Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26.264
Filtrar
1.
Zhonghua Yi Xue Za Zhi ; 99(33): 2586-2591, 2019 Sep 03.
Artigo em Chinês | MEDLINE | ID: mdl-31510717

RESUMO

Objective: To evaluate the value of ultrasound contrast agent with enteral nutrition suspension as mixed medium in locating indwelling nasointestinal tube in critically ill patients. Methods: Total of 45 critically ill patients had nasointestinal tube indwelled were collected from June 1,2018 to April 1,2019 in the Intensive Care Unit of Zhejiang Provincial People's Hospital, including 30 males and 15 females, with an average age of (63±17) years.Enteral nutritional suspension Peptisorb Liquid was used as research medium,with the ultrasonic imaging performance of it confirmed by in vitro and in vivo experiments.The optimal mixing ratio of microbubble ultrasound contrast agent and Peptisorb Liquid was confirmed by in vitro experiment, then the mixture was quietly placed and its stability was dynamically observed. The nasointestinal tube was confirmed in the digestive tract by conventional ultrasound and then the ultrasound contrast mode turned on. Ultrasound contrast agent with Peptisorb Liquid as mixed medium was injected into the nasointestinal tube and the tube direction and end position were observed and recorded in real time. Abdominal X-ray examination or CT was used as the gold standard for verifying the location of the nasointestinal tube and the same result represented successful positioning. Results: The in vitro and in vivo experiments showed that Peptisorb Liquid had good ultrasound imaging uniformity and penetrating power, which could clearly show the range and boundary of the filling intestine cavity; the in vitro experiment showed that the ultrasound contrast agent prepared with the microbubble ultrasound contrast agent and Peptisorb Liquid by the ratio of 1∶1 000 and 1∶500 which had the best imaging effect and the best distribution uniformity, with the best stability within 10 minutes after quietly placed. Nasointestinal tubes were successfully located by using ultrasound contrast agent with enteral nutritional suspension as mixed medium in 95.6%(43/45) of the patients collected in this study,including success at one attempt in 39 cases, the operating time was (1.6±0.5) minutes and 4 cases were successfully located after multiple operations with (5.1±0.5) minutes, the tube bent in the stomach in one case and flexed back into the stomach from the descending duodenum in another. The operation failed in 2 cases (4.4%). No significant complications occurred during the examination. Conclusion: The ultrasound contrast agent with enteral nutritional suspension as mixed medium has the advantages of both, which can conveniently, safely and effectively locate the direction and end position of nasointestinal tube in critically ill patients.


Assuntos
Estado Terminal , Nutrição Enteral , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Intestino Delgado , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade , Ultrassonografia
2.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 898-903, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31506150

RESUMO

OBJECTIVE: To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score III (PRISM III), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis. METHODS: A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM III, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system. RESULTS: The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM III and pSOFA had a similar predictive value (P=0.210), while PRISM III had a better predictive value than PCIS (P=0.045). PRISM III had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM III and PCIS. CONCLUSIONS: All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM III and PCIS.


Assuntos
Escores de Disfunção Orgânica , Sepse , Criança , Estado Terminal , Humanos , Prognóstico , Curva ROC , Estudos Retrospectivos
3.
Cochrane Database Syst Rev ; 8: CD012248, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31476022

