratio 2.58, 95% confidence interval 0.69, 4.46, p < .01). In unadjusted analyses, Hispanic ethnicity was associated with greater child stress. In adjusted analyses, race, income, ICU length of stay, and language were not associated with child stress and did not moderate the parent-child stress relationship. Conclusions: Parent stress is closely correlated with child stress during ICU hospitalization. Hispanic ethnicity may be associated with increased risk for child stress, but further studies are required to define the roles of other social and clinical measures.
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Affiliation(s)
- Hannah R Daughtrey
- Pediatric Cardiac Critical Care Medicine, Children's National Heart Institute, Washington, DC, USA
| | - Justin Lee
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Derek B Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Georgiana M Burnside
- Pediatric Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA, USA
| | - Kanwaljeet J S Anand
- Pediatric Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA, USA
| | - Lee M Sanders
- Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA, USA
- Academic General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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45
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Shimada H, Matsuoka Y, Miyakoshi C, Ito J, Seo R, Ariyoshi K, Yamamoto Y, Mima H. Predictive performance of the sequential organ failure assessment score for in-hospital mortality in patients with end-stage kidney disease in intensive care units: A multicenter registry in Japan. Ther Apher Dial 2024; 28:305-313. [PMID: 37985004 DOI: 10.1111/1744-9987.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION There is limited evidence regarding whether the performance of the Sequential Organ Failure Assessment (SOFA) score differs between patients with and without end-stage kidney disease (ESKD) in intensive care units (ICUs). METHODS We used a multicenter registry (Japanese Intensive care Patient Database) to enroll adult ICU patients between April 2018 and March 2021. We recalibrated the SOFA score using a logistic regression model and evaluated its predictive ability in both ESKD and non-ESKD groups. The primary outcome was in-hospital mortality. RESULTS 128 134 patients were enrolled. The AUROC of the SOFA score was lower in the ESKD group than in the non-ESKD group [0.789 (95% CI, 0.774-0.804) vs. 0.846 (95% CI, 0.841-0.850)]. The calibration plot revealed good performance in both groups. However, it overestimated in-hospital mortality in ESKD groups. CONCLUSION The SOFA score demonstrated good predictive ability in patients with and without ESKD, but it overestimated the in-hospital mortality in ESKD patients.
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Affiliation(s)
- Hiroki Shimada
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chisato Miyakoshi
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Jiro Ito
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mima
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Chang W. Influence of severity of illnesses on risk of death in intensive care unit patients with severity of pressure injuries as mediating variable. Int Wound J 2024; 21:e14623. [PMID: 38149748 PMCID: PMC10961870 DOI: 10.1111/iwj.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
This study was to verify whether the severity of pressure injuries (PIs) in intensive care unit (ICU) patients plays a mediating role in the relationship between severity of their illnesses and risk of death. I examined adult patients admitted to the ICUs between 1 January 2014 and 31 August 2021. The average follow-up period was 11.34 months. A total of 390 ICU patients suffered from PIs. The influences of the APACHE II score of the ICU patients on the mediating variable 'unstageable & DTPIs vs. Stage 1&2 PIs' and on risk of death were significant. After controlling the influence of APACHE II score on risk of death, the influences of mediating variables 'Stage 3&4 PIs vs. Stage 1&2 PIs' and 'unstageable & DTPIs vs. Stage 1&2 PIs' on risk of death were also significant. The regression coefficient of APACHE II score of the ICU patients declined after the severity of PIs was included. The Sobel test on the indirect effects also reached the level of significance. The severity of illnesses is a factor that is beyond my control, severe PIs should still be prevented to lower the risk of death.
