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ICU survivors

Christopher G Hughes, Mayur B Patel, Nathan E Brummel, Jennifer L Thompson, J Brennan McNeil, Pratik P Pandharipande, James C Jackson, Rameela Chandrasekhar, Lorraine B Ware, E Wesley Ely, Timothy D Girard
PURPOSE: Neurologic and endothelial injury biomarkers are associated with prolonged delirium during critical illness and may reflect injury pathways that lead to poor long-term outcomes. We hypothesized that blood-brain barrier (BBB), neuronal, and endothelial injury biomarkers measured during critical illness are associated with cognitive impairment and disability after discharge. METHODS: We enrolled adults with respiratory failure and/or shock and measured plasma concentrations of BBB (S100B), neuronal (UCHL1, BDNF), and endothelial (E-selectin, PAI-1) injury markers within 72 h of ICU admission...
March 9, 2018: Intensive Care Medicine
M Elizabeth Wilcox, Andrew S Lim, Ruxandra Pinto, Sandra E Black, Mary Pat McAndrews, Gordon D Rubenfeld
BACKGROUND: Few studies have investigated sleep in patients after intensive care despite the possibility that inadequate sleep might further complicate an acute illness impeding recovery. AIMS: Our objectives were to assess the quality and quantity of a patients' sleep on the ward by polysomnography (PSG) within a week of intensive care unit (ICU) discharge and to explore the prevalence of key in-ICU risk factors for persistent sleep fragmentation. METHODS: We enrolled twenty patients after they have been mechanically ventilated for at least 3 days and survived to ICU discharge...
March 9, 2018: Internal Medicine Journal
X Huang, L Weng, L Yi, M Li, Y Y Feng, Y Tian, J G Xia, Q Y Zhan, B Du
Objective: To investigate the clinical manifestations and prognostic factors of hospital death in connective tissue disease patients with acute respiratory failure caused by pneumocystis pneumonia (PCP) admitted to two medical intensive care units(MICU). Methods: A retrospective review was conducted for all connective tissue disease (CTD) patients with acute respiratory failure from PCP in MICU of 2 academic medical centers between 2010 and 2015. The patients were divided into survivors and non-survivors. Demographic and clinical data, including laboratory, radiological and microbiological findings, as well as therapy, clinical course, mortality and prognostic factors of hospital mortality were included in the analysis...
March 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
Bridgette Kram, Kylie M Weigel, Michelle Kuhrt, Daniel L Gilstrap
OBJECTIVE: To evaluate the proportion of patients receiving a hospital discharge prescription for a scheduled enteral opioid following initiation as a weaning strategy from a continuous opioid infusion in the Intensive Care Unit (ICU). DESIGN: Retrospective, observational study. SETTING: Five adult ICUs at a large, quaternary care academic medical center. PATIENTS: Endotracheally intubated, opioid-naive adults receiving a continuous opioid infusion with a concomitant scheduled enteral opioid initiated...
January 2018: Journal of Opioid Management
Timothy D Girard, Jennifer L Thompson, Pratik P Pandharipande, Nathan E Brummel, James C Jackson, Mayur B Patel, Christopher G Hughes, Rameela Chandrasekhar, Brenda T Pun, Leanne M Boehm, Mark R Elstad, Richard B Goodman, Gordon R Bernard, Robert S Dittus, E W Ely
BACKGROUND: Delirium during critical illness results from numerous insults, which might be interconnected and yet individually contribute to long-term cognitive impairment. We sought to describe the prevalence and duration of clinical phenotypes of delirium (ie, phenotypes defined by clinical risk factors) and to understand associations between these clinical phenotypes and severity of subsequent long-term cognitive impairment. METHODS: In this multicentre, prospective cohort study, we included adult (≥18 years) medical or surgical ICU patients with respiratory failure, shock, or both as part of two parallel studies: the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, and the Delirium and Dementia in Veterans Surviving ICU Care (MIND-ICU) study...
March 2018: Lancet Respiratory Medicine
Tetsu Ohnuma, Daisuke Shinjo, Alan M Brookhart, Kiyohide Fushimi
Background: Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Methods: Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014...
2018: Journal of Intensive Care
Michael E Wilson, Abdul M Majzoub, Claudia C Dobler, J Randall Curtis, Tarek Nayfeh, Bjorg Thorsteinsdottir, Amelia K Barwise, Jon C Tilburt, Ognjen Gajic, Victor M Montori, M Hassan Murad
OBJECTIVES: To assess the effectiveness of noninvasive ventilation in patients with acute respiratory failure and do-not-intubate or comfort-measures-only orders. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception to January 1, 2017. STUDY SELECTION: Studies of all design types that enrolled patients in the ICU or hospital ward who received noninvasive ventilation and had preset do-not-intubate or comfort-measures-only orders...
