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1.
Ann Hematol ; 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32440790

RESUMO

Secondary hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal condition with various underlying disorders in adult patients and is diagnosed based on the HLH-2004 criteria, which were established based on experience in pediatric patients. However, few studies have prospectively evaluated the treatment outcomes and diagnostic performance of HLH criteria in adult patients with secondary HLH. Thus, we performed a single-center, prospective cohort study of adult patients with suspected HLH, and we analyzed treatment outcomes of patients enrolled between 2017 and 2019 as an interim analysis (ClinicalTrials.gov Identifier: NCT03117010). Of the 73 patients with suspected HLH, 70 patients completed the evaluation for ≥ 7 of the HLH-2004 criteria, and 55 patients were diagnosed with HLH (55/73, 75%). Although serum ferritin and fever had a sensitivity of more than 90%, both had exceptionally low specificity, whereas soluble CD25 had a sensitivity of more than 90% and specificity of 80%. Forty patients with malignancy-associated HLH had B cell (n = 19) or T- or NK-cell (n = 21) lymphoid malignancy, whereas 15 patients had non-malignant disorders. Non-malignancy-associated HLH had greater than 90% 1-year overall survival (OS) after diagnosis of HLH, whereas that for malignancy-associated HLH was less than 40%. In conclusion, our study showed promising treatment outcomes for patients enrolled in our prospective cohort study, and prospectively demonstrated the diagnostic performance of the HLH-2004 criteria in adult patients with suspected HLH. Given that lymphoma was the most common cause of HLH in adults, thorough evaluation for lymphoma should be performed in adults with suspected HLH.

2.
J Korean Med Sci ; 35(15): e101, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32301293

RESUMO

BACKGROUND: Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. METHODS: A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. RESULTS: During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65-0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77-0.88). CONCLUSION: In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.

3.
Eur J Cardiothorac Surg ; 57(2): 317-324, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504394

RESUMO

OBJECTIVES: Patients on extracorporeal life support (ECLS), like other critically ill patients, are transported to other institutions for various reasons. However, little has been reported concerning the characteristics and clinical outcomes of transported patients compared with those of in-house patients. METHODS: A total of 281 adult patients received ECLS between January 2014 and August 2016. Patients who underwent cannulation at another institution by our team were excluded. Patients were divided into 2 groups: transported group (N = 46) and in-house group (N = 235). All 46 patients were safely transported without serious adverse events. The mean travel distance was 206±140 km, with a mean travel time of 78 ± 57 min. Following propensity score matching, 44 transported patients were matched to 148 in-house patients. RESULTS: In the matched population, the mean age was 48 ± 13 years in the transported group and 49 ± 17 years in the in-house group (P = 0.70). The ECLS type (venoarterial/venovenous) comprised 35/9 (79.5/20.5%) in the transported group and 119/29 (80.4/19.6%) in the in-house group (P = 0.93). Seventeen (38.6%) extracorporeal cardiopulmonary resuscitations were performed in the transported group and 59 (39.9%) were performed in the in-house group (P = 0.91). The incidence of limb ischaemia and acute kidney injury was higher in the transported group (P = 0.007 and P = 0.001, respectively). However, the rate of survival to discharge did not differ between the groups (63.6% in the transported group vs 64.2% in the in-house group, P = 0.94) and there was no difference in overall mortality (P = 0.99). CONCLUSIONS: Although transported patients had more complications than in-house ECLS patients, clinical outcomes were comparable in the matched population. Transporting ECLS patients to an experienced centre may be justified based on our experience.