RESUMO

BACKGROUND: Hospital-acquired infection is a frequent adverse event in patient care; it can lead to longer stays in the intensive care unit (ICU), additional medical complications, permanent disability or death. Whilst all hospital-based patients are susceptible to infections, prevalence is particularly high in the ICU, where people who are critically ill have suppressed immunity and are subject to increased invasive monitoring. People who are mechanically-ventilated are at infection risk due to tracheostomy and reintubation and use of multiple central venous catheters, where lines and tubes may act as vectors for the transmission of bacteria and may increase bloodstream infections and ventilator-associated pneumonia (VAP). Chlorhexidine is a low-cost product, widely used as a disinfectant and antiseptic, which may be used to bathe people who are critically ill with the aim of killing bacteria and reducing the spread of hospital-acquired infections. OBJECTIVES: To assess the effects of chlorhexidine bathing on the number of hospital-acquired infections in people who are critically ill. SEARCH METHODS: In December 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared chlorhexidine bathing with soap-and-water bathing of patients in the ICU. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and undertook risk of bias and GRADE assessment of the certainty of the evidence . MAIN RESULTS: We included eight studies in this review. Four RCTs included a total of 1537 individually randomised participants, and four cluster-randomised cross-over studies included 23 randomised ICUs with 22,935 participants. We identified one study awaiting classification, for which we were unable to assess eligibility.The studies compared bathing using 2% chlorhexidine-impregnated washcloths or dilute solutions of 4% chlorhexidine versus soap-and-water bathing or bathing with non-antimicrobial washcloths.Eight studies reported data for participants who had a hospital-acquired infection during the ICU stay. We are uncertain whether using chlorhexidine for bathing of critically ill people reduces the rate of hospital-acquired infection, because the certainty of the evidence is very low (rate difference 1.70, 95% confidence interval (CI) 0.12 to 3.29; 21,924 participants). Six studies reported mortality (in hospital, in the ICU, and at 48 hours). We cannot be sure whether using chlorhexidine for bathing of critically-ill people reduces mortality, because the certainty of the evidence is very low (odds ratio 0.87, 95% CI 0.76 to 0.99; 15,798 participants). Six studies reported length of stay in the ICU. We noted that individual studies found no evidence of a difference in length of stay; we did not conduct meta-analysis because data were skewed. It is not clear whether using chlorhexidine for bathing of critically ill people reduced length of stay in the ICU, because the certainty of the evidence is very low. Seven studies reported skin reactions as an adverse event, and five of these reported skin reactions which were thought to be attributable to the bathing solution. Data in these studies were reported inconsistently and we were unable to conduct meta-analysis; we cannot tell whether using chlorhexidine for bathing of critically ill people reduced adverse events, because the certainty of the evidence is very low.We used the GRADE approach to downgrade the certainty of the evidence of each outcome to very low. For all outcomes, we downgraded evidence because of study limitations (most studies had a high risk of performance bias, and we noted high risks of other bias in some studies). We downgraded evidence due to indirectness, because some participants in studies may have had hospital-acquired infections before recruitment. We noted that one small study had a large influence on the effect for hospital-acquired infections, and we assessed decisions made in analysis of some cluster-randomised cross-over studies on the effect for hospital-acquired infections and for mortality; we downgraded the evidence for these outcomes due to inconsistency. We also downgraded the evidence on length of stay in the ICU, because of imprecision. Data for adverse events were limited by few events and so we downgraded for imprecision. AUTHORS' CONCLUSIONS: Due to the very low-certainty evidence available, it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the ICU, or whether the use of chlorhexidine results in more skin reactions.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Estado Terminal , Infecção Hospitalar/prevenção & controle , Banhos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/prevenção & controle
7.
Clin Nurse Spec ; 33(5): 237-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404002

RESUMO

AIMS: The aim of this study was to decrease the number of patients with acquired aspiration mortality. DESIGN: This was an evaluation research study. Data were collected on acutely ill hospitalized patients from January 2013 to December 2017. METHODS: In 2016, a 1100-bed Midwestern quaternary care facility found an increasing trend in mortality rates of patients with acquired aspiration from 2013 to 2015. A need for improved detection of patients at risk of aspiration was identified. A multidisciplinary team analyzed this need and developed a screening process found on the American College of Chest Physicians practice guidelines and the Massey Bedside Swallowing Screen to reduce these rates. Nurses implemented the aspiration risk screening process on all hospitalized patients. Data were collected through nursing responses and chart reviews. RESULTS: Initial implementation of the aspiration risk screening process yielded procedural concerns that were ameliorated through increased education and refinement of the screen. After refinement and reimplementation, mortality data from 2016 to 2017 revealed a decrease to zero aspiration-related events. CONCLUSION: Our findings suggest implementation of a nursing-led aspiration risk screening process with acutely ill patients is a factor in decreasing patient mortality from acquired aspiration. These clinical practice changes of identifying patients at risk of aspirating and involving dysphagia therapists prior to oral intake increase patient safety while decreasing acquired aspiration mortality. IMPACT: This study addressed upward trends in patient mortality with acquired aspiration. Mortality rates declined after implementation of the aspiration risk screening process on hospitalized patients. These findings have potential to impact healthcare personnel and all acutely ill hospitalized patients.