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Affiliation(s)
- Wen‐Pei Chang
- Department of NursingShuang Ho Hospital, Taipei Medical UniversityNew Taipei CityTaiwan
- School of NursingCollege of Nursing, Taipei Medical UniversityTaipeiTaiwan
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Bhattacharyay S, Beqiri E, Zuercher P, Wilson L, Steyerberg EW, Nelson DW, Maas AIR, Menon DK, Ercole A. Therapy Intensity Level Scale for Traumatic Brain Injury: Clinimetric Assessment on Neuro-Monitored Patients Across 52 European Intensive Care Units. J Neurotrauma 2024; 41:887-909. [PMID: 37795563 PMCID: PMC11005383 DOI: 10.1089/neu.2023.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Intracranial pressure (ICP) data from traumatic brain injury (TBI) patients in the intensive care unit (ICU) cannot be interpreted appropriately without accounting for the effect of administered therapy intensity level (TIL) on ICP. A 15-point scale was originally proposed in 1987 to quantify the hourly intensity of ICP-targeted treatment. This scale was subsequently modified-through expert consensus-during the development of TBI Common Data Elements to address statistical limitations and improve usability. The latest 38-point scale (hereafter referred to as TIL) permits integrated scoring for a 24-h period and has a five-category, condensed version (TIL(Basic)) based on qualitative assessment. Here, we perform a total- and component-score analysis of TIL and TIL(Basic) to: 1) validate the scales across the wide variation in contemporary ICP management; 2) compare their performance against that of predecessors; and 3) derive guidelines for proper scale use. From the observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, we extract clinical data from a prospective cohort of ICP-monitored TBI patients (n = 873) from 52 ICUs across 19 countries. We calculate daily TIL and TIL(Basic) scores (TIL24 and TIL(Basic)24, respectively) from each patient's first week of ICU stay. We also calculate summary TIL and TIL(Basic) scores by taking the first-week maximum (TILmax and TIL(Basic)max) and first-week median (TILmedian and TIL(Basic)median) of TIL24 and TIL(Basic)24 scores for each patient. We find that, across all measures of construct and criterion validity, the latest TIL scale performs significantly greater than or similarly to all alternative scales (including TIL(Basic)) and integrates the widest range of modern ICP treatments. TILmedian outperforms both TILmax and summarized ICP values in detecting refractory intracranial hypertension (RICH) during ICU stay. The RICH detection thresholds which maximize the sum of sensitivity and specificity are TILmedian ≥ 7.5 and TILmax ≥ 14. The TIL24 threshold which maximizes the sum of sensitivity and specificity in the detection of surgical ICP control is TIL24 ≥ 9. The median scores of each TIL component therapy over increasing TIL24 reflect a credible staircase approach to treatment intensity escalation, from head positioning to surgical ICP control, as well as considerable variability in the use of cerebrospinal fluid drainage and decompressive craniectomy. Since TIL(Basic)max suffers from a strong statistical ceiling effect and only covers 17% (95% confidence interval [CI]: 16-18%) of the information in TILmax, TIL(Basic) should not be used instead of TIL for rating maximum treatment intensity. TIL(Basic)24 and TIL(Basic)median can be suitable replacements for TIL24 and TILmedian, respectively (with up to 33% [95% CI: 31-35%] information coverage) when full TIL assessment is infeasible. Accordingly, we derive numerical ranges for categorising TIL24 scores into TIL(Basic)24 scores. In conclusion, our results validate TIL across a spectrum of ICP management and monitoring approaches. TIL is a more sensitive surrogate for pathophysiology than ICP and thus can be considered an intermediate outcome after TBI.
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Affiliation(s)
- Shubhayu Bhattacharyay
- Division of Anaesthesia, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Ewout W. Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - David W. Nelson
- Department of Physiology and Pharmacology, Section for Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - David K. Menon
- Division of Anaesthesia, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Ari Ercole
- Division of Anaesthesia, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- Cambridge Center for Artificial Intelligence in Medicine, Cambridge, United Kingdom
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Polastri M, Eden A, Swol J. Rehabilitation for adult patients undergoing extracorporeal membrane oxygenation. Perfusion 2024; 39:115S-126S. [PMID: 38651577 DOI: 10.1177/02676591231226289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND PURPOSE Current information on the latest rehabilitative practices is limited, with previous reviews only covering data up to October 2021, and some considering only patients on awake ECMO or with COVID-19. This review aims to present a concise overview of the latest findings on rehabilitation and highlight emerging trends for patients undergoing ECMO support. METHODS This integrative review was conducted by searching the National Library of Medicine - PubMed database. Two different search strings "extracorporeal membrane oxygenation" AND "rehabilitation" and "extracorporeal membrane oxygenation" AND "physiotherapy" were used to search the published literature. Articles that did not describe rehabilitation techniques, editorials, conference proceedings, letters to editor, reviews and research protocols were excluded. Studies conducted on pediatric populations were also excluded. The search process was completed in December 2023. RESULTS Thirteen articles were included in the final analysis. Eight hundred and thirty-nine patients aged between 27 and 63 years were included; 428 were men (51%). In 31% of the included studies, patients had COVID-19; nevertheless, rehabilitative activities did not differ from non-COVID-19 patients. In most studies, rehabilitation commenced within the first 48-96 h and consisted of progressive exercise and out-of-bed activities such as sitting, standing and walking. CONCLUSION Current practice focuses on rehabilitative protocols that incorporate exercise routines with progressive intensity, greater emphasis on out-of-bed activities, and a multidisciplinary approach to patient mobilization.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Allaina Eden