4.
Ther Adv Respir Dis ; 13: 1753466619888131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31736407

RESUMO

BACKGROUND: No data are available on the duration of time needed to assess the adequacy of lung function after stopping sweep gas for weaning of venovenous extracorporeal membrane oxygenation (ECMO). The objective of this study was to investigate changes in arterial blood gases (ABGs) during sweep gas off trials in patients receiving venovenous ECMO. METHODS: Data on patients receiving venovenous ECMO, with a weaning trial at least once, were collected prospectively from January 2012 through December 2017. Serial changes in ABGs during sweep gas off trial and clinical outcomes after weaning from venovenous ECMO were evaluated. RESULTS: Over the study period, 192 sweep gas off trials occurred in 93 patients: 115 (60%) failed and 77 (40%) were successful. During the trial, significant changes in blood gases were observed within 1 h in all patients. When serial ABGs were compared according to trial off results, there were no significant differences in the pH, PaCO2, and HCO3- trends across time points between successful and failed trials. However, PaO2 (70.6 versus 93.4 mmHg), SaO2 (91.9 versus 95.2%), and PaO2/FiO2 ratio (164.0 versus 233.4) were significantly lower in failed trials than successful trials within 1 h after stopping sweep gas. After 2 h of trial off, no significant change in blood gases was observed until the end of the trial. CONCLUSIONS: No change in blood gases was observed 2 h after stopping sweep gas in patients receiving venovenous ECMO. Based on our institutional experience, however, we suggest monitoring for 2 h or more after stopping sweep gas flow to assess if patients are ready for decannulation. The reviews of this paper are available via the supplemental material section.

5.
PLoS One ; 14(10): e0223323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31581263

RESUMO

There was a pandemic of influenza A (H1N1) in 2009; in Korea, there was also an H1N1 epidemic in 2016. We aim to investigate whether survival had improved in the setting of recent advances in intensive care unit (ICU) management. We conducted a retrospective analysis of acute respiratory failure patients with H1N1 influenza pneumonia in 2016 and 2009 respectively at two tertiary referral hospitals in Korea. A total of 28 patients were treated in 2016, and 34 in 2009. There was no significant difference in SOFA scores on ICU admission day. In-hospital mortality was significantly lower in patients of 2016 compared to those of 2009 (18% vs. 44% P = 0.028). By multivariable analyses, the treatment year 2016 was associated with a greater likelihood of survival. Compared to the patients treated in 2009, those treated in 2016 were one seventh as likely to die after adjusting for other clinical variables (hazard ratio for mortality, 0.15; 95% confidence interval. 0.03-0.63, P = 0.010). Improved survival in patients who underwent extracorporeal membrane oxygenation treatment (in-hospital mortality, 17% vs. 60%, P = 0.242) and decreased tidal volumes during mechanical ventilation (median 5.4 mL/kg vs. median 9.2 mL/kg, P = 0.018) were observed in 2016 compared to 2009. Treatment outcomes for patients with H1N1 acute respiratory failure improved from 2009 to 2016 in two tertiary referral centers in South Korea.

6.
Biomed Eng Online ; 18(1): 83, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345220

RESUMO

BACKGROUND: Electrical impedance tomography (EIT) has been used for functional lung imaging of regional air distributions during mechanical ventilation in intensive care units (ICU). From numerous clinical and animal studies focusing on specific lung functions, a consensus about how to use the EIT technique has been formed lately. We present an integrated EIT system implementing the functions proposed in the consensus. The integrated EIT system could improve the usefulness when monitoring of mechanical ventilation for lung protection so that it could facilitate the clinical acceptance of this new technique. METHODS: Using a custom-designed 16-channel EIT system with 50 frames/s temporal resolution, the integrated EIT system software was developed to implement five functional images and six EIT measures that can be observed in real-time screen view and analysis screen view mode, respectively. We evaluated the performance of the integrated EIT system with ten mechanically ventilated porcine subjects in normal and disease models. RESULTS: Quantitative and simultaneous imaging of tidal volume (TV), end-expiratory lung volume change ([Formula: see text]EELV), compliance, ventilation delay, and overdistension/collapse images were performed. Clinically useful parameters were successfully extracted including anterior/posterior ventilation ratio (A/P ratio), center of ventilation ([Formula: see text], [Formula: see text]), global inhomogeneity (GI), coefficient of variation (CV), ventilation delay and percentile of overdistension/collapse. The integrated EIT system was demonstrated to suggest an optimal positive end-expiratory pressure (PEEP) for lung protective ventilation in normal and in the disease model of an acute injury. Optimal PEEP for normal and disease model was 2.3 and [Formula: see text], respectively. CONCLUSIONS: The proposed integrated approach for functional lung ventilation imaging could facilitate clinical acceptance of the bedside EIT imaging method in ICU. Future clinical studies of applying the proposed methods to human subjects are needed to show the clinical significance of the method for lung protective mechanical ventilation and mechanical ventilator weaning in ICU.