Assuntos
Deglutição , Programas de Rastreamento/organização & administração , Aspiração Respiratória/prevenção & controle , Estado Terminal , Mortalidade Hospitalar/tendências , Hospitalização , Humanos , Enfermeiras Clínicas , Pesquisa em Avaliação de Enfermagem , Aspiração Respiratória/mortalidade
8.
Z Gastroenterol ; 57(8): 977-982, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31398769

RESUMO

Sclerosing Cholangitis of the Critically Ill (SC-CIP) is a relatively new entity within the spectrum of secondary cholangitis that develops in the wake of intensive care therapy with mechanical ventilation and catecholamine treatment. It is caused by ischemic or immunologic injury to small bile ducts that becomes self-aggravating and persists beyond the end of the intensive care stay. Early clinical and laboratory findings show acute cholangitis with elevated CRP, gamma GT, AP, and bilirubin. ERCP shows damaged intrahepatic bile ducts with irregular calibers and biliary casts. The following phase is chronic and oligosymptomatic. Still, all laboratory parameters will stay mildly elevated and ERCP and MRCP will show progressive loss of small bile ducts. Long-term prognosis is poor. Even with UDCA therapy, most patients will develop liver cirrhosis within months or years.


Assuntos
Ductos Biliares Intra-Hepáticos/fisiopatologia , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/fisiopatologia , Cirrose Hepática/fisiopatologia , Colangiopancreatografia Retrógrada Endoscópica , Colangite Esclerosante/complicações , Cuidados Críticos , Estado Terminal , Humanos
9.
Stud Health Technol Inform ; 264: 1805-1806, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438353

RESUMO

More and more researchers have recommended critically ill patients to start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low for patients in the intensive care units (ICU) because of various factors. In order to promote the rehabilitation of critically ill patients, a multidisciplinary research team, including academic researchers, ICU head nurses, respiratory therapists, and a software engineer, has developed a virtual reality system for early mobilization in ICU. This system has four main features-the diverse forms of mobilization based on muscle strength, the integration of exercise and cognitive training, the visualization of the mobilization process and the record of the trajectory during mobilization exercises. This paper presents and discusses the development process of this system.


Assuntos
Deambulação Precoce , Realidade Virtual , Estado Terminal , Terapia por Exercício , Humanos , Unidades de Terapia Intensiva
10.
Adv Exp Med Biol ; 1145: 155-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31364078

RESUMO

Due to lack of better therapeutic options, colistin use for extensively drug-resistant Gram-negative organisms was revived in the past two decades, including in patients in intensive-care units (ICU). There are multiple knowledge gaps pertaining to the clinical use and utility of colistin in critically-ill patients, but due to lack of options, it is used in these high risk patients. In this chapter, we critically review the various topics pertaining to colistin use in critically-ill patients, while highlighting the (lack of) controlled evidence supporting common current practices pertaining to colistin use by clinicians.


Assuntos
Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Estado Terminal , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Humanos , Unidades de Terapia Intensiva
11.
Crit Care Resusc ; 21(3): 162-170, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462203

RESUMO

BACKGROUND: The Standard versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial is a multinational randomised controlled trial that will enrol a minimum of 2866 patients comparing two strategies for initiating renal replacement therapy in critically ill patients with acute kidney injury. OBJECTIVE: To describe a pre-specified statistical analysis plan (SAP) for the STARRT-AKI trial before completion of patient recruitment and data collection. METHODS: The SAP was designed by the principal investigators and statisticians and approved by the international STARRT-AKI Steering Committee. The primary and secondary outcomes are defined, the approach to safety monitoring and data collection are summarised, and a detailed description of the planned statistical analyses, including pre-specified subgroup and secondary analyses, is described. RESULTS: We have developed the SAP for the STARRT-AKI trial, including a mock CONSORT diagram, figures and tables. The primary outcome is 90-day all-cause mortality. The primary analysis will be reported as a relative risk (95% CI), absolute risk difference (95% CI), and tested with the χ2 test. Secondary analyses of the primary outcome will include adjustment for baseline covariates and site, and evaluation for heterogeneity in treatment effect. Pre-specified subgroups will include patient sex, baseline kidney function, illness acuity, surgical status, presence of sepsis, and geographic location. CONCLUSION: To align with best practice standards for rigour, internal validity and transparency, we have developed a SAP for the STARRT-AKI trial before trial completion. The analysis will adhere to the SAP to avoid bias arising from knowledge of trial results. REGISTRATION: ClinicalTrials.gov identifier: NCT02568722 (6 October 2015).


