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Older ICU survivors

Li Weng, Xu Huang, Lie Chen, Li-Qin Feng, Wei Jiang, Xiao-Yun Hu, Jin-Min Peng, Chun-Yao Wang, Qing-Yuan Zhan, Bin Du
BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission. METHODS: Retrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015. RESULTS: Eighty-two patients were enrolled in the study...
September 29, 2016: BMC Infectious Diseases
Elizabeth R Pfoh, Amy W Wozniak, Elizabeth Colantuoni, Victor D Dinglas, Pedro A Mendez-Tellez, Carl Shanholtz, Nancy D Ciesla, Peter J Pronovost, Dale M Needham
PURPOSE: Survivors of acute respiratory distress syndrome (ARDS) are at high risk for new or ongoing physical declines after hospital discharge. The objective of our study was to evaluate the epidemiology of physical declines over 5-year follow-up and identify patients at risk for decline. METHODS: This multi-site prospective cohort study evaluated ARDS survivors who completed a physical status assessment at 3 or 6 months post-discharge. Three measures were evaluated: muscle strength (Medical Resource Council sumscore); exercise capacity [6-min walk test (6MWT)]; physical functioning [36-Item Short Form Health Survey (SF-36 survey)]...
October 2016: Intensive Care Medicine
Ignacio Martin-Loeches, Richard G Wunderink, Rahul Nanchal, Jean Yves Lefrant, Farhad Kapadia, Yasser Sakr, Jean-Louis Vincent
PURPOSE: To investigate which factors influence time to death in hospital in critically ill patients worldwide, including the possible impact of gross national income (GNI). METHODS: This was a pre-defined post hoc analysis of the Intensive Care Over Nations (ICON) database, which included 10,069 patients. For this sub-analysis, we included only the 2062 60-day in-hospital non-survivors (22.3 %) among the 9258 patients with available hospital mortality and length-of-stay data...
September 2016: Intensive Care Medicine
Steven Grangé, Gérard Buchonnet, Emmanuel Besnier, Elise Artaud-Macari, Gaetan Beduneau, Dorothée Carpentier, Julien Dehay, Christophe Girault, Antoine Marchalot, Dominique Guerrot, Fabienne Tamion
OBJECTIVES: Thrombocytopenia is a common, multifactorial, finding in ICU. Hemophagocytosis is one of the main explanatory mechanisms, possibly integrated into hemophagocytic lymphohistiocytosis syndrome, of infectious origin in the majority of cases in ICU. The hemophagocytic lymphohistiocytosis is probably underdiagnosed in the ICU, although it is associated with dramatic outcomes. The main objectives of this work were to identify the frequency of secondary hemophagocytic lymphohistiocytosis, and the main prognostic factors for mortality...
November 2016: Critical Care Medicine
Konrad Schmidt, Susanne Worrack, Michael Von Korff, Dimitry Davydow, Frank Brunkhorst, Ulrike Ehlert, Christine Pausch, Juliane Mehlhorn, Nico Schneider, André Scherag, Antje Freytag, Konrad Reinhart, Michel Wensing, Jochen Gensichen
IMPORTANCE: Survivors of sepsis face long-term sequelae that diminish health-related quality of life and result in increased care needs in the primary care setting, such as medication, physiotherapy, or mental health care. OBJECTIVE: To examine if a primary care-based intervention improves mental health-related quality of life. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial conducted between February 2011 and December 2014, enrolling 291 patients 18 years or older who survived sepsis (including septic shock), recruited from 9 intensive care units (ICUs) across Germany...
June 28, 2016: JAMA: the Journal of the American Medical Association
Gary E Weissman, Michael O Harhay, Ricardo M Lugo, Barry D Fuchs, Scott D Halpern, Mark E Mikkelsen
RATIONALE: Transitions to outpatient care are crucial after critical illness, but the documentation practices in discharge documents after critical illness are unknown. OBJECTIVES: To characterize the rates of documentation of various features of critical illness in discharge documents of patients diagnosed with acute respiratory distress syndrome (ARDS) during their hospital stay. METHODS: We used natural language processing tools to build a keyword-based classifier that categorizes discharge documents by presence of terms from four groups of keywords related to critical illness...
September 2016: Annals of the American Thoracic Society
Damian L Clarke, Jennifer A Chipps, Benn Sartorius, John Bruce, Grant L Laing, Petra Brysiewicz
BACKGROUND: This study used a prospective surgical database, to investigate the level of systolic blood pressure (SBP) at which the mortality rates begin to increase in septic surgical patients. METHODS: All acute, septic general surgical patients older than 15 years of age admitted between January 2012 and January 2015 were included in these analyses. RESULTS: Of a total of 6,020 adult surgical patients on the database, 3,053 elective patients, 1,664 nonseptic, 52 duplicates, and 11 patients with missing SBP were excluded to leave a cohort of 1,232 acute, septic surgical patients...
