Clinical Mortality in a Large COVID-19 Cohort: Observational Study
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Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic.We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non-intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls.A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, at 15 Northwell Health hospitals. The findings for these patients were abstracted into a database and statistically analyzed.Of 2634 patients who died of COVID-19, 1478 (56.1%) had oxygen saturation levels ≥90% on presentation and required no respiratory support. At least one RRT/CA was called on 1112/2634 patients (42.2%) at a non-ICU level of care. Before the RRT/CA call, the most recent oxygen saturation levels for 852/1112 (76.6%) of these non-ICU patients were at least 90%. At the time the RRT/CA was called, 479/1112 patients (43.1%) had an oxygen saturation of <80%.This study represents one of the largest reviewed cohorts of mortality that also captures data in nonstructured fields. Approximately 50% of deaths occurred at a non-ICU level of care despite admission to the appropriate care setting with normal staffing. The data imply a sudden, unexpected deterioration in respiratory status requiring RRT/CA in a large number of non-ICU patients. Patients admitted at a non-ICU level of care suffered rapid clinical deterioration, often with a sudden decrease in oxygen saturation. These patients could benefit from additional monitoring (eg, continuous central oxygenation saturation), although this approach warrants further study.Keywords:
Oxygen Saturation
Pandemic
Medical record
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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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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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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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Objective:The aim of this study was to describe in a gender specific perspective, demographic data from adult patients that have been treated in an intensive care unit.Background:Many studies show that there are differences between men and women when it comes to different aspects of health care. The knowledge of these differences is limited when relating to intensive care in Sweden.Method:Demographic data registered in the Swedish intensive care register including all intensive care cases during the year of 2009 (n=695) in an intensive care unit in a hospital in southern Sweden was analyzed. A group comparison between the sexes was made with the following variables: number of patients admitted, length of stay in the ICU, SAPS 3 (Simplified Acute Physiology Score) points, the five most common diagnosis, mortality and mortality per diagnosis.Results:The study showed an over-representation of men (62,2 %, p<0.001) in number of intensive care patients. The mortality was 9,9% overall and significantly higher amongst men (11,8 %), compared with women (6,8 %, p=0.034). There were no differences between the sexes in length of stay, diagnosis, SAPS 3 points and mortality per diagnosis.Conclusions:This study has shown that more men than women are treated in the intensive care unit and that more men die during their time in the intensive care unit.
SAPS II
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Aim: This research is a descriptive study which has been carried out to investigate experiences lived by the patients in intensive care unit and the factors that affect these experiences. admitted to the coronary intensive care units and the intensive care units of the thoracic and cardiovascular surgery of the two different university hospital in Aegean zone, who transferred to the clinic after staying at least 24 hours in the intensive care unit. In collecting the data, the information form related to the socio-demographic characteristics and The Intensive Care Experience Scale which has been developed by Rattray et al 2004 and studied reliability and validity of the Turkish version by Demir et al 2009 were used. Results: The mean age of the patients in the study was 54.3±11.5, 53.9% of them were men, 72.4% were married, and 34.2% were primary school graduates. It was determined that 52.6% of the patients had ventilated during their stay in the intensive care unit, their duration of stay in the intensive care unit were 3.5±1.4 days. It was found that the total scale score was 57.7±5.5, there was a decreasing in the lived negative experiences while the patient’s age increased p
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