Assuntos
Lesão Renal Aguda/terapia , Seleção de Pacientes , Terapia de Substituição Renal , Estatística como Assunto , Estado Terminal , Coleta de Dados , Humanos , Guias de Prática Clínica como Assunto/normas , Sepse
12.
Crit Care Resusc ; 21(3): 200-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462207

RESUMO

OBJECTIVE: To provide a contemporary description of the demographics, characteristics and outcomes of critically ill Indigenous patients in Australia. DESIGN, SETTING AND PARTICIPANTS: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for intensive care unit (ICU) admissions in 2017-18. Characteristics of critically ill Indigenous patients were compared with non-Indigenous patients. MAIN OUTCOME MEASURES: Primary outcome was hospital mortality. Secondary outcomes examined demographics and resource use. RESULTS: Per capita, Indigenous Australians were overrepresented in the intensive care. They were younger (51 v 66 years), more likely to be admitted from outer regional, rural and remote settings (59% v 15%), more likely to require emergency admission (81% v 59%), and had higher rates of mechanical ventilation (35% v 32%; P < 0.01 for all). Indigenous patients were over-represented in the diagnostic categories of sepsis (15% v 9%), trauma (7% v 5%), and respiratory illness (17% v 15%), and had higher rates of ICU re-admission (7% v 5%; P < 0.01 for all). There was no difference in either unadjusted (7.9% for each; P = 0.96) or adjusted (odds ratio, 1.1; 95% CI, 1.0-1.2) in-hospital mortality. CONCLUSION: Indigenous patients, especially young Indigenous patients, were disproportionately represented in Australian ICUs, particularly for sepsis. The high level of acute illness and high proportion of emergency admissions could be interpreted as representing delayed presentation, which, with a higher re-admission rate, suggest access barriers to health care may exist. Nevertheless, there was no mortality gap between Indigenous and non-Indigenous Australians during a hospital admission for critical illness.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde do Indígena/estatística & dados numéricos , Mortalidade Hospitalar/etnologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Distribuição por Idade , Austrália , Estado Terminal , Diagnóstico Tardio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
13.
Crit Care Resusc ; 21(3): 212-219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462208

RESUMO

OBJECTIVE: Ionising radiation is a valuable tool in modern medicine including for patients in an intensive care unit (ICU). However, clinicians are faced with a trade-off between benefit of information received from procedure versus risks associated with radiation. As a first step to understanding the risk and benefits of radiation exposure to ICU patients, we aimed to assess the cumulative levels of ionising radiation patients receive during their ICU stay. DESIGN: Retrospective audit. SETTING: A single tertiary care ICU in South Australia. PARTICIPANTS: This audit included 526 patients admitted to the ICU at Flinders Medical Centre, Adelaide, SA, for longer than 120 hours (long stay) over a 12-month period from April 2015 to April 2016. MAIN OUTCOME MEASURES: Cumulative radiation exposure to ICU patients. RESULTS: The 526 patients audited underwent 4331 procedures totalling 5688.45 mSv of ionising radiation. The most frequent procedure was chest x-ray (82%), which contributed 1.2% to cumulative effective dose (CED). Although only 3.6% of the total procedures, abdominal and pelvic computed tomography (CT) contributed the most to CED (68%). Over 50% of patients received less than 1 mSv CED during their stay in the ICU. However, 6% received > 50 mSv and 1.3% received > 100 mSv CED. Trauma patients received significantly higher CED compared with other admission diagnoses, and CED increased with length of stay. CONCLUSION: Most ICU patients received low CED during their stay, with the majority receiving less than the recommended limit for members of the public (1 mSv). These results may educate clinicians regarding radiation exposures in ICU settings, highlighting the relatively low exposures and thus low risk to the patients.


Assuntos
Estado Terminal , Diagnóstico por Imagem/estatística & dados numéricos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Doses de Radiação , Exposição à Radiação , Radiação Ionizante , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Austrália , Feminino , Humanos , Masculino , Estudos Retrospectivos
15.
Stud Health Technol Inform ; 264: 368-372, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437947

RESUMO

The onset of acute kidney injury (AKI) during an intensive care unit (ICU) admission is associated with increased morbidity and mortality. Developing novel methods to identify early AKI onset is of critical importance in preventing or reducing AKI complications. We built and applied multiple machine learning models to integrate clinical notes and structured physiological measurements and estimate the risk of new AKI onset using the MIMIC-III database. From the clinical notes, we generated clinically meaningful word representations and embeddings. Four supervised learning classifiers and mixed-feature deep learning architecture were used to construct prediction models. The best configurations consistently utilized both structured and unstructured clinical features and yielded competitive AUCs above 0.83. Our work suggests that integrating structured and unstructured clinical features can be effectively applied to assist clinicians in identifying the risk of incident AKI onset in critically-ill patients upon admission to the ICU.