- Department of Rehabilitation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
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Liang P, Xie Y, Liu Z, Wang D, Li Q, Lu Y, Xue S, Wang Y, Chen S, Wu D, Fu J. Venetoclax and hypomethylating agents in critically ill patients with newly diagnosed acute myeloid leukaemia. Br J Haematol 2024; 204:1219-1226. [PMID: 38180132 DOI: 10.1111/bjh.19291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/10/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
Venetoclax (VEN) in combination with hypomethylating agents (HMAs) is considered the standard of treatment for individuals with newly diagnosed acute myeloid leukaemia (AML) who are ineligible for intensive chemotherapy. We conducted a retrospective analysis that encompassed 16 critically ill patients newly diagnosed with AML who were admitted to the intensive care unit (ICU) and received the VEN and HMA regimen. Among them, 13 were primary AML, and three were MDS-transformed AML. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 18.9, and the mean sepsis-related organ failure assessment score (SOFA) was 6.2. The average length of the ICU stay was 27.3 days. The median duration of VEN administration was 16 days. After the first course of VEN + HMA, 12 cases (75%) achieved complete remission (CR) or CR with incomplete haematological recovery (CRi). Among the five patients harbouring TP53 mutations, the overall response rate (ORR) was 90%. All patients experienced grade 3-4 haematological adverse events (AEs). With a median follow-up of 9.5 months (range: 0.5-23), the overall survival (OS) rate was 43.75%. TP53-wild patients and CR state after the first course of VEN-HMA indicated better survival. The combination of VEN and HMA has demonstrated a significantly elevated therapeutic response rate in newly diagnosed AML patients with critical illness.
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Affiliation(s)
- Peiqi Liang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Yan Xie
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Ziyi Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Dong Wang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Qian Li
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Yin Lu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Shengli Xue
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Ying Wang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Suning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Deipei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Jianhong Fu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
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Areskog Lejbman I, Torisson G, Resman F, Sjövall F. Beta-lactam antibiotic concentrations in critically ill patients with standard and adjusted dosages: A prospective observational study. Acta Anaesthesiol Scand 2024; 68:530-537. [PMID: 38407447 DOI: 10.1111/aas.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Antibiotic concentration target attainment is known to be poor in critically ill patients. Dose adjustment is recommended in patients with altered clearance, obesity and those with bacterial species with intermediate susceptibility. The aim of this study was to investigate the variation of antibiotic concentration in critically ill patients with standard or adjusted dosing regimens. METHODS The concentration of three beta-lactam antibiotics used in the intensive care unit (ICU) setting, cefotaxime, piperacillin/tazobactam, and meropenem, was measured in patients with confirmed or suspected infection. Mid-dose and trough values were collected during a single dosing interval. The pharmacokinetic endpoints were a free antibiotic concentration that, during the whole dosing interval, was above MIC (100% ƒT > MIC, primary endpoint) or above four times MIC (100% ƒT > 4MIC, secondary endpoint). Non-species related MIC breakpoints were used (1 mg/L for cefotaxime, 8 mg/L for piperacillin/tazobactam, and 2 mg/L for meropenem). RESULTS We included 102 patients (38 cefotaxime, 30 piperacillin/tazobactam, and 34 meropenem) at a single ICU, with a median age of 66 years. In total, 73% were males, 40% were obese (BMI ≥30) and the median SAPS 3 score was 63 points. Of all patients, 78 patients (76%) reached the primary endpoint (100%ƒT > MIC), with 74% for cefotaxime, 67% for piperacillin/tazobactam and 88% for meropenem. Target attainment for 100% ƒT > 4MIC was achieved in 40 (39%) patients, overall, with 34% for cefotaxime, 30% for piperacillin/tazobactam and 53% for meropenem. In patients with standard dose 71% attained 100%ƒT > MIC and 37% for 100%ƒT > 4MIC. All patients with reduced dose attained 100%ƒT > MIC and 27% attained 100% ƒT > 4MIC. In patients with increased dose 79% attained 100%ƒT > MIC and 48% 100%ƒT > 4MIC respectively. CONCLUSIONS Beta-lactam antibiotics concentration vary widely in critically ill patients. The current standard dosing regimens employed during the study were not sufficient to reach 100% ƒT > MIC in approximately a quarter of the patients. In patients where dose adjustment was performed, the group with increased dose also had low target attainment, as opposed to patients with dose reduction, who all reached target. This suggests the need for further individualization of dosing where therapeutic drug monitoring can be an alternative to further increase target attainment.
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Affiliation(s)
- Ilja Areskog Lejbman
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Fredrik Resman
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Fredrik Sjövall
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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