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Frailty in ICU

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https://www.readbyqxmd.com/read/28676896/the-impact-of-frailty-on-intensive-care-unit-outcomes-a-systematic-review-and-meta-analysis
#1
REVIEW
John Muscedere, Braden Waters, Aditya Varambally, Sean M Bagshaw, J Gordon Boyd, David Maslove, Stephanie Sibley, Kenneth Rockwood
PURPOSE: Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials...
August 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28659433/effect-of-communication-skills-training-on-outcomes-in-critically-ill-patients-with-life-limiting-illness-referred-for-intensive-care-management-a-before-and-after-study
#2
Neil R Orford, Sharyn Milnes, Nicholas Simpson, Gerry Keely, Tania Elderkin, Allison Bone, Peter Martin, Rinaldo Bellomo, Michael Bailey, Charlie Corke
OBJECTIVES: To describe the effect of a communication skills training programme on patient-centred goals of care documentation and clinical outcomes in critically ill patients with life-limiting illnesses (LLI) referred for intensive care management. METHODS: Prospective before-and-after cohort study in a tertiary teaching hospital in Australia. The population was 222 adult patients with LLI referred to the intensive care unit (ICU). The study was divided into two periods, before (1 May to 31 July 2015) and after (15 September to 15December 2015) the intervention...
June 28, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28574881/the-relationship-between-frailty-and-the-subjective-decision-to-conduct-a-goals-of-care-discussion-with-burned-elders
#3
Tarik D Madni, Paul A Nakonezny, Steven E Wolf, Bellal Joseph, M Jane Mohler, Jonathan B Imran, Audra Clark, Brett A Arnoldo, Herb A Phelan
Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our ABA-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition...
May 31, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28510786/the-impact-of-frailty-on-noninvasive-mechanical-ventilation-in-elderly-medical-intensive-care-unit-patients
#4
Iskender Kara, F Yildirim, A Zerman, Z Gullu, N Boyaci, B B Aydogan, U Gaygisiz, K Gonderen, G Arik, M Turkoglu, M Aydogdu, G Aygencel, Z Ulger, G Gursel
AIM: Many factors affecting noninvasive ventilation (NIV) in critically ill patients have been reported in the literature, but there is no study about the effect of frailty. With this study, the frailty prevalence was evaluated with two different frailty scores among the NIV population of a medical intensive care unit (ICU). Besides, the impact of frailty on NIV success and mortality and its association with NIV application problems were evaluated. METHOD: A prospective observational cohort study was performed on patients who were over 50 years of age and assigned to NIV due to hypercapnic respiratory failure...
May 16, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28486318/asking-a-better-question-development-and-evaluation-of-the-need-for-trauma-intervention-nfti-metric-as-a-novel-indicator-of-major-trauma
#5
Jacob W Roden-Foreman, Nakia R Rapier, Luanna Yelverton, Michael L Foreman
Many existing metrics, such as Injury Severity Score (ISS), cannot fully describe many trauma patients because of comorbidities. This study developed and evaluated the Need For Trauma Intervention (NFTI) metric as a novel indicator of major trauma. The NFTI metric was developed from an analysis of 2,396 trauma patients at a Level I trauma center. Six commonly recorded registry variables were found to be indicative of major trauma and comprised the NFTI criteria: receiving packed red blood cells within 4 hr; discharge from the emergency department (ED) to the operating room within 90 min; discharge from the ED to interventional radiology; discharge from the ED to the intensive care unit (ICU) with an ICU length of stay (LOS) of 3 or more days; mechanical ventilation outside of procedural anesthesia within 3 days; or death within 60 hr...
May 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28449296/frailty-index-intensive-care-unit-complications-in-head-and-neck-oncologic-regional-and-free-flap-reconstruction
#6
Nicholas B Abt, Yanjun Xie, Sidharth V Puram, Jeremy D Richmon, Mark A Varvares
BACKGROUND: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. METHODS: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression...
August 2017: Head & Neck
https://www.readbyqxmd.com/read/28398076/refining-low-physical-activity-measurement-improves-frailty-assessment-in-advanced-lung-disease-and-survivors-of-critical-illness
#7
Matthew R Baldwin, Jonathan P Singer, Debbie Huang, Jessica Sell, Wendy C Gonzalez, Lauren R Pollack, Mathew S Maurer, Frank F D'Ovidio, Matthew Bacchetta, Joshua R Sonett, Selim M Arcasoy, Lori Shah, Hilary Robbins, Steven R Hays, Jasleen Kukreja, John R Greenland, Rupal J Shah, Lorriana Leard, Matthew Morrell, Cynthia Gries, Patricia P Katz, Jason D Christie, Joshua M Diamond, David J Lederer
RATIONALE: The frail phenotype has gained popularity as a clinically relevant measure in adults with advanced lung disease and in critical illness survivors. Because respiratory disease and chronic illness can greatly limit physical activity, the measurement of participation in traditional leisure time activities as a frailty component may lead to substantial misclassification of frailty in pulmonary and critical care patients. OBJECTIVES: To test and validate substituting the Duke Activity Status Index (DASI), a simple 12-item questionnaire, for the Minnesota Leisure Time Physical Activity (MLTA) questionnaire, a detailed questionnaire covering 18 leisure time activities, as the measure of low activity in the Fried frailty phenotype (FFP) instrument...