Assuntos
Pulmão/fisiologia , Ventilação Pulmonar , Tomografia/métodos , Animais , Impedância Elétrica , Software , Suínos , Volume de Ventilação Pulmonar
7.
Pediatr Crit Care Med ; 20(7): e301-e310, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31162369

RESUMO

OBJECTIVES: Although several studies have reported outcome data on critically ill children, detailed reports by age are not available. We aimed to evaluate the age-specific estimates of trends in causes of diagnosis, procedures, and outcomes of pediatric admissions to ICUs in a national representative sample. DESIGN: A population-based retrospective cohort study. SETTING: Three hundred forty-four hospitals in South Korea. PATIENTS: All pediatric admissions to ICUs in Korea from August 1, 2009, to September 30, 2014, were covered by the Korean National Health Insurance Corporation, with virtually complete coverage of the pediatric population in Korea. Patients less than 18 years with at least one ICUs admission between August 1, 2009, and September 30, 2014. We excluded neonatal admissions (< 28 days), neonatal ICUs, and admissions for health status other than a disease or injury. The final sample size was 38,684 admissions from 32,443 pediatric patients. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The overall age-standardized admission rate for pediatric patients was 75.9 admissions per 100,000 person-years. The most common primary diagnosis of admissions was congenital malformation (10,897 admissions, 28.2%), with marked differences by age at admission (5,712 admissions [54.8%] in infants, 3,994 admissions [24.6%] in children, and 1,191 admissions [9.9%] in adolescents). Injury was the most common primary diagnosis in adolescents (3,248 admissions, 27.1%). The overall in-hospital mortality was 2,234 (5.8%) with relatively minor variations across age. Neoplasms and circulatory and neurologic diseases had both high frequency of admissions and high in-hospital mortality. CONCLUSIONS: Admission patterns, diagnosis, management, and outcomes of pediatric patients admitted to ICUs varied by age groups. Strategies to improve critical care qualities of pediatric patients need to be based on the differences of age and may need to be targeted at specific age groups.

8.
PLoS One ; 14(6): e0218196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167000

RESUMO

[This corrects the article DOI: 10.1371/journal.pone.0211240.].

9.
PLoS One ; 14(5): e0217641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150465

RESUMO

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Procedimentos Neurocirúrgicos/métodos , Trombose/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Radiologistas , Trombose/fisiopatologia , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/efeitos adversos
10.
Ann Thorac Surg ; 108(3): 749-755, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30981847