Assuntos
Lesão Renal Aguda , Área Sob a Curva , Cuidados Críticos , Estado Terminal , Humanos , Unidades de Terapia Intensiva
16.
Stud Health Technol Inform ; 264: 462-466, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437966

RESUMO

Acute Kidney Injury (AKI) is the most common cause of organ dysfunction in critically ill adults and prior studies have shown AKI is associated with a significant increase of the mortality risk. Early prediction of the mortality risk for AKI patients can help clinical decision makers better understand the patient condition in time and take appropriate actions. However, AKI is a heterogeneous disease and its cause is complex, which makes such predictions a challenging task. In this paper, we investigate machine learning models for predicting the mortality risk of AKI patients who are stratified according to their AKI stages. With this setup we demonstrate the stratified mortality prediction performance of patients with AKI is better than the results obtained on the mixed population.


Assuntos
Lesão Renal Aguda , Cuidados Críticos , Estado Terminal , Humanos , Aprendizado de Máquina
17.
Zhonghua Nei Ke Za Zhi ; 58(8): 572-576, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365978

RESUMO

Objective: To assess the rate achieving the target vancomycin trough level (VTL) and its influencing factors in critically ill patients. Methods: The retrospective observational study recruited adult patients treated with intravenous vancomycin in the intensive care unit (ICU) at Zhongda Hospital from January 2015 to December 2017. Serum VTL was tested at steady state. Patients' demographics, the sites of infection, microbial culture results, the severity of illness, laboratory data and vancomycin regimen were obtained at the baseline. The rate achieving target VTL (15-20 mg/L) was analyzed based on renal function. Linear regression was performed to determine the influencing factors of VTL. Results: A total of 85 patients were enrolled, among whom only 23.5% (20/85) achieved the target VTL. In patients with normal renal function, the achieving rate was only 11.4% (4/35), and 80.0% (28/35) was lower than the target trough level multiple linear regression analysis showed that procalcitonin (PCT), estimated glomerular filtration rate (eGFR) and acute physiology and chronic health disease classification system Ⅱ (APACHE Ⅱ) score were independent factors associated with VTL. Conclusion: Achieving target VTL in critically ill patients is not satisfactory. Further study to optimize the administration is needed to facilitate prompt attainment of target VTL.


Assuntos
Antibacterianos/farmacocinética , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/metabolismo , Vancomicina/farmacocinética , Administração Intravenosa , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Estado Terminal , Humanos , Pró-Calcitonina/sangue , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/sangue
19.
Rev Assoc Med Bras (1992) ; 65(7): 952-958, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389504

RESUMO

PURPOSE: In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS: 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS: There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION: Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.


Assuntos
Estado Nutricional/fisiologia , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/patologia , Ultrassonografia/métodos , APACHE , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Masculino , Desnutrição/diagnóstico por imagem , Desnutrição/patologia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Avaliação Nutricional , Terapia Nutricional/métodos , Estudos Prospectivos , Músculo Quadríceps/fisiopatologia , Valores de Referência , Respiração Artificial/efeitos adversos , Medição de Risco , Sensibilidade e Especificidade
20.
Medicine (Baltimore) ; 98(31): e16678, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374047

RESUMO

RATIONALE: The benefits of prolonged endotracheal intubation (ETI) in comparison to early tracheotomy is still over the controversy. Little information is available in concern to prolonged ETI more than years. We report the consequence of oral ETI in a 95-year old man for 839 days. PATIENT CONCERNS: This patient was transferred to the intensive care unit due to sputum asphyxia and respiratory arrest. Timely ETI was performed. However, as a neurological insult, extubation had a high risk of failure due to the insufficient ability of sputum clearance. In addition, his family members refused further surgical interventions including tracheotomy. DIAGNOSES: Prolonged ETI occurred in this patient. On day 240 and 329 after ETI, 3D airway image did not reveal laryngeal stenosis or laryngeal lesions. On day 459 and 662, ET tube (ETT) exchanged was performed and the balloon became stiff and inelasticity. INTERVENTIONS: Although a possible tracheoesophageal fistula was suspected by imaging findings on day 547, the gastroscopy did not reveal the fistula on the esophagus. Enteral nutrition was delivered through the gastric tube, while the mediastinal infection was not observed during subsequent follow-up of computed tomography. OUTCOMES: He received tracheostomy due to acute sputum obstruction within ETT and abrupt oxygen desaturation on day 839. LESSONS: During prolonged ETI, more attention should focus on airway humidification, proper cuff pressure and optimal time for tube exchange in order to avoid severe complications.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Intubação Intratraqueal/métodos , Insuficiência Respiratória/terapia , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Esôfago/diagnóstico por imagem , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Qualidade de Vida , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA