Aerosplenism in the intensive care unit
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ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Zante B, Happ S, Haltmeier T, Schefold J. Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy. 2017;49(3). APA Zante, B., Happ, S., Haltmeier, T., & Schefold, J. (2017). Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy, 49(3). Chicago Zante, Bjoern, Sebastian Happ, Tobias Haltmeier, and Joerg C. Schefold. 2017. "Aerosplenism in the intensive care unit". Anaesthesiology Intensive Therapy 49 (3). Harvard Zante, B., Happ, S., Haltmeier, T., and Schefold, J. (2017). Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy, 49(3). MLA Zante, Bjoern et al. "Aerosplenism in the intensive care unit." Anaesthesiology Intensive Therapy, vol. 49, no. 3, 2017. Vancouver Zante B, Happ S, Haltmeier T, Schefold J. Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy. 2017;49(3).Background: The number of elderly patients admitted to the intensive care unit is constantly growing. However, a decision regarding intensive care in these populations remains a challenge. Aim: To identify factors that influences the decision of elderly patients and their families about whether to initiate intensive care in case of an acute event. Design/participants: Medical records of patients (>80 years), who were admitted to general wards and referred for intensive care, were retrospectively reviewed. Patients who received intensive care were compared with those not agreeing to the initiation of intensive care. Results: Among the 125 patients, 45 agreed to receiving intensive care. Baseline characteristics at the time of intensive care unit referral were similar between the intensive care and non-intensive care groups. Only one patient had advance directives before the intensive care unit referral. Lower economic status (odds ratio = 0.27, 95% confidence interval = 0.08–0.94) and cognitive impairment (odds ratio = 0.20, 95% confidence interval = 0.07–0.56) were found associated with a lower likelihood of agreeing to intensive care, while a large number of participants involved in the decision-making process were associated with a higher likelihood of intensive care unit use (odds ratio = 1.82, 95% confidence interval = 1.08–3.09). Mean duration of hospital stay was longer for the intensive care group as compared with the non-intensive care group (28.8 days and 19.8 days, respectively, p = 0.03). However, there was no significant difference in the survival rate. Conclusion: The initiation of intensive care in elderly patients was influenced not only by medical conditions but also by the patient’s economic status and the number of family members involved in the decision-making process.
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ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Zante B, Happ S, Haltmeier T, Schefold J. Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy. 2017;49(3). APA Zante, B., Happ, S., Haltmeier, T., & Schefold, J. (2017). Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy, 49(3). Chicago Zante, Bjoern, Sebastian Happ, Tobias Haltmeier, and Joerg C. Schefold. 2017. "Aerosplenism in the intensive care unit". Anaesthesiology Intensive Therapy 49 (3). Harvard Zante, B., Happ, S., Haltmeier, T., and Schefold, J. (2017). Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy, 49(3). MLA Zante, Bjoern et al. "Aerosplenism in the intensive care unit." Anaesthesiology Intensive Therapy, vol. 49, no. 3, 2017. Vancouver Zante B, Happ S, Haltmeier T, Schefold J. Aerosplenism in the intensive care unit. Anaesthesiology Intensive Therapy. 2017;49(3).
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Fungal infections are increasing nationwide, paralleling increases in the number of immunosuppressed hosts. Most of the candida infections seen in the intensive care unit are likely due to iatrogenic factors such as hyperalimentation, catheters, broad-spectrum antibiotics, and postprocedure complications that are prevalent in intensive care unit patients. Delays in appropriate therapy are common and may compromise care. Fortunately, the recognition of several clinical syndromes in the intensive care unit that require specialized treatment can improve outcomes. The issue of antifungal prophylaxis has to be balanced against issues of resistance, and current guidelines are reviewed here for prophylactic use of fluconazole only in selected intensive care unit patients. Finally, several new antifungal agents are available to treat the emerging resistant fungi, with better toxic/therapeutic ratios than in the past. Thus, there are an increasing number of safer and more effective options for treating fungal infections in the intensive care unit.
Antifungal drugs
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The most recent edition of the Acute Physiology and Chronic Health Evaluation provides a prediction of intensive care unit length of stay in addition to the probability of hospital mortality. Intensive care length of stay is an important determinant of intensive care costs and may be an important indicator of quality of care. Data were collected from 22 Scottish intensive care units over a 2‐year period to allow comparison of actual intensive care unit length of stay with that predicted by the Acute Physiology and Chronic Health Evaluation III system. Correlation between actual and predicted stay for individual patients was poor. However, performance of the model for patients, grouped either by predicted length of stay or by intensive care unit, indicated that the model stratified patient groups appropriately while demonstrating a consistent bias. Length of stay in Scottish intensive care units was found to be consistently lower than that predicted by a model which is based on intensive care practice in the USA. Variations in severity of illness in intensive care unit populations cannot readily explain differences in intensive care unit length of stay. The availability of a model capable of predicting length of intensive care stay, based on data reflecting practice in the UK, would compliment current methods of assessing effectiveness of intensive care.
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To assess variations in case-mix-adjusted hospital and intensive care unit length of stay and to examine the relationship between intensive care unit and hospital stay.Retrospective cohort study.Sixty-nine intensive and cardiac care units in 23 U.S. hospitals during 2002 to 2008.Intensive care unit admissions (202,300) who met inclusion criteria.None.We obtained hospital and intensive care unit characteristics and patient demographic, clinical, diagnostic, and physiologic variables, mortality, and lengths of stay. We developed and validated a model to assess case-mix-adjusted hospital stay and modified and updated a previously validated model to assess adjusted intensive care unit stay. We used these models to compare observed and expected hospital and intensive care unit stay for each patient by calculating the observed minus expected length of stay. Mean observed intensive care unit stay was 4.33 days and mean predicted intensive care unit stay was 4.09 days (5.9-hr difference); mean observed hospital stay was 9.93 days and mean predicted hospital stay was 9.52 days (9.7-hr difference). Observed minus expected intensive care unit and hospital length of stay were significantly shorter (p < .01) at one intensive care unit and significantly longer (p < .01) at nine intensive care units. There was a correlation between hospital and intensive care unit observed minus expected length of stay across individuals (R2 = .40), which was much stronger across units (R2 = .76).Case-mix-adjusted benchmarks for hospital and intensive care unit stays reveal substantial differences in unit efficiency. Hospital and intensive care unit stays are strongly correlated at the patient and unit level, suggesting that there are causal factors common to both.
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This study aimed to characterize which are the early determinants of immediate failure of the use of noninvasive mechanical ventilation (NIMV) outside the ICU.This prospective study included patients who were admitted to the Military Hospital in Guayaquil, Ecuador. Each variable was analyzed independently by using a multiple logistic regression model toward establishing an association with the event.A total of 249 cases of NIMV over a 10 year period of its application outside the ICU was included in the study. Fifty-five (22.10%) patients were transferred to the ICU, A multivariate analysis showed that the determinants of immediate NIMV failure outside the ICU were the following: age (OR: 1.12; P = 0.03); SBP (OR: 1.04; P = 0.001); HR (OR: 1.66; P < 0.0001); pCO₂ (OR: 1.16; P = 0.007); pO2 (OR: 1.35; P = 0.003); levels of IPAP (OR: 1.35; P < 0.0001); and the number of quadrants affected, as shown in a chest X-ray (OR: 1.40; P < 0.0001).The number of affected quadrants in a chest X-ray, tachyarrhythmia and hypoxemia may be useful in the initial decision in the use of NIMV outside the ICU. High values of IPAP, the persistence of elevated pCO₂, arterial hypotension, and age could be useful as a second screening associated with immediate NIMV failure outside the ICU.
Noninvasive Ventilation
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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.
Extracorporeal circulation
Extracorporeal
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Context: Iatrogenic injuries are very common in critically ill adults. However, the financial implications of these events are incompletely understood. Objective: To determine the costs of adverse events in patients in the medical intensive care unit and in the cardiac intensive care unit. Design, Setting, and Patients: We performed a matched case-control analysis on data collected during a prospective 1-yr observation study (July 2002 to June 2003) of medical intensive care unit and cardiac intensive care unit patients at an academic, tertiary care urban hospital. A total of 108 cases were matched with 375 controls in our study. Main Outcome Measures: Costs of care and lengths of stay were determined from hospital billing systems for patients in the medical and cardiac intensive care units. We then determined the incremental costs and lengths of stay for patients with adverse events compared with patients without events while in the intensive care unit. Costs were truncated for patients with a second adverse event on a subsequent day during the intensive care unit stay. Results: For 56 medical intensive care unit patients, the cost of an adverse event was $3,961 (p = .010) and the increase in length of stay was 0.77 days (p = .048). This extrapolated to annual costs of $853,000 for adverse events in the medical intensive care unit. Similarly, for 52 cardiac intensive care unit patients, the cost of an adverse event was $3,857 (p = .023), corresponding to $630,000 in annual costs. On average, patients with events in the cardiac intensive care unit had an increase of 1.08 days in length of stay (p = .003). Conclusions: Patients who require intensive care are especially at risk for adverse events, and the associated costs with such events are substantial. The costs of adverse events may justify further investment in prevention strategies.
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Background and Purpose of the study: Hyperglycemia and insulin resistance are common findings among critically ill patients. Intensive insulin therapy reduces morbidity and mortality in patients of surgical and medical intensive care units (ICUs), but its role in patients of general intensive care units still remains unknown. The present study was designed to determine the effect of intensive insulin therapy on ICU mortality. Methods: Adult patients admitted to general intensive care units in Valiy-e- Asr Hospital, who required intensive care for at least five days were considered for a prospective, randomized and control study. On admission, patients were randomly chosen either to normalize their blood glucose levels or to prepare them for conventional therapy. Results: Intensive insulin therapy reduced blood glucose levels of 129 patients but did not have any significant effect on reduction of mortality rate of hospitalized patients (30.6% in the conventional-treatment group vs. 38.8% in the intensive-treatment group, p > 0.05). However, the morbidity rate was significantly plummeted as a consequence of acceleration in the process of weaning of the patient from mechanical ventilation, and subsequently discharging from the ICU. The benefit of intensive insulin therapy was attributed to its effect on mortality among patients who remained in the intensive care unit for more than five days (78.9% conventionaltreatment group vs. 46.2% intensive-treatment group, p = 0.04). Conclusion: Intensive insulin therapy significantly reduced morbidity but not mortality among the patients in general intensive care units. The very possible risk of subsequent diseaseassociated and fatal complications was reduced in patients who were treated for five days or longer time. Further studies are required to confirm these preliminary results.
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