RESUMO

BACKGROUND: This study aimed to develop a risk prediction model for neurologic outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: Between May 2004 and April 2016, a total of 274 patients who underwent ECPR were included in this analysis. The primary outcome was neurologic status on discharge from the hospital, as assessed by Cerebral Performance Categories (CPC) scale. To develop a new predictive scoring system, backward stepwise elimination and a z-score-based scoring scheme were used on the basis of logistic regression analyses. RESULTS: A total of 95 patients (34.7%) survived until discharge. Of these, 78 patients (28.5%) had favorable neurologic outcomes (CPC scores of 1 or 2). In the multivariable logistic regression analysis, significant predictors of poor neurologic outcome included age older than 65 years, initial Sequential Organ Failure Assessment score greater than 13 points, first monitored arrest rhythm, low-flow time longer than 30 minutes, initial pulse pressure less than 25 mm Hg, initial mean arterial pressure less than 70 mm Hg, and serum glucose level greater than 300 mg/dL. There was also a significant interaction between age and low-flow time. The newly developed neurologic outcome score after ECPR (nECPR) more effectively predicted poor neurologic outcome (C-statistic, 0.867; 95% confidence interval, 0.823 to 0.912) than the former ECPR score (p = 0.019) and the survival after venoarterial ECMO score (p < 0.001). CONCLUSIONS: The investigators created a risk prediction model for neurologic outcomes using independent predictors and the interaction between age and low-flow time, and this new scoring system could predict early neurologic prognosis more effectively in ECPR-treated patients. It may be help guide decisions in ECPR management for intensivists, cardiovascular surgeons, or cardiologists.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/terapia , Doenças do Sistema Nervoso/etiologia , Centros Médicos Acadêmicos , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Seguimentos , Parada Cardíaca/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Valor Preditivo dos Testes , Curva ROC , República da Coreia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas
11.
PLoS One ; 14(4): e0214602, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947283

RESUMO

Recent studies showed that physical and/or neuropsychiatric impairments significantly affect long-term mortality of ICU survivors. We conducted this study to investigate that simplified measurement of physical function and level of consciousness at hospital discharge by attending nurses could predict long-term outcomes after hospital discharge. A retrospective analysis of prospectively and retrospectively collected data of 246 patients who received medical ICU treatment was conducted. We grouped patients according to physical function and level of consciousness measured by the simplified method at hospital discharge as follow; group A included patients with alert mental and capable of walking or moving by wheel chairs; group B included those with alert mental and bed-ridden status; and Group C included those with confused mental and bed-ridden status. The two-year survival rate after hospital discharge was compared. Of 246 patients, 157 patients were included in the analysis and there were 103 survivors after two-year follow up. Compared to non-survivors, survivors were more likely to be younger (P = 0.026) and have higher body mass index (P = 0.019) and no malignant disease (P = 0.001). There were no statistically significant differences in treatment modalities including medication, use of medical devices, and physical therapy between the survivors and non-survivors. The analysis showed significant differences in survival between the groups classified by physical function (P < 0.001) and level of consciousness (P < 0.01). Multivariate analysis showed that survival rate was significantly lower among the patients in group C than in those in group B or group A (P < 0.001). Simplified method to assess physical function and level of consciousness at hospital discharge can predict long-term outcomes of medical ICU survivors.


Assuntos
Unidades de Terapia Intensiva , Sobreviventes , Idoso , Cognição , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Locomoção , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
12.
J Korean Med Sci ; 34(9): e70, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30863267

RESUMO

Background: Admission blood glucose (BG) level is a predictor of mortality in critically ill patients with various conditions. However, limited data are available regarding this relationship in critically ill patients with cardiovascular diseases according to diabetic status. Methods: A total of 1,780 patients (595 with diabetes) who were admitted to cardiac intensive care unit (CICU) were enrolled from a single center registry. Admission BG level was defined as maximal serum glucose level within 24 hours of admission. Patients were divided by admission BG level: group 1 (< 7.8 mmol/L), group 2 (7.8-10.9 mmol/L), group 3 (11.0-16.5 mmol/L), and group 4 (≥ 16.6 mmol/L). Results: A total of 105 patients died in CICU (62 non-diabetic patients [5.2%] and 43 diabetic patients [7.9%]; P = 0.105). The CICU mortality rate increased with admission BG level (1.7%, 4.8%, 10.3%, and 18.8% from group 1 to group 4, respectively; P < 0.001). On multivariable analysis, hypertension, mechanical ventilator, continuous renal replacement therapy, acute physiology and chronic health evaluation II (APACHE II) score, and admission BG level significantly influenced CICU mortality in non-diabetic patients (group 1 vs. group 3: hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.47-7.44; P = 0.004; group 1 vs. group 4: HR, 6.56; 95% CI, 2.76-15.58; P < 0.001). However, in diabetic patients, continuous renal replacement therapy and APACHE II score influenced CICU mortality but not admission BG level. Conclusion: Admission BG level was associated with increased CICU mortality in critically ill, non-diabetic patients admitted to CICU but not in diabetic patients.


