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2.
Intensive Crit Care Nurs ; 62: 102967, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33162312

RESUMO

INTRODUCTION: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS: Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.


Assuntos
/enfermagem , Enfermagem de Cuidados Críticos , Cuidados Pós-Operatórios/enfermagem , Insuficiência Respiratória/enfermagem , Sepse/enfermagem , Choque Cardiogênico/enfermagem , Carga de Trabalho , APACHE , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bélgica , Terapia de Substituição Renal Contínua/enfermagem , Feminino , Humanos , Higiene , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Mortalidade , Movimentação e Reposicionamento de Pacientes/enfermagem , Enfermeiras e Enfermeiros , Cuidados de Enfermagem/estatística & dados numéricos , Posicionamento do Paciente/enfermagem , Respiração Artificial/enfermagem , Estudos Retrospectivos , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(49): e23361, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285716

RESUMO

This retrospective study aimed to investigate the efficacy and safety of existing approach of ulinastatin for the treatment of severe sepsis (SS).A total of 130 eligible patients with SS were included in this study. We divided them into an intervention group (n = 65) and a control group (n = 65). Patients in both groups received conventional therapy. In addition, patients in the intervention group received ulinastatin for 7 days. Outcomes were measured by Acute Physiology and Chronic Health Evaluation II (APACHE II), Multiple Organ Failure (MOF), Glasgow Coma Scale (GCS), CD3, CD4, CD8, CD4/CD8, and adverse events. We assessed all outcomes before and after treatment.After treatment, patients in the intervention group showed better improvement in APACHE II (P < .01), MOF (P < .01), GCS (P < .01), CD3 (P = .03), CD4 (P = .03), and CD4/CD8 (P < .01), than those of patients in the control group. There are similar safety profiles between both groups.This study suggests that ulinastatin may be beneficial for SS. Future studies are still needed to warrant the results of this study.


Assuntos
Glicoproteínas/uso terapêutico , Sepse/tratamento farmacológico , Inibidores da Tripsina/uso terapêutico , APACHE , Feminino , Escala de Coma de Glasgow , Glicoproteínas/administração & dosagem , Glicoproteínas/efeitos adversos , Humanos , Masculino , Insuficiência de Múltiplos Órgãos , Estudos Retrospectivos , Sepse/imunologia , Inibidores da Tripsina/administração & dosagem , Inibidores da Tripsina/efeitos adversos
4.
Medicine (Baltimore) ; 99(49): e23472, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285748

RESUMO

The aim of this study was to determine the factors that are associated with prolonged mechanical ventilation in elderly patients.Retrospective cohort studySingle tertiary hospital in JapanWe retrospectively identified 228 patients aged 75 years or older who were admitted to a single tertiary care center in Japan between January 1, 2014 and December 31, 2017 because of endogenous diseases and underwent mechanical ventilation.The primary outcome was extubation difficulty, which was defined as the need for mechanical ventilation for more than 14 days after intubation, reintubation within 72 hours after extubation, tracheotomy or extubation, or death within 14 days after intubation.A multivariate analysis showed that age (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.66-1.38; P = .80), gender (OR = 0.56; 95%CI = 0.27-1.17; P = .13), body mass index (BMI) (OR = 1.05; 95%CI = 0.98-1.14; P = .16), smoking history (OR = 0.64; 95%CI = 0.29-1.41; P = .27), Activities of daily living (ADL) (OR = 0.95; 95%CI = 0.49-1.83; P = .87), and modified acute physiology and chronic health evaluation (APACHE) II score (OR = 1.02; 95%CI = 0.95-1.09; P = .61) were not statistically significantly different. However, there were statistically significant differences in extubation difficulty between patients with diabetes mellitus (OR = 2.3; 95%CI = 1.01-5.12; P = .04) and those with cardiovascular disease diagnosis on admission (OR = 0.31; 95%CI = 0.1-0.97; P = .04).Diabetes mellitus and cardiovascular disease diagnosis on admission were factors that were associated with prolonged mechanical ventilation in the elderly. The results of this study may help to support shared decision making with patients or surrogate decision makers at the start of intensive care in the elderly.