August 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28394177/delirium-clinical-motor-subtypes-a-narrative-review-of-the-literature-and-insights-from-neurobiology
#8
James M FitzGerald
INTRODUCTION: Clinical motor subtypes have been long recognised in delirium and, despite a growing body of research, a lack of clarity exists regarding the importance of these motor subtypes. The aims of this review are to (1) examine how the concept of motor subtypes has evolved, (2) explore their relationship to the clinical context, (3) discuss the relationship between the phenomenology of delirium and motor activity, (4) discuss the application of neurobiology to the theory of delirium motor subtypes, and (5) identify methodological issues and provide solutions for further studies...
April 10, 2017: Aging & Mental Health
https://www.readbyqxmd.com/read/28358584/assessing-the-usefulness-and-validity-of-frailty-markers-in-critically-ill-adults
#9
Aluko A Hope, S J Hsieh, Alex Petti, Mariana Hurtado-Sbordoni, Joe Verghese, Michelle Ng Gong
RATIONALE: Identifying frailty by the presence of a critical number of frailty markers has been difficult to operationalize in the intensive care unit (ICU), where patients often cannot complete performance measures or answer complex questions. OBJECTIVES: To assess the construct and predictive validity of a questionnaire-based approach to identifying frailty in adult ICU patients. METHODS: We conducted an observational cohort study of adults admitted to a medical or surgical ICU at one of two hospitals in New York...
June 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28289812/the-icm-research-agenda-on-intensive-care-unit-acquired-weakness
#10
Nicola Latronico, Margaret Herridge, Ramona O Hopkins, Derek Angus, Nicholas Hart, Greet Hermans, Theodore Iwashyna, Yaseen Arabi, Giuseppe Citerio, E Wesley Ely, Jesse Hall, Sangeeta Mehta, Kathleen Puntillo, Johannes Van den Hoeven, Hannah Wunsch, Deborah Cook, Claudia Dos Santos, Gordon Rubenfeld, Jean-Louis Vincent, Greet Van den Berghe, Elie Azoulay, Dale M Needham
We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques...
March 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28263377/the-frailty-phenotype-and-palliative-care-needs-of-older-survivors-of-critical-illness
#11
Lauren R Pollack, Nathan E Goldstein, Wendy C Gonzalez, Craig D Blinderman, Mathew S Maurer, David J Lederer, Matthew R Baldwin
OBJECTIVES: To assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs. DESIGN: A prospective cohort study. SETTING: Urban tertiary care hospital and community hospital. PARTICIPANTS: Medical ICU survivors of mechanical ventilation aged 65 and older (N = 125). MEASUREMENTS: Baseline measurements of the Edmonton Symptom Assessment Scale (ESAS), categorized as mild (0-3), moderate (4-6), and severe (7-10), and the frailty phenotype were made during the week before hospital discharge...
June 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28031245/robotic-enhanced-coronary-surgery-in-octogenarians
#12
Apostolos Roubelakis, Filip Casselman, Johan van der Merwe, Bernard Stockman, Ivan Degrieck, Frank Van Praet
Objectives: Robotic-enhanced minimally invasive direct coronary artery bypass grafting surgery (RE-MIDCAB) is based on the use of a robotic console and instrumentation for the dissection of the left internal thoracic artery (LITA). The LITA to left anterior descending (LAD) artery anastomosis is subsequently constructed through a mini thoracotomy. The purpose of this study is to present our experience of RE-MIDCAB outcomes in elderly patients. Methods: From 2002 until 2015, 44 octogenarians (the mean age of 82...
March 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27965877/survivors-of-intensive-care-with-type-2-diabetes-and-the-effect-of-shared-care-follow-up-clinics-study-protocol-for-the-sweet-as-randomised-controlled-feasibility-study
#13
Yasmine Ali Abdelhamid, Liza Phillips, Michael Horowitz, Adam Deane
BACKGROUND: Many patients who survive the intensive care unit (ICU) experience long-term complications such as peripheral neuropathy and nephropathy which represent a major source of morbidity and affect quality of life adversely. Similar pathophysiological processes occur frequently in ambulant patients with diabetes mellitus who have never been critically ill. Some 25 % of all adult ICU patients have diabetes, and it is plausible that ICU survivors with co-existing diabetes are at heightened risk of sequelae from their critical illness...
