Risk factors of prolonged intensive care after early activation of cardiosurgical patients
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Abstract:
The purpose of the study was to reveal the predictors of more than 24-hour intensive care unit stay for patients activated early (up to 5 hours) after surgery under extracorporeal circulation and to explore the possibilities of predicting the prolongation of postoperative intensive care in the clinical situation under examination. The protocols of anesthetic maintenance, early activation, and postoperative intensive care were analyzed in 83 patients (50 males and 33 females) aged 31 to 82 years, who had been operated on under extracorporeal circulation for various cardiosurgical diseases. The multiple regression analysis showed that the significant predictors of more prolonged intensive care after early activation were the level of arterial lactatemia (p = 0.0021), the dosages of adrenaline and/or noradrenaline (p = 0.0048), age (p = 0.0051), and female sex (p = 0.0142). It was shown that the multiple regression analysis could approximately predict the duration of intensive care after early activation. The predicted and actual durations of intensive care in patients with an intensive care unit stay length of more than 24 hours coincided in 52% of cases. In patients with an intensive care unit stay length of less than 24 hours, the estimated and actual durations of intensive care were in agreement in 92% of cases. It is concluded that it is expedient to take into account the results of the performed analysis in choosing the optimum postoperative management policy in cardiosurgical patients who are to undergo early activation.Keywords:
Extracorporeal circulation
Extracorporeal
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Background: Early mobilization of the Intensive Care Unit (ICU) patients improves muscle strength and functional capacity. It has been demonstrated that prevents Intensive Care Unit Acquired Weakness (ICUAW) and accelerates ICU discharge. However, data on mobilization early after cardiac surgery are inadequate. This study aimed to record early mobilization and investigates the association with ICU findings in cardiac surgery patients.Material and Methods: In this observational study, 165 patients after cardiac surgery were enrolled. Of these, 159 were assessed for early mobilization and mobilization status during ICU stay. Mobilization practices were recorded from 1st post ICU admission and every 48 h until 7th day. The duration of mechanical ventilation (MV) support, ICU length of stay and clinical outcome were recorded from medical records registration. Results: Early mobilization consisted of active and passive limb mobilization, sitting in bed and transferring from bed to chair. The proportion of patients mobilized, was 18% (n = 29/159) on day 1, 53% (n = 46/87) on day 3, 54% (n = 22/41) on day 5 and 62% (n = 15/24) on day 7. ICU length of stay was reduced for mobilized patients (n = 29) on day 1 compared to non-mobilized ones (24 ± 10 vs 47 ± 73 h respectively, P = 0.001). The duration of MV was shorter in mobilized patients on day 3 (n =46) compared to bedridden, (18 ± 9 vs 23 ± 30 h respectively, P = 0.01).Conclusions: Early mobilization after cardiac surgery was found to be low with a significant trend to increase over ICU stay. It is also associated with a reduced duration of MV and ICU length of stay.
Mobilization
Sitting
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Aims: In recent years, the number of surgical procedures performed in high-risk patients has increased, and the need for postoperative intensive care has also increased. In this study, it is aimed to identify the risk factors that can be used to estimate the need for intensive care stay of more than 1 day for patients with brain tumor resection.Methods: In this study, an open-accessible dataset was used, which included preoperative, perioperative, and intensive care follow-up data of 400 patients who were admitted to intensive care unit (ICU) after craniotomy due to brain tumor. The patients were divided into two groups according to the length of stay in the ICU. Patients who had less than a day stay were included in the short-term intensive care need (SICN) group and those staying more than 1 day were included in the long-term intensive care need (LICN). The effect of patients' data on ICU length of stay in ICU was investigated by logistic regression analysis.Results: Thirty-nine (9.75%) patients and 361 (90.25%) patients were assigned to the LICN group and SICN group, respectively. In the multivariate binary logistic regression model, the increase in total intravenous anesthesia (TIVA) and patient-controlled analgesia (PCA) applications decreases the patients' LICN likelihood while being intubated at ICU admission, need of mechanical ventilation (MV), postoperative hematoma formation, and increased duration of anesthesia increase the patients' LICN likelihood.Conclusions: The results of our study showed that the likelihood of patients' stay in ICU for more than 1 day could be estimated by such parameters as anesthesia duration, TIVA application, use of PCA device, being intubated at ICU admission, MV requirement, and postoperative hematoma formation.