Assuntos
Glicemia/análise , Doenças Cardiovasculares/patologia , Complicações do Diabetes/patologia , APACHE , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Estado Terminal , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/patologia , Terapia de Substituição Renal
13.
Tuberc Respir Dis (Seoul) ; 82(3): 251-260, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30841015

RESUMO

BACKGROUND: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. METHODS: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). RESULTS: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen (FiO2) ratio was higher (97 vs. 61, p<0.001) while the median FiO2 was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. CONCLUSION: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

14.
Ann Thorac Surg ; 108(1): 176-182, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30836100

RESUMO

BACKGROUND: Limited data are available regarding mechanical ventilation strategies in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation (ECMO). METHODS: A retrospective analysis of acute respiratory distress syndrome patients on ECMO was conducted in 9 hospitals in Korea. Data on ventilator settings (pre-ECMO and 0, 4, 24, and 48 hours after ECMO) were collected. Based on the effect of the duration and intensity of mechanical ventilator on outcomes, time-weighted average values were calculated for ventilator parameters. RESULTS: The 56 patients included in the study had a mean age of 55.5 years. The hospital and 6-month mortality rates were 48.1% and 54.0%, respectively, with a median ECMO duration of 9.4 days. After initiation of ECMO, peak inspiratory pressure, above positive end-expiratory pressure, tidal volume, and respiration rate were reduced, while lung compliance did not change significantly. Before and during ECMO support, tidal volume and lung compliance were higher in 6-month survivors than in nonsurvivors. In Cox proportional models, both lung compliance (odds ratio, 0.961; 95% confidence interval, 0.928 to 0.995) and time-weighted average-lung compliance (odds ratio, 0.943; 95% confidence interval, 0.903 to 0.986) were significantly associated with 6-month mortality. Kaplan-Meier curves revealed that patients with higher lung compliance before ECMO had a longer survival time at the 6-month follow-up than did those with lower lung compliance. CONCLUSIONS: Lung compliance, whether before or during ECMO, may be an important predictor of outcome in acute respiratory distress syndrome patients receiving ECMO. However, this result requires confirmation in larger clinical studies.


Assuntos
Oxigenação por Membrana Extracorpórea , Complacência Pulmonar , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Idoso , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Respiração por Pressão Positiva Intrínseca , Modelos de Riscos Proporcionais , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Testes de Função Respiratória , Taxa Respiratória , Estudos Retrospectivos , Volume de Ventilação Pulmonar
15.
Circ J ; 83(4): 743-748, 2019 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-30773520

RESUMO

BACKGROUND: Data on the association between obesity and mortality in patients who require acute cardiac care are limited, so we investigated the effect of obesity on clinical outcomes in patients admitted to the cardiac intensive care unit (CICU). Methods and Results: We reviewed 2,429 eligible patients admitted to the CICU at Samsung Medical Center between January 2012 and December 2015. After excluding 197 patients with low body mass index (BMI) to adjust for the possibility of frailty, patients were divided into 3 categories: normal BMI (n=822), 18.5-22.9 kg/m2; moderate BMI (n=1,050), 23-27.4 kg/m2; and high BMI (n=360), ≥27.5 kg/m2. The primary outcome was 28-day mortality. Overall, 124 (2.6%) of 2,232 patients died during 28-day follow-up after CICU admission. The 28-day mortality was numerically lower in the moderate (4.5%) and high (5.3%) BMI groups than in the normal BMI group (7.1%), but the difference was not statistically significant (P=0.052). After multivariable adjustment, the moderate and high BMI categories were not significant predictors of primary outcome (adjusted hazard ratio [HR] 0.74, 95% CI 0.50-1.09, P=0.127 and adjusted HR 0.80, 95% CI 0.47-1.36, P=0.404, respectively). However, Acute Physiology and Chronic Health Evaluation II scores, liver cirrhosis, malignancy, history of cardiac arrest, and need for organ support treatment were independent predictors of 28-day mortality. CONCLUSIONS: Obesity was not associated with short-term mortality in patients requiring cardiac critical care.