May 7, 2016: American Journal of Surgery
Patricia Villa, María-Consuelo Pintado, Jimena Luján, Natalia González-García, María Trascasa, Rocío Molina, José-Andrés Cambronero, Raúl de Pablo
OBJECTIVES: To evaluate functional status and quality of life in elderly intensive care unit (ICU) survivors at 1-year follow-up. DESIGN: Prospective 18-month observational study. SETTING: University medical-surgical ICU. PARTICIPANTS: ICU survivors aged 75 and older. MEASUREMENTS: Functional status at baseline (Barthel Index (BI)) was compared with that at hospital discharge and 1-year follow-up...
March 2016: Journal of the American Geriatrics Society
Lauren E Ferrante, Margaret A Pisani, Terrence E Murphy, Evelyne A Gahbauer, Linda S Leo-Summers, Thomas M Gill
RATIONALE: Most of the 1.4 million older adults who survive the intensive care unit (ICU) annually in the United States face increased disability, but little is known about those who achieve functional recovery. OBJECTIVES: Our objectives were twofold: to evaluate the incidence and time to recovery of premorbid function within 6 months of a critical illness and to identify independent predictors of functional recovery among older ICU survivors. METHODS: Potential participants included 754 persons aged 70 years or older who were evaluated monthly in 13 functional activities (1998-2012)...
August 1, 2016: American Journal of Respiratory and Critical Care Medicine
X-Y Fu, M Chen, T Yu, X-K Liu
PURPOSE: This study aimed to assess the health-related quality of life (HRQOL) in trauma patients 2 years after discharge from an intensive care unit (ICU) in Zunyi, China, and to investigate the possible determinants of HRQOL. METHODS: A total of 436 trauma patients treated in the ICU were followed up for 2 years. The Medical Outcomes Study Short Form 36 (SF-36) was used to measure the quality of life 1 and 2 years after their discharge. RESULTS: After a 2-year follow-up, there were, in total, 347 (79...
December 2011: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Pei-Wen Chao, Hsi Chu, Yung-Tai Chen, Yu-Ning Shih, Shu-Chen Kuo, Szu-Yuan Li, Shuo-Ming Ou, Chia-Jen Shih
OBJECTIVE: To evaluate the long-term survival rate of critically ill sepsis survivors following cardiopulmonary resuscitation on a national scale. DESIGN: Retrospective and observational cohort study. SETTING: Data were extracted from Taiwan's National Health Insurance Research Database. PATIENTS: A total of 272,897 ICU patients with sepsis were identified during 2000-2010. Patients who survived to hospital discharge were enrolled...
June 2016: Critical Care Medicine
Helen M Ackland, David V Pilcher, Owen S Roodenburg, Susan A McLellan, Peter A Cameron, D James Cooper
INTRODUCTION: The incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous 'baby-boomer' generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management. METHODS: Major trauma patients admitted to ICU over a 5year period to June 2011 after ladder falls >1m were identified from prospectively collected trauma data at a Level 1 trauma service...
May 2016: Injury
Stéphanie Dizier, Jean-Marie Forel, Louis Ayzac, Jean-Christophe Richard, Sami Hraiech, Samuel Lehingue, Anderson Loundou, Antoine Roch, Claude Guerin, Laurent Papazian
INTRODUCTION: Bilirubin is well-recognized marker of hepatic dysfunction in intensive care unit (ICU) patients. Multiple organ failure often complicates acute respiratory distress syndrome (ARDS) evolution and is associated with high mortality. The effect of early hepatic dysfunction on ARDS mortality has been poorly investigated. We evaluated the incidence and the prognostic significance of increased serum bilirubin levels in the initial phase of ARDS. METHODS: The data of 805 patients with ARDS were retrospectively analysed...
2015: PloS One
M Hauguel, Py Boelle, C Pichereau, S Bourcier, N Bigé, J L Baudel, E Maury, B Guidet, H Ait-Oufella
Bleeding is the most frequent complication of anticoagulant therapy, responsible for a number of hospitalizations or deaths. However, studies describing the management and prognosis factors of extra-cerebral anticoagulant-related bleedings in intensive care unit (ICU) are lacking.Retrospective observational study in an 18-bed ICU in a tertiary teaching hospital. From January 2000 to December 2013, all consecutive patients, older than 18 years, admitted for severe anticoagulant-related bleeding (SAB) except intracerebral site were included...
November 2015: Medicine (Baltimore)
Vivek K Moitra, Carmen Guerra, Walter T Linde-Zwirble, Hannah Wunsch
OBJECTIVES: To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States. DESIGN: Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation. INTERVENTIONS: None...
April 2016: Critical Care Medicine
Rob J Forsyth, Joseph Raper, Emma Todhunter
BACKGROUND: We know that the brain damage resulting from traumatic and other insults is not due solely to the direct consequences of the primary injury. A significant and potentially preventable contribution to the overall morbidity arises from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) prevents adequate cerebral perfusion with well-oxygenated blood.Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury...
2015: Cochrane Database of Systematic Reviews
Ignacio Martin-Loeches, Pedro Povoa, Alejandro Rodríguez, Daniel Curcio, David Suarez, Jean-Paul