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Hospital discharge
Acute care
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Abstract Background: Cardiac surgical patients with postoperative complications frequently require prolonged intensive care yet survive to hospital discharge. Methods: From January 1, 2002 to December 31, 2007, 11,541 consecutive patients underwent cardiac operations at a single academic institution. Of these, 11,084 (95.9%) survived to hospital discharge and comprised the study sample. Patients were retrospectively categorized into four groups according to intensive care unit (ICU) length of stay (LOS): <3 days, three to seven days, 7 to 14 days, and >14 days. Survival at 12 months was determined using the Social Security Death Index. Kaplan–Meier (KM) survival curves and Cox proportional hazards regression modeling (hazard ratio, HR) were used to analyze group differences in survival. Results: One-year survival among the four groups according to ICU LOS was: <3 days, 97.0% (8407/8666); three to seven days, 91.2% (1481/1625); 7 to 14 days, 87.9% (356/405); and >14 days, 68.3% (265/388) (p < 0.001). Using multivariable regression analysis, adjusted overall mortality was significantly greater in patients with ICU LOS of three to seven days (HR = 1.51), 7 to 14 days (HR = 1.40), and >14 days (HR = 1.90) compared to patients with ICU LOS <3 days. Mortality among patients who survived more than six months postsurgery was significantly greater in patients with ICU LOS of three to seven days (HR = 1.37), 7 to 14 days (HR = 1.34), and >14 days (HR = 1.63). Conclusions: Although cardiac surgery patients with major postoperative complications frequently survive to hospital discharge, survival after discharge is significantly reduced in patients requiring prolonged ICU care. Reduced survival in patients with a high risk of complications and anticipated long ICU stays should be considered when discussing surgical versus nonsurgical options. (J Card Surg 2012;27:13-19)
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This study aimed to examine the clinical characteristics, weaning pattern, and outcome of patients requiring prolonged mechanical ventilation in acute intensive care unit settings in a resource-limited country.This was a prospective single-center observational study in India, where all adult patients requiring prolonged ventilation were followed for weaning duration and pattern and for survival at both intensive care unit discharge and at 12 months. The definition of prolonged mechanical ventilation used was that of the National Association for Medical Direction of Respiratory Care.During the one-year period, 49 patients with a mean age of 49.7 years had prolonged ventilation; 63% were male, and 84% had a medical illness. The median APACHE II and SOFA scores on admission were 17 and 9, respectively. The median number of ventilation days was 37. The most common reason for starting ventilation was respiratory failure secondary to sepsis (67%). Weaning was initiated in 39 (79.5%) patients, with success in 34 (87%). The median weaning duration was 14 (9.5 - 19) days, and the median length of intensive care unit stay was 39 (32 - 58.5) days. Duration of vasopressor support and need for hemodialysis were significant independent predictors of unsuccessful ventilator liberation. At the 12-month follow-up, 65% had survived.In acute intensive care units, more than one-fourth of patients with invasive ventilation required prolonged ventilation. Successful weaning was achieved in two-thirds of patients, and most survived at the 12-month follow-up.
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Introduction: In recent years, with the implementation of new chemotherapy protocols, radiation and surgery, there was an improvement in cancer patient’s prognosis. However, both the treatment and the disease itself generate a series of complications, worsening clinical condition, which may lead to the need for admission to the intensive care unit (ICU). Physical therapy works on physical and functional recovery of these individuals, using manual and / or mechanical features, among them the cycle ergometer is gaining prominence, but there is in the literature any study evaluating the use of this technique in critical cancer patients. Objective: To evaluate the influence length of stay and type of treatment on hemodynamic behavior in response to an active cycle ergometer in cancer patients in intensive care. Methods: We performed a single active intervention cycle ergometer lower limb (no load) for 10 minutes. The variables included heart rate and mean arterial blood pressure and systolic blood pressure, which were evaluated in four stages: rest, 5 and10 minutes of activity and 10 minutes of recovery. Data on the patient and his or her medical history were previously obtained from their medical records. Results: The study included 23 patients, most were males; under the age of 65; hospital stays shorter than 14 days. It was observed that elderly patients, females, patients with a long hospital stay greater than 14 days, and patients in a clinical hospital showed higher variations in heart rate, mean arterial blood pressure and systolic blood pressure during the entire activity. Conclusion: The results of this study indicate that no individual had clinical complications during exercise. Hemodynamic changes occurred more frequently in the group of elderly patients, clinical and longer hospital stays.
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Medical record
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