16.
Ther Adv Respir Dis ; 13: 1753466618821038, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30803350

RESUMO

BACKGROUND: Bacterial pneumonia is a major cause of acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) support. However, it is unknown whether the type of pneumonia, community-acquired pneumonia (CAP) versus hospital-acquired pneumonia (HAP), should be considered when predicting outcomes for ARDS patients treated with ECMO. METHODS: We divided a sample of adult patients receiving ECMO for acute respiratory distress syndrome caused by bacterial pneumonia between January 2012 and December 2016 into CAP ( n = 21) and HAP ( n = 35) groups and compared clinical and bacteriological characteristics and outcomes. RESULTS: The median acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 22 and 8, respectively, in the CAP and HAP groups. The most commonly identified organism in the CAP group was Streptococcus pneumonia ( n = 12, 57.1%), while Acinectobacter baumanii was the most commonly identified in the HAP group ( n = 13, 37.1%). However, the incidence of multidrug resistant bacteria was not different between groups (57.1% versus 74.3%, p = 0.125). Of the 56 patients in the study, 26 were successfully weaned from ECMO, and 20 were discharged from the hospital. There were no significant differences in ECMO weaning rate (47.6% versus 45.7%, p > 0.999) or survival to discharge rate (33.3% versus 37.1%, p > 0.999) between the two groups. The 30-day and 90-day mortality rates were also similar. CONCLUSION: Patients with CAP and HAP who received ECMO for respiratory support had similar characteristics and clinical outcomes.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Associada a Assistência à Saúde/terapia , Pneumonia Bacteriana/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Idoso , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Farmacorresistência Bacteriana Múltipla , Feminino , Pneumonia Associada a Assistência à Saúde/epidemiologia , Pneumonia Associada a Assistência à Saúde/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/mortalidade , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/microbiologia , Estudos Retrospectivos , Taxa de Sobrevida
17.
PLoS One ; 14(1): e0211240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30677085

RESUMO

BACKGROUND: Intensive care unit (ICU) readmission is generally associated with increased hospital stays and increased mortality. However, there are limited data on ICU readmission in critically ill cancer patients. METHOD: We conducted a retrospective cohort study based on the prospective registry of all critically ill cancer patients admitted to the oncology medical ICU between January 2012 and December 2013. After excluding patients who were discharged to another hospital or decided to end-of-life care, we divided the enrolled patients into four groups according to the time period from ICU discharge to unexpected events (ICU readmission or ward death) as follows: no (without ICU readmission or death, n = 456), early (within 2 days, n = 42), intermediate (between 2 and 7 days, n = 64), and late event groups (after 7 days of index ICU discharge, n = 129). The independent risk factors associated with ICU readmission or unexpected death after ICU discharge were also analyzed using multinomial logistic regression model. RESULTS: There were no differences in the reasons for ICU readmission across the groups. ICU mortality did not differ among the groups, but hospital mortality was significantly higher in the late event group than in the early event group. Mechanical ventilation during ICU stay, tachycardia, decreased mental status, and thrombocytopenia on the day of index ICU discharge increased the risk of early ICU readmission or unexpected ward death, while admission through the emergency room and sepsis and respiratory failure as the reasons for index ICU admission were associated with increased risk of late readmission or unexpected ward death. Interestingly, recent chemotherapy within 4 weeks before index ICU admission was inversely associated with the risk of late readmission or unexpected ward death. CONCLUSION: In critically ill cancer patients, patient characteristics predicting ICU readmission or unexpected ward death were different according to the time period between index ICU discharge and the events.