Assuntos
APACHE , Avaliação Geriátrica/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Extubação/efeitos adversos , Índice de Massa Corporal , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/terapia , Cuidados Críticos , Complicações do Diabetes/complicações , Complicações do Diabetes/terapia , Serviço Hospitalar de Emergência , Feminino , Humanos , Japão , Tempo de Internação , Masculino , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
5.
Medicine (Baltimore) ; 99(50): e23444, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327275

RESUMO

This study aimed to investigate the correlation of long non-coding RNA taurine upregulated gene 1 (lncRNA TUG1) with microRNA-223 (miR-223) as well as their associations with risk, severity, and mortality of sepsis.Totally122 sepsis patients and 122 healthy controls were enrolled. Plasma lncRNA TUG1 and miR-223 levels were detected by reverse transcription quantitative polymerase chain reaction. General severity of sepsis was assessed within 24 hours after admission using acute pathologic and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score. Patients were intensively followed up until death or 28 days after enrollment to assess mortality.LncRNA TUG1 expression was decreased (P < .001) but miR-223 expression (P < .001) was elevated in sepsis patients. Additionally, a negative correlation of lncRNA TUG1 expression with miR-223 expression was observed in sepsis patients (P < .001). Moreover, in sepsis patients, lncRNA TUG1 expression was negatively correlated with respiratory infection, serum creatinine (Scr), white blood cell (WBC), C-reactive protein (CRP), APACHE II score, and SOFA score but positively correlated with albumin (all P < .05); miR-223 expression was negatively correlated with skin and soft tissue infection and albumin but positively correlated with Scr, WBC, CRP, APACHE II score, and SOFA score (all P < 0.05). As to mortality, lncRNA TUG1 expression was decreased (P = .001) but miR-223 was elevated (P < .001) in 28-day sepsis deaths compared with 28-day sepsis survivors.Our findings offer the potential of lncRNA TUG1 and miR-223 as biomarkers for progression and prognosis of sepsis.


Assuntos
MicroRNAs/sangue , RNA Longo não Codificante/sangue , Sepse/genética , Sepse/mortalidade , APACHE , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Marcadores Genéticos , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Fatores de Risco , Taxa de Sobrevida
6.
Eur Rev Med Pharmacol Sci ; 24(24): 13065-13071, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33378060

RESUMO

OBJECTIVE: Whether patients with COVID-19 require invasive mechanical ventilation (MV) is not yet clear. This article summarizes the clinical treatment process and clinical data of patients with COVID-19 and analyzes the predictive factors for mechanical ventilation for these patients. MATERIALS AND METHODS: A retrospective study was carried out from January 5, 2020, to March 23, 2020, including 98 patients with COVID-19 treated at three designated hospitals in Huangshi City, Hubei Province. Data collection included demographics, previous underlying diseases, clinical manifestations, laboratory examinations, imaging examination results, diagnosis, and prognosis. This study presents a summary of the patients' overall clinical characteristics and clarifies the predictive factors for MV in patients with COVID-19. RESULTS: There were 56 males and 42 females included in this study. The mortality rate was 26.53% (26/98). Fever, cough, and chest tightness were the most common symptoms (64.3%, 37.8%, and 12.2%, respectively). Thirty cases required MV, 30.61% of the total cases, and the mortality rate was 73.33%. The univariate comparison showed that dyspnea, acute physiologic assessment, chronic health evaluation (APACHE II) score, and the ratio between arterial blood oxygen partial pressure (PaO2) and oxygen concentration (FiO2) (P/F) were statistically different between the MV group and the non-MV group (p < 0.05). CONCLUSIONS: Results showed the following: dyspnea; increased white blood cell count; decreased platelets; lowered albumin levels; increased urea nitrogen; increased levels of myocardial enzymes Creatine Kinase (CK), Creatine Kinase, MB Form (CKMB) and lactate dehydrogenase (LDH); increased lactate, and lowered blood calcium tests. These findings may indicate that the patients have an increased probability of needing MV support. A cutoff value for the initial APACHE II score of >11.5 and the initial PaO2/FiO2 ratio of <122.17 mmHg should be considered for MV support for patients with COVID-19.


Assuntos
/terapia , Oxigênio/sangue , Pressão Parcial , Respiração Artificial/estatística & dados numéricos , APACHE , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Nitrogênio da Ureia Sanguínea , /mortalidade , Creatina Quinase/sangue , Creatina Quinase Forma MB/sangue , Dispneia/fisiopatologia , Feminino , Humanos , Hipoalbuminemia/sangue , Hipocalcemia/sangue , L-Lactato Desidrogenase/sangue , Ácido Láctico/sangue , Leucocitose/sangue , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Medição de Risco , Trombocitopenia/sangue
8.
Medicine (Baltimore) ; 99(47): e22702, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217793