March 1, 2018: Critical Care Medicine
Rita N Bakhru, James F Davidson, Rebecca E Bookstaver, Michael T Kenes, Kristin G Welborn, Peter E Morris, D Clark Files
PURPOSE: The aims were to 1) determine feasibility of measuring physical function in our ICU Recovery Clinic (RC), 2) determine if physical function was associated with 6-month re-hospitalization and 1-year mortality and 3) compare ICU survivors' physical function to other comorbid populations. MATERIALS AND METHODS: We established the Wake Forest ICU RC. Patients were seen in clinic 1month following hospital discharge. Testing included the Short Form-36 questionnaire and Short Physical Performance Battery (SPPB)...
February 3, 2018: Journal of Critical Care
T Lo, I Piper, B Depreitere, G Meyfroidt, M Poca, J Sahuquillo, T Durduran, P Enblad, P Nilsson, A Ragauskas, K Kiening, K Morris, R Agbeko, R Levin, J Weitz, C Park, P Davis
OBJECTIVES: Validated optimal cerebral perfusion pressure (CPP) treatment thresholds in children do not exist. To improve the intensive care unit (ICU) management of the paediatric traumatic brain injury (TBI) population, we are forming a new paediatric multi-centre collaboration to recruit standardised ICU data for running and reporting upon models for assessing autoregulation and optimal CCP (CPPopt). MATERIALS AND METHODS: We are adapting the adult BrainIT group's approach to develop a new Paediatric Brain Monitoring and Information Technology Group (KidsBrainIT), which will include a repository to store prospectively collected high-resolution physiological, clinical, and outcome data...
2018: Acta Neurochirurgica. Supplement
Beverley A Ewens, Joyce M Hendricks, Deborah Sundin
AIM: To investigate stories of recovery through the lens of intensive care unit survivors. BACKGROUND: Survival from intensive care units is increasing, as are associated physical and psychological complications. Despite the significant impact on survivors, there is inadequate support provision in Australia and world-wide for this population. DESIGN: An interpretive biographical approach of intensive care survivors' experiences of recovery...
February 28, 2018: Journal of Advanced Nursing
Bridgette L Kram, Jennifer M Schultheis, Shawn J Kram, Christopher E Cox
PURPOSE: To evaluate whether a pharmacist-initiated electronic handoff tool can reduce the overall, and potentially inappropriate, hospital discharge prescribing rate of atypical antipsychotics (AAP) initiated in AAP-naive critically ill adults. METHODS: This pre-post quality improvement study was initiated in 5 intensive care units (ICUs) at a large academic medical center. An electronic handoff tool (iVent) was utilized in the post-intervention period to enhance pharmacist communication at inpatient transitions of care...
January 1, 2018: Journal of Pharmacy Practice
Omar Badawi, Xinggang Liu, Erkan Hassan, Pamela J Amelung, Sunil Swami
OBJECTIVES: Evaluate the accuracy of different ICU risk models repurposed as continuous markers of severity of illness. DESIGN: Nonintervention cohort study. SETTING: eICU Research Institute ICUs using tele-ICU software calculating continuous ICU Discharge Readiness Scores between January 2013 and March 2016. PATIENTS: Five hundred sixty-one thousand four hundred seventy-eight adult ICU patients with an ICU length of stay between 4 hours and 30 days...
March 2018: Critical Care Medicine
Alberto Porta, Riccardo Colombo, Andrea Marchi, Vlasta Bari, Beatrice De Maria, Giovanni Ranuzzi, Stefano Guzzetti, Tommaso Fossali, Ferdinando Raimondi
This study checks whether autonomic markers derived from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) and from their interactions with spontaneous or mechanical respiration (R) are associated with mortality in patients admitted to intensive care unit (ICU). Three-hundred consecutive HP, SAP and R values were recorded during the first day in ICU in 123 patients. Population was divided into survivors (SURVs, n = 83) and non-survivors (NonSURVs, n = 40) according to the outcome...
February 22, 2018: Scientific Reports
M Katsiari, A Mavroidi, E D Platsouka, C Nikolaou
OBJECTIVES: The aim of the present study was to determine potential host-, pathogen-, infection- and treatment-related risk factors that might predict a fulminant, fatal course of bacteremia caused extensively drug-resistant A. baumannii (XDR Aba). METHODS: Eighty-seven patients with monomicrobial growth of XDR Aba in blood cultures within a 6-year period were studied. Patients were divided into three groups, according to ICU outcome. Group A (n=40) consisted of patients who survived, Group B (n=10) included patients with fulminant sepsis that died early (<48h), whereas Group C (n=37) included patients that died later (> 48h) after the onset of bacteremia...
February 19, 2018: Journal of Global Antimicrobial Resistance
Wan-Ling Chen, Chin-Ming Chen, Shu-Chen Kung, Ching-Min Wang, Chih-Cheng Lai, Chien-Ming Chao
This retrospective cohort study investigated the outcomes and prognostic factors in nonagenarians (patients 90 years old or older) with acute respiratory failure. Between 2006 and 2016, all nonagenarians with acute respiratory failure requiring invasive mechanical ventilation (MV) were enrolled. Outcomes including in-hospital mortality and ventilator dependency were measured. A total of 173 nonagenarians with acute respiratory failure were admitted to the intensive care unit (ICU). A total of 56 patients died during the hospital stay and the rate of in-hospital mortality was 32...
January 23, 2018: Oncotarget
Joanna L Stollings, Sarah L Bloom, Li Wang, E Wesley Ely, James C Jackson, Carla M Sevin
BACKGROUND: Many patients experience complications following critical illness; these are now widely referred to as post-intensive care syndrome (PICS). An interprofessional intensive care unit (ICU) recovery center (ICU-RC), also known as a PICS clinic, is one potential approach to promoting patient and family recovery following critical illness. OBJECTIVES: To describe the role of an ICU-RC critical care pharmacist in identifying and treating medication-related problems among ICU survivors...
February 1, 2018: Annals of Pharmacotherapy
Anne Kathrine Langerud, Tone Rustøen, Cathrine Brunborg, Ulf Kongsgaard, Audun Stubhaug
A growing number of studies have addressed the long-term consequences of intensive care unit (ICU) treatment, but few have studied the prevalence of chronic pain and pain characteristics longitudinally. The goal of the work described here was to investigate the prevalence and characteristics of chronic pain in ICU survivors 3 months and 1 year after ICU discharge and to identify risk factors for chronic pain 1 year after ICU discharge. The design used was an explorative and longitudinal study. The patients in this work had stayed >48 hours in two mixed ICUs in Oslo University Hospital, a tertiary referral hospital...
February 15, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
J Mesquida, P Saludes, A Pérez-Madrigal, L Proença, E Cortes, L Enseñat, C Espinal, G Gruartmoner
Central venous-to-arterial carbon dioxide difference (Pcva CO2 ), and its correction by the arterial-to-venous oxygen content difference (Pcva CO2 /Cav O2 ) have been proposed as additional tools to evaluate tissue hypoxia. Since the relationship between pressure and content of CO2 (CCO2 ) might be affected by several factors, some authors advocate for the use of Ccva CO2 /Cav O2 . The aim of the present study was to explore the factors that might intervene in the difference between Pcva CO2 /Cav O2 and Ccva CO2 /Cav O2 , and to analyze their association with mortality...
February 17, 2018: Journal of Clinical Monitoring and Computing
Elizabeth C Parsons, Catherine L Hough, Michael V Vitiello, Brian Palen, Douglas Zatzick, Dimitry S Davydow
BACKGROUND: There is no insomnia screening tool validated in intensive care unit (ICU) survivors. OBJECTIVES: To examine the validity of a single item from the PTSD checklist-Civilian version (PCL-C) to detect insomnia by Insomnia Severity Index (ISI) METHODS: We performed a secondary analysis of data from a longitudinal investigation in 120 medical-surgical ICU survivors. At 1 year post-ICU, patients completed ISI, PCL-C, and Medical Short-Form 12 (SF-12) by telephone...
February 12, 2018: Heart & Lung: the Journal of Critical Care
Masaharu Nagae, Moritoki Egi, Kenta Kubota, Shohei Makino, Satoshi Mizobuchi
Background: Hyperbilirubinemia is a common postoperative complication. Elevated direct bilirubin (D-Bil) and indirect bilirubin (I-Bil) levels are related to different pathophysiologies; therefore, their associations with outcomes also differ. However, there have been few comparative studies of such associations in postoperative patients. Methods: This retrospective study compared the associations of postoperative D-Bil and I-Bil with outcomes. We included adult patients requiring postoperative intensive care for more than 48 hours between 2008 and 2013, except those undergoing liver operations...
February 2018: Korean Journal of Anesthesiology
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