2016: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/27632681/readmissions-to-intensive-care-a-prospective-multicenter-study-in-australia-and-new-zealand
#14
MULTICENTER STUDY
John D Santamaria, Graeme J Duke, David V Pilcher, D James Cooper, John Moran, Rinaldo Bellomo
OBJECTIVES: To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality. DESIGN: Prospective multicenter observational study. SETTING: Forty ICUs in Australia and New Zealand. PATIENTS: Consecutive adult patients discharged alive from ICU to hospital wards between September 2009 and February 2010. INTERVENTIONS: Measurement of hospital mortality...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27604332/prevalence-goals-of-care-and-long-term-outcomes-of-patients-with-life-limiting-illness-referred-to-a-tertiary-icu
#15
Neil R Orford, Sharyn L Milnes, Nigel Lambert, Laura Berkeley, Stephen E Lane, Nicholas Simpson, Tania Elderkin, Allison Bone, Peter Martin, Charlie Corke, Rinaldo Bellomo, Michael Bailey
OBJECTIVE: To describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit. DESIGN, SETTING AND PATIENTS: A prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia...
September 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27486262/dementia-in-the-acute-hospital-the-prevalence-and-clinical-outcomes-of-acutely-unwell-patients-with-dementia
#16
R Briggs, A Dyer, S Nabeel, R Collins, J Doherty, T Coughlan, D O'Neill, S P Kennelly
BACKGROUND: Studies have demonstrated that a significant minority of older persons presenting to acute hospital services are cognitively impaired; however, the impact of dementia on long-term outcomes is less clear. AIM: To evaluate the prevalence of dementia, both formally diagnosed and hitherto unrecognised in a cohort of acutely unwell older adults, as well as its impact on both immediate outcomes (length of stay and in-hospital mortality) and 12-month outcomes including readmission, institutionalisation and death...
January 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27484461/construction-and-internal-validation-of-a-new-mortality-risk-score-for-patients-admitted-to-the-intensive-care-unit
#17
Cristina Dólera-Moreno, Antonio Palazón-Bru, Francisco Colomina-Climent, Vicente Francisco Gil-Guillén
BACKGROUND: The existing models to predict mortality in intensive care units (ICU) present difficulties in clinical practice. OBJECTIVES: The aim of this study was to develop and internally validate a points system to predict mortality in the ICU, which can be applied instantly and with high discriminating power. METHODS: This cohort study comprised all patients admitted to the ICU in a Spanish region between January 2013 and April 2014, followed from admission to death or discharge (N=1113)...
November 2016: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/27318887/-peritoneal-dialysis-for-acute-renal-failure-rediscovery-of-an-old-modality-of-renal-replacement-therapy
#18
Belkacem Issad, Guy Rostoker, Corinne Bagnis, Gilbert Deray
Acute renal failure (ARF) in adults in the intensive care unit (ICU) often evolves in a context of multiple organ failure, which explains the high mortality rate and increase treatment needs. Among, two modalities of renal replacement therapy, peritoneal dialysis (PD) was the first modality used for the treatment of ARF in the 1950s. Today, while PD is generalized for chronic renal failure treatment, its use in the ICU is limited, particularly, due to the advent of new hemodialysis techniques and the development of continuous replacement therapy...
July 2016: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/27263535/a-prospective-multicenter-cohort-study-of-frailty-in-younger-critically-ill-patients
#19
M Bagshaw, Sumit R Majumdar, Darryl B Rolfson, Quazi Ibrahim, Robert C McDermid, H Tom Stelfox
BACKGROUND: Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserve that heightens vulnerability. Frailty has been well described among elderly patients (i.e., 65 years of age or older), but few studies have evaluated frailty in nonelderly patients with critical illness. We aimed to describe the prevalence, correlates, and outcomes associated with frailty among younger critically ill patients. METHODS: We conducted a prospective cohort study of 197 consecutive critically ill patients aged 50-64...
June 6, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27241560/the-impact-of-frailty-syndrome-and-risk-scores-on-emergency-cholecystectomy-patients
#20
Laura Lorenzon, Gianluca Costa, Giulia Massa, Barbara Frezza, Francesco Stella, Genoveffa Balducci
PURPOSE: Cholecystectomy, which is one of the most common surgical procedures, is also performed in the emergency setting. A number of risk scores have been introduced in recent studies; moreover, over the last few years literature has focused on surgical patients with frailty syndrome. The aim of the present study is to evaluate whether frailty syndrome and the risk scores are correlated with morbidity, post-operative hospital stay and the ICU admission rate following emergency cholecystectomy...
January 2017: Surgery Today
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