RESUMO

This study aimed to assess the predictive value of velocity time integral (VTI) of the left ventricular outflow tract (LVOT) on volume expansion test (VET) as an indicator of volume responsiveness in septic shock patients. Septic shock patients undergoing mechanical ventilation were recruited. The hemodynamic parameters before and after VE were monitored by pulse indicated continuous cardiac output (PiCCO) and echocardiography. Heart rate, cardiac index (CI), mean arterial pressure (MAP), central venous pressure, stroke volume variation (SVV), CI and variation of pulse pressure (PPV), and the changes in cardiac parameters (Dheart rate, Dmean arterial pressure, Dcentral venous pressure, DSVV, DCI, and DPPV) were determined. The relationships of hemodynamic parameters and their changes with DVTI were further evaluated with Pearson relation analysis. The value of these parameters in fluid responsiveness prediction was evaluated by using the receiver operating characteristic (ROC) curve analysis. Results showed that 44 VETs were performed in 44 septic shock patients with responsiveness in 24 patients and non-responsiveness in 20. The CI increased by ≥ 15% in responsive patients, but by<15% in non-responsive patients after VET. There were significant differences in the SVV and PPV after VET between responsive and non-responsive groups. DSVV, DPPV, and DCI were positively related to DVTI. The area under ROC curve (AUC) for SVV in fluid responsiveness prediction was 0.80, and the sensitivity and specificity of SVV were 66.5% and 95%, respectively, when the cut-off value was 24.8%. The AUC for PPV in fluid responsiveness prediction was 0.843, and the sensitivity and specificity of PPV were 83.3% and 75%, respectively, when the cut-off value was 25.8%. The AUC for DVTILVOT in fluid responsiveness prediction was 0.956, and the sensitivity and specificity were 87.5% and 95%, respectively, when the cut-off value was 15.9%. In conclusion, DVTILVOT is effective to predict fluid responsiveness after VET in mechanical ventilation patients with septic shock. It may serve as a new, noninvasive and functional hemodynamic parameter with the same accuracy to SVV.


Assuntos
Hidratação/métodos , Hemodinâmica , Choque Séptico/fisiopatologia , Choque Séptico/terapia , APACHE , Pressão Arterial , Pressão Sanguínea , Débito Cardíaco , Ecocardiografia Doppler em Cores , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Prospectivos , Respiração Artificial , Sensibilidade e Especificidade , Volume Sistólico
9.
Medicine (Baltimore) ; 99(47): e23413, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217887

RESUMO

This study aims to explore effect of initiation of renal replacement therapy (RRT) on mortality in acute pancreatitis (AP) patients. In this study, a total of 92 patients from the surgical intensive care unit (SICU) of the Second Affiliated Hospital of Harbin Medical University who were diagnosed with AP and underwent RRT or not between January 2014 and December 2018 were included in this retrospective study. Demographic and clinical data were obtained on admission to SICU. Patients were divided into early initiation of RRT group (n = 44) and delayed initiation of RRT group (n = 48). Duration of mechanical ventilation (MV), intra-peritoneal pressure, vasopressors infusion, body temperature, procalcitonin, creatinine, platelet counts, length of hospital stay and prognosis were recorded during hospitalization, and then compared between groups. Patients with delayed initiation of RRT exhibited significantly higher APACHE II score, SOFA score and lower GCS score than those with early initiation of RRT (P < 0.001, <0.001,  = 0.04, respectively). No difference in the rest of the baseline data and vasopressors infusion was found. Dose of Norepinephrine, maximum and mean PCT, maximum and mean creatinine, maximum and mean intra-peritoneal pressure, length of hospital stay, prognosis of ICU and hospitalization showed significant difference between groups. Early initiation of RRT may be beneficial for AP patients, which can provide some insight and support for patients' treatment in clinic.


Assuntos
Pancreatite/mortalidade , Pancreatite/terapia , Terapia de Substituição Renal , APACHE , Adulto , Biomarcadores/sangue , China , Feminino , Escala de Coma de Glasgow , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos
10.
Einstein (Sao Paulo) ; 18: eAO5480, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33237246

RESUMO

OBJECTIVE: To propose a preliminary artificial intelligence model, based on artificial neural networks, for predicting the risk of nosocomial infection at intensive care units. METHODS: An artificial neural network is designed that employs supervised learning. The generation of the datasets was based on data derived from the Japanese Nosocomial Infection Surveillance system. It is studied how the Java Neural Network Simulator learns to categorize these patients to predict their risk of nosocomial infection. The simulations are performed with several backpropagation learning algorithms and with several groups of parameters, comparing their results through the sum of the squared errors and mean errors per pattern. RESULTS: The backpropagation with momentum algorithm showed better performance than the backpropagation algorithm. The performance improved with the xor. README file parameter values compared to the default parameters. There were no failures in the categorization of the patients into their risk of nosocomial infection. CONCLUSION: While this model is still based on a synthetic dataset, the excellent performance observed with a small number of patterns suggests that using higher numbers of variables and network layers to analyze larger volumes of data can create powerful artificial neural networks, potentially capable of precisely anticipating nosocomial infection at intensive care units. Using a real database during the simulations has the potential to realize the predictive ability of this model.


Assuntos
Inteligência Artificial , Infecção Hospitalar , Redes Neurais de Computação , Medição de Risco/métodos , APACHE , Algoritmos , Humanos , Unidades de Terapia Intensiva
11.
Crit Care ; 24(1): 653, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-33225952

RESUMO

BACKGROUND: A substantial proportion of critically ill COVID-19 patients develop thromboembolic complications, but it is unclear whether higher doses of thromboprophylaxis are associated with lower mortality rates. The purpose of the study was to evaluate the association between initial dosing strategy of thromboprophylaxis in critically ill COVID-19 patients and the risk of death, thromboembolism, and bleeding. METHOD: In this retrospective study, all critically ill COVID-19 patients admitted to two intensive care units in March and April 2020 were eligible. Patients were categorized into three groups according to initial daily dose of thromboprophylaxis: low (2500-4500 IU tinzaparin or 2500-5000 IU dalteparin), medium (> 4500 IU but < 175 IU/kilogram, kg, of body weight tinzaparin or > 5000 IU but < 200 IU/kg of body weight dalteparin), and high dose (≥ 175 IU/kg of body weight tinzaparin or ≥ 200 IU/kg of body weight dalteparin). Thromboprophylaxis dosage was based on local standardized recommendations, not on degree of critical illness or risk of thrombosis. Cox proportional hazards regression was used to estimate hazard ratios with corresponding 95% confidence intervals of death within 28 days from ICU admission. Multivariable models were adjusted for sex, age, body mass index, Simplified Acute Physiology Score III, invasive respiratory support, and initial dosing strategy of thromboprophylaxis. RESULTS: A total of 152 patients were included: 67 received low-, 48 medium-, and 37 high-dose thromboprophylaxis. Baseline characteristics did not differ between groups. For patients who received high-dose prophylaxis, mortality was lower (13.5%) compared to those who received medium dose (25.0%) or low dose (38.8%), p = 0.02. The hazard ratio of death was 0.33 (95% confidence intervals 0.13-0.87) among those who received high dose, and 0.88 (95% confidence intervals 0.43-1.83) among those who received medium dose, as compared to those who received low-dose thromboprophylaxis. There were fewer thromboembolic events in the high (2.7%) vs medium (18.8%) and low-dose thromboprophylaxis (17.9%) groups, p = 0.04. CONCLUSIONS: Among critically ill COVID-19 patients with respiratory failure, high-dose thromboprophylaxis was associated with a lower risk of death and a lower cumulative incidence of thromboembolic events compared with lower doses. TRIAL REGISTRATION: Clinicaltrials.gov NCT04412304 June 2, 2020, retrospectively registered.


Assuntos
Anticoagulantes/administração & dosagem , Estado Terminal/mortalidade , Dalteparina/administração & dosagem , Trombose/mortalidade , Trombose/prevenção & controle , Tinzaparina/administração & dosagem , APACHE , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suécia/epidemiologia
12.
Am J Emerg Med ; 38(10): 2088-2095, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33152585

RESUMO

OBJECTIVES: We investigate the clinical utility of the lactate/albumin (L/A) ratio as an early prognostic marker of ICU mortality in a large cohort of unselected critically ill patients. METHODS: A retrospective single-center study using data from the Multiparameter Intelligent Monitoring Intensive Care III (MIMIC-III) database collected between 2001 and 2012. We screened adult patients (age ≥ 15) with measured lactate and albumin on the first day of ICU stay to evaluate the prognostic performance of the lactate and lactate/albumin (L/A) ratio for ICU mortality prediction. RESULTS: The overall ICU mortality in the 6414 eligible ICU patients was 16.4%. L/A showed a receiver-operating characteristics area under the curve (ROC-AUC) value of 0.69 (95% CI: 0.67, 0.70) to predict ICU mortality, higher than lactate 0.67 (95%CI: 0.65, 0.69). Regardless of the lactate level, L/A yielded better ROC-AUC compared to the lactate level [normal lactate (<2.0 mmol/L): 0.63 vs 0.60; intermediate lactate (2.0 mmol/L ≤ lactate <4.0 mmol/L): 0.58 vs 0.56; high lactate (≥4.0 mmol/L): 0.67 vs 0.66]. L/A was a better prognostic marker for ICU mortality in patients with decreased lactate elimination [hepatic dysfunction: 0.72 vs 0.70; renal dysfunction 0.70 vs 0.68]. The L/A ratio ROC-AUC was better in patients with sepsis (0.68 vs 0.66) and those who developed severe sepsis or septic shock (0.68 vs 0.66). CONCLUSIONS: The performance of L/A and lactate were equivalent in predicting ICU mortality and can be used as early prognostic markers for ICU patients with different initial lactate level and the presence of hepatic or renal dysfunction.