Assuntos
Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva , Neoplasias/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Estudos de Coortes , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Alta do Paciente , Estudos Retrospectivos , Fatores de Risco
18.
PLoS One ; 14(1): e0210498, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30699150

RESUMO

There is conflicting evidence for the clinical benefit of statin therapy in patients with vasospastic angina (VSA). We investigated the association of statin therapy with clinical outcomes in relatively large populations with clinically suspected VSA from a nationwide population-based database. Data were collected from the Health Insurance Review and Assessment database records of 4,099 patients that were in an intensive care unit with VSA between January 1, 2008 and May 31, 2015. We divided the patients into a statin group (n = 1,795) and a non-statin group (n = 2,304). The primary outcome was a composite of cardiac arrest and acute myocardial infarction (AMI). The median follow-up duration was 3.8 years (interquartile range: 2.2 to 5.8 years). Cardiac arrest or AMI occurred in 120 patients (5.2%) in the statin group, and 97 patients (5.4%) in the non-statin group (P = 0.976). With inverse probability of treatment weighting, there was no significant difference in the rate of cardiac arrest or AMI between the two groups (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.76-1.30; P = 0.937), or even between the non-statin group and high-intensity statin group (adjusted HR, 1.08; 95% CI, 0.69-1.70; P = 0.75). The beneficial association of statin use with the primary outcome was consistently lacking across the various comorbidity types. Statin therapy was not associated with reduced cardiac arrest or AMI in patients with VSA, regardless of statin intensity. Prospective, randomized trials will be needed to confirm our findings.


Assuntos
Angina Pectoris/tratamento farmacológico , Vasoespasmo Coronário/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Seguro Saúde/estatística & dados numéricos , Adulto , Idoso , Angina Pectoris/complicações , Angina Pectoris/etnologia , Grupo com Ancestrais do Continente Asiático , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , /estatística & dados numéricos , Pontuação de Propensão , República da Coreia , Estudos Retrospectivos
19.
Crit Care ; 23(1): 1, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606235

RESUMO

BACKGROUND: Although the utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea. METHODS: This was a multicenter study on consecutive patients who underwent ECMO across 16 hospitals in Korea. The records of all patients who required ECMO for acute respiratory failure between 2012 and 2015 were retrospectively reviewed, and the utilization of ECMO was analyzed over time. RESULTS: During the study period, 5552 patients received ECMO in Korea as a whole, and a total of 2472 patients received ECMO at the participating 16 hospitals. We analyzed 487 (19.7%) patients who received ECMO for respiratory failure. The number of ECMO procedures provided for respiratory failure increased from 104 to 153 during the study period. The in-hospital survival rate increased from 30.8% to 35.9%. The use of prone positioning increased from 6.8% to 49.0% (p < 0.001), and the use of neuromuscular blockers also increased from 28.2% to 58.2% (p < 0.001). Multiple regression analysis showed that old age (OR 1.038 (95% CI 1.022, 1.054)), use of corticosteroid (OR 2.251 (95% CI 1.153, 4.397)), continuous renal replacement therapy (OR 2.196 (95% CI 1.135, 4.247)), driving pressure (OR 1.072 (95% CI 1.031, 1.114)), and prolonged ECMO duration (OR 1.020 (95% CI 1.003, 1.038)) were associated with increased odds of mortality. CONCLUSIONS: Utilization of ECMO and survival rates of patients who received ECMO for respiratory failure increased over time in Korea. The use of pre-ECMO prone positioning and neuromuscular blockers also increased during the same period.