Assuntos
Estado Terminal/mortalidade , Ácido Láctico/análise , Albumina Sérica/análise , APACHE , Idoso , Área Sob a Curva , Estudos de Coortes , Estado Terminal/terapia , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Fatores de Risco , Escala Psicológica Aguda Simplificada
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1253-1256, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198875

RESUMO

OBJECTIVE: To explore the clinical characteristics and prognostic risk factors of severe influenza. METHODS: Clinical data of severe influenza patients admitted to the department of respiratory and critical care medicine of the Second Affiliated Hospital of Anhui Medical University from March 2014 to June 2019 were retrospectively analyzed. General information, laboratory test results, and etiological test results of the hospitalization outcomes for survival group and death group during the 28-day follow-up were analyzed using Logistic regression analysis. RESULTS: Among the 37 patients, 29 were males and 8 were females. They aged 25-86 years old with an average of (59.59±15.16) years old. Twenty-one cases had chronic underlying diseases; 28 cases had co-infections, including 6 cases with bacterial infections, 7 cases with fungal infections, 3 case with other pathogens, and 12 cases with mixed infection. Among the 37 patients, 9 died during hospitalization and 5 died within 28-day of discharge. The overall mortality rate was 37.84%. Compared with the survival group, patients in the death group were older (years old: 66.57±3.94 vs. 55.35±14.53), British Thoracic Society's modified pneumonia score (CURB-65 score), acute physiology and chronic health evaluation II (APACHE II) score, neutrophil count, D-dimer, 48-hour C-reactive protein (CRP) and procalcitonin (PCT) were higher [CURB-65 score: 2 (2, 3) vs. 1 (0, 2), APACHE II: 16.00±4.62 vs. 11.00±4.22, neutrophil count (×109/L): 8.87 (5.42, 11.33) vs. 3.58 (2.55, 7.13), D-dimer (mg/L): 7.97 (5.19, 12.68) vs. 2.91 (1.19, 5.02), 48-hour CRP (mg/L): 127.83±92.24 vs. 87.01±57.00, 48-hour PCT (µg/L): 1.79 (0.59, 4.44) vs. 0.37 (0.13, 0.99)], oxygenation index (PaO2/FiO2) and creatinine clearance rate were lower [PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 109.52±49.30 vs. 204.82±67.61, creatinine clearance rate (mL×min-1×1.73 m-2): 55.49±21.23 vs. 77.59±29.73], and the differences were statistically significant (all P < 0.05). There was no significant difference in gender, combined chronic underlying diseases, lymphocyte count, albumin, lactate dehydrogenase (LDH), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), 24-hour CRP and PCT between the two groups. A total of 37 pathogens were cultured, including 17 Gram-negative bacteria (45.95%), 3 Gram-positive bacteria (8.10%), and 17 fungi (45.95%). The number of Acinetobacter baumannii infections in the death group was significantly higher than that in the survival group (cases: 7 vs. 2, P < 0.05). Logistic regression analysis showed that age, CURB-65 score, APACHE II score, PaO2/FiO2, neutrophil count, creatinine clearance rate, combined Acinetobacter baumannii infection, deep vein catheterization, catheterization, and stomach preservation during hospitalization were risk factors for the prognosis of patients with severe influenza [hazard ratios (HR) were 1.064, 4.920, 1.286, 0.975, 1.286, 0.965, 0.095, 0.083, 9.333, 0.089, respectively, all P < 0.05]. Multivariate analysis showed that low PaO2/FiO2 and Acinetobacter baumannii infection were risk factors for prognosis of severe influenza (HR were 0.834 and 0.000, respectively, both P < 0.05). CONCLUSIONS: Old age, high CURB-65 score, high APACHE II score, and co-infection are risk factors for the prognosis of patients with severe influenza.


Assuntos
Influenza Humana , Pneumonia , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Influenza Humana/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos
14.
Am J Emerg Med ; 38(10): 2070-2073, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33142177

RESUMO

OBJECTIVES: The Resuscitation & Critical Care Unit (ResCCU) is a novel ED-based ICU designed to provide early critical care services. This study sought to identify characteristics of poisoned patients treated in the ResCCU. METHODS: We conducted a retrospective, single-center case study of poisoned patients over the age of 18 years old over a 16-month period. Patient demographics, drug concentrations, and severity of illness scores were extracted from electronic medical records. Patients were divided into two groups, those who required short term ICU level care (< 24 h) and prolonged ICU care (> 24 h). RESULTS: A total of 58 ED visits with a tox-related illness were analyzed. There were 24 women (41%) and 34 men (59%). There were 42 patients (72%) who required short term ICU level care and 16 patients (28%) who required prolonged ICU care. In the short-term ICU group, 13 patients (31%) were discharged home directly from the ResCCU, 29 patients (69%) were sent to the inpatient floor, and 1 of the admitted floor patients expired. There were no patients admitted to the floor that required a step-up to the inpatient ICU. 56 patients (97%) were alive at post-admit day 7 and 28, and only 8 (14%) were re-admitted within 30 days. CONCLUSIONS: Patients who were treated in the ED-based ICU for toxicology-related illnesses were frequently able to be either discharged home or admitted to a regular floor after their initial stabilization and treatment, and none that were sent to the floor required an ICU step-up.


Assuntos
Envenenamento/terapia , Ressuscitação/tendências , APACHE , Adolescente , Adulto , Idoso , Estudos de Coortes , Cuidados Críticos/métodos , Cuidados Críticos/tendências , Gerenciamento Clínico , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitalização , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Envenenamento/complicações , Estudos Prospectivos , Melhoria de Qualidade , Ressuscitação/métodos , Ressuscitação/normas , Estudos Retrospectivos
15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1056-1060, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081890

RESUMO

OBJECTIVE: To assess the impact of not inflated lung tissue (NILT) volume on the prognosis of patients with moderate-to-severe acute respiratory distress syndrome (ARDS). METHODS: The clinical data of 131 patients with moderate-to-severe ARDS admitted to the intensive care unit (ICU) of Tianjin Third Central Hospital from March 2016 to June 2019 were collected. The basic data of patients, including gender, age, body mass index (BMI), causes of ARDS, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and oxygenation index (PaO2/FiO2), were collected. The CT imaging data of patients on the 1st and 7th day in the ICU were collected. According to the CT value, they were divided into hyperventilated areas (-1 000 to -900 HU), normal ventilation areas (-899 to -500 HU), poorly ventilated areas (-499 to -100 HU), and atelectasis area (-99 to 100 HU). The total lung volume and the percentage of NILT to the total lung volume (NILT%) were calculate. At the same time, duration of mechanical ventilation, length of ICU stay, total length of hospital stay were collected. According to the 28-day follow-up, they were divided into survival group and death group. Multivariate Logistic regression analysis was used to determine the risk factors for 28-day death in ARDS patients. The receiver operating characteristic (ROC) curve was drawn, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were calculated to determine the accuracy of NILT% in predicting the 28-day prognosis of ARDS patients, and the NILT% threshold was used for subgroup analysis of patients. RESULTS: Among the 131 patients with moderate-to-severe ARDS, patients were excluded for more than 48 hours after ARDS diagnosis, repeated admission to ICU due to ARDS, the ICU duration less than 7 days, death within 72 hours of admission, chronic interstitial lung disease or congestive heart failure, no chest CT examination within 7 days of admission to ICU, and no specimen collection within 2 hours of admission to ICU. Finally, a total of 53 patients were enrolled in the analysis. Of the 53 patients, 31 patients survived and 22 patients died. The 28-day mortality was 41.5%. Compared with the survival group, patients in the death group were older (years old: 65.32±11.29 vs. 55.77±14.23), and had a higher SOFA score (11.68±3.82 vs. 8.39±2.23) with significant differences (both P < 0.05), while there were no significant differences in gender, BMI, ARDS cause, APACHE II score and PaO2/FiO2 between the two groups. There was no significant difference in CT value, total lung volume and NILT% between the two groups at 1st day after admission to ICU; NILT% on day 7 after admission to ICU in the death group was significantly higher than that in the survival group [(28.95±8.40)% vs. (20.35±5.91)%, P < 0.01], but there was no significant difference in CT value and total lung volume between the two groups. Multivariate Logistic regression analysis showed that the 28-day prognosis of ARDS was related to age, SOFA score and NILT% independently [age: odds ratio (OR) = 0.892, 95%CI was 0.808-0.984, P = 0.023; SOFA score: OR = 0.574, 95%CI was 0.387-0.852, P = 0.006; NILT%: OR = 0.841, 95%CI was 0.730-0.968, P = 0.016]. ROC curve analysis showed that 7-day NILT% could predict the 28-day prognosis of patients with moderate-to-severe ARDS, and AUC was 0.810 (95%CI was 0.678-0.952, P < 0.01). The NILT% threshold was 15.50%, sensitivity was 95.5%, specificity was 80.6%, positive predictive value was 85.7%, and negative predictive value was 74.6%. According to the 7-day NILT% threshold, a subgroup analysis of patients was performed, and 7-day NILT% > 15.50% was defined as a high-risk clinical prognosis, and ≤ 15.50% was a low-risk. Compared with low-risk patients (n = 7), the duration of mechanical ventilation, the length of ICU stay and total length of hospital stay in high-risk patients (n = 46) were significantly prolonged [duration of mechanical ventilation (days): 9.37±6.14 vs. 4.43±1.72, length of ICU stay (days): 12.11±5.85 vs. 7.57±1.13, total length of hospital stay (days): 18.39±5.87 vs. 11.29±2.22, all P < 0.05]. CONCLUSIONS: The 7-day NILT% > 15.50% of patients with moderate-to-severe ARDS after ICU admission is related to poor prognosis.