Assuntos
Oxigenação por Membrana Extracorpórea/normas , Insuficiência Respiratória/terapia , APACHE , Idoso , Distribuição de Qui-Quadrado , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Estatísticas não Paramétricas , Taxa de Sobrevida/tendências , Resultado do Tratamento
20.
Rev. esp. cardiol. (Ed. impr.) ; 72(1): 40-47, ene. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182497

RESUMO

Introducción y objetivos: Este estudio investigó si la escala de vasoactivos inotrópicos (VIS) es un predictor independientemente de la mortalidad en el shock cardiogénico (SC). Métodos: Estudio observacional retrospectivo. Se estudió a los pacientes que ingresaron entre enero de 2012 y diciembre de 2015 en la unidad de cuidados intensivos cardiacos, y finalmente se incluyó a 493 pacientes con SC. Para cuantificar el apoyo farmacológico, se dividió a los pacientes en quintiles de VIS: 1-10, 11-20, 21-38, 39-85 y > 85 puntos. El objetivo primario fue la mortalidad hospitalaria. Resultados: La mortalidad hospitalaria de los quintiles de VIS, en orden creciente, fue del 8,2, el 14,1, el 21,1, el 32,0 y el 65,7% respectivamente (p < 0,001). El análisis multivariable indicó que los valores de VIS de 39-85 (ORa = 3,85; IC95%, 1,60-9,22; p = 0,003) y > 85 puntos (ORa = 10,83; IC95%, 4,43-26,43; p < 0,001) siguieron siendo predictores de mortalidad hospitalaria. En la regresión logística múltiple para eliminar cualquier efecto de confusión, se halló que la probabilidad de muerte (tratamiento solo médico frente a combinado con oxigenador extracorpóreo de membrana) se cruzaron entre sí cuando el valor de VIS era de 130 puntos. En contraste con la correlación lineal entre la VIS y la mortalidad de los pacientes tratados solo con terapia médica, hubo poca asociación entre VIS ≥ 130 puntos y la mortalidad hospitalaria de los pacientes tratados además con membrana de oxigenación extracorpórea. Conclusiones: Un alto grado de apoyo con vasoactivos inotrópicos durante las primeras 48 h se asocia significativamente con mayor mortalidad hospitalaria de pacientes adultos con SC


Introduction and objectives: This study investigated whether the vasoactive inotropic score (VIS) is independently predictive of mortality in cardiogenic shock (CS). Methods: This study was retrospective, observational study. Patients who were admitted to the cardiac intensive care unit from January 2012 to December 2015 were screened, and 493 CS patients were finally enrolled. To quantify pharmacologic support, the patients were divided into 5 groups based on a quintile of VIS: 1 to 10, 11 to 20, 21 to 38, 39 to 85, and > 85. The primary outcome was in-hospital mortality. Results: In-hospital mortalities in the 5 VIS groups in increasing order were 8.2%, 14.1%, 21.1%, 32.0%, and 65.7%, respectively (P < .001). Multivariable analysis indicated that VIS ranges of 39 to 85 (aOR, 3.85; 95%CI, 1.60-9.22; P = .003) and over 85 (aOR, 10.83; 95%CI, 4.43-26.43; P < .001) remained significant prognostic predictors for in-hospital mortality. With multiple logistic regression to remove any confounding effects, we found that the localized regression lines regarding the odds of death intersected each other's (medical therapy alone and combined extracorporeal membrane oxygenation group) path at VIS = 130. In contrast to linear correlation between VIS and mortality for patients treated with medical therapy alone, there was little association between a VIS of 130 or more and the probability of in-hospital mortality for patients who were treated with extracorporeal membrane oxygenation. Conclusions: A high level of vasoactive inotropic support during the first 48 hours was significantly associated with increased in-hospital mortality in adult CS patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Cardiotônicos/sangue , Choque Cardiogênico/diagnóstico , Oxigenação por Membrana Extracorpórea/métodos , Choque Cardiogênico/mortalidade , Fatores de Risco , Biomarcadores/análise , Cardiotônicos/efeitos adversos
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