Assuntos
Atelectasia Pulmonar , Síndrome do Desconforto Respiratório do Adulto , APACHE , Humanos , Pulmão , Prognóstico
16.
Ann Acad Med Singap ; 49(7): 434-448, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33000106

RESUMO

INTRODUCTION: Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU. MATERIALS AND METHODS: A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records. RESULTS: Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30-45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25-7) and 10 (8.25-12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173-213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9-17.75) and 16 days (IQR 12-32) respectively. CONCLUSION: Low COVID-19 ICU mortality was observed in our "pandemic-ready" ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , APACHE , Adulto , Idoso , Infecções por Coronavirus/mortalidade , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Respiração Artificial , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Singapura
17.
Medicine (Baltimore) ; 99(38): e21970, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957315

RESUMO

The main objective of this study was to evaluate the outcomes of extremely elderly patients receiving orotracheal intubation and mechanical ventilation after planned extubation. This retrospective cohort study included extremely elderly patients (>90 years) who received mechanical ventilation and passed planned extubation. We reviewed all intensive care unit patients in a medical center between January 1, 2010, and December 31, 2017. There were 19,518 patients (aged between 20 and 105 years) during the study period. After application of the exclusion criteria, there were 213 patients who underwent planned extubation: 166 patients survived, and 47 patients died. Compared with the mortality group, the survival group had lower Acute Physiology and Chronic Health Evaluation II scores and higher Glasgow Coma Scale (GCS) scores, with scores of 19.7 ±â€Š6.5 (mean ±â€Šstandard deviation) vs 22.2 ±â€Š6.0 (P = .015) and 9.5 ±â€Š3.5 vs 8.0 ±â€Š3.0 (P = .007), respectively. The laboratory data revealed no significant difference between the survival and mortality groups except for blood urea nitrogen (BUN) and hemoglobin. After multivariate logistic regression analysis, a lower GCS, a higher BUN level, weaning beginning 3 days after intubation and reintubation during hospitalization were associated with poor prognosis. In this cohort of extremely elderly patients undergoing planned extubation, a lower GCS, a higher BUN level, weaning beginning 3 days after intubation and reintubation during hospitalization were associated with mortality.


Assuntos
Extubação/mortalidade , Intubação Intratraqueal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Desmame do Respirador/estatística & dados numéricos , APACHE , Fatores Etários , Idoso de 80 Anos ou mais , Nitrogênio da Ureia Sanguínea , Índice de Massa Corporal , Comorbidade , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
18.
Am J Trop Med Hyg ; 103(6): 2472-2477, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32959771

RESUMO

Scrub typhus and Queensland tick typhus (QTT)-rickettsial infections endemic to tropical Australia-can cause life-threatening disease. This retrospective study examined the clinical course of all patients with laboratory-confirmed scrub typhus or QTT admitted to the intensive care unit (ICU) of a tertiary referral hospital in tropical Australia between 1997 and 2019. Of the 22 patients, 13 had scrub typhus and nine had QTT. The patients' median (interquartile range [IQR]) age was 50 (38-67) years; 14/22 (64%) had no comorbidity. Patients presented a median (IQR) of seven (5-10) days after symptom onset. Median (IQR) Acute Physiology and Chronic Health Evaluation II scores were 13 (9-17) for scrub typhus and 13 (10-15) for QTT cases (P = 0.61). Following hospital admission, the median (IQR) time to ICU admission was five (2-19) hours. The median (IQR, range) length of ICU stay was 4.4 (2.9-15.9, 0.8-33.8) days. Multi-organ support was required in 11/22 (50%), 5/22 (22%) required only vasopressor support, 2/22 (9%) required only invasive ventilation, and 4/22 (18%) were admitted for monitoring. Patients were ventilated using protective lung strategies, and fluid management was conservative. Standard vasopressors were used, indications for renal replacement therapy were conventional, and blood product usage was restrictive; 9/22 (41%) received corticosteroids. One patient with QTT died, and two (8%) additional patients with QTT developed purpura fulminans requiring digital amputation. Death or permanent disability occurred in 3/9 (33%) QTT and 0/13 scrub typhus cases (P = 0.055). Queensland tick typhus and scrub typhus can cause multi-organ failure requiring ICU care in otherwise well individuals. Queensland tick typhus appears to have a more severe clinical phenotype than previously believed.


Assuntos
Lesão Renal Aguda/fisiopatologia , Unidades de Terapia Intensiva , Tifo por Ácaros/fisiopatologia , Rickettsiose do Grupo da Febre Maculosa/fisiopatologia , APACHE , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Corticosteroides/uso terapêutico , Adulto , Idoso , Amputação , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Estudos de Coortes , Doxiciclina/uso terapêutico , Feminino , Hidratação/métodos , Hospitalização , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Hipotensão/terapia , Hipóxia/etiologia , Hipóxia/fisiopatologia , Hipóxia/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Insuficiência de Múltiplos Órgãos/terapia , Escores de Disfunção Orgânica , Púrpura Fulminante/etiologia , Púrpura Fulminante/fisiopatologia , Queensland/epidemiologia , Terapia de Substituição Renal/métodos , Respiração Artificial/métodos , /terapia , Estudos Retrospectivos , Tifo por Ácaros/complicações , Tifo por Ácaros/terapia , Rickettsiose do Grupo da Febre Maculosa/complicações , Rickettsiose do Grupo da Febre Maculosa/terapia , Centros de Atenção Terciária , Vasoconstritores/uso terapêutico , Adulto Jovem
19.
Br J Anaesth ; 125(6): 872-879, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32988602

RESUMO

BACKGROUND: The role of tracheostomy in coronavirus disease 2019 (COVID-19) is unclear, with several consensus guidelines advising against this practice. We developed both a dedicated airway team and coordinated education programme to facilitate ward management of tracheostomised COVID-19 patients. Here, we report outcomes in the first 100 COVID-19 patients who underwent tracheostomy at our institution. METHODS: This was a prospective observational cohort study of patients confirmed to have COVID-19 who required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction (Acute Physiology and Chronic Health [APACHE]-II score>17). Secondary outcomes included duration of ventilation, ICU stay, and healthcare workers directly involved in tracheostomy care acquiring COVID-19. RESULTS: A total of 164 patients with COVID-19 were admitted to the ICU between March 9, 2020 and April 21, 2020. A total of 100 patients (mean [standard deviation] age: 55 [12] yr; 29% female) underwent tracheostomy; 64 (age: 57 [14] yr; 25% female) did not undergo tracheostomy. Despite similar APACHE-II scores, 30-day survival was higher in 85/100 (85%) patients after tracheostomy, compared with 27/64 (42%) non-tracheostomised patients {relative risk: 3.9 (95% confidence intervals [CI]: 2.3-6.4); P<0.0001}. In patients with APACHE-II scores ≥17, 68/100 (68%) tracheotomised patients survived, compared with 12/64 (19%) non-tracheotomised patients (P<0.001). Tracheostomy within 14 days of intubation was associated with shorter duration of ventilation (mean difference: 6.0 days [95% CI: 3.1-9.0]; P<0.0001) and ICU stay (mean difference: 6.7 days [95% CI: 3.7-9.6]; P<0.0001). No healthcare workers developed COVID-19. CONCLUSION: Independent of the severity of critical illness from COVID-19, 30-day survival was higher and ICU stay shorter in patients receiving tracheostomy. Early tracheostomy appears to be safe in COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Traqueostomia/efeitos adversos , Traqueostomia/métodos , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Cuidados Críticos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente , Segurança do Paciente , Seleção de Pacientes , Estudos Prospectivos , Respiração Artificial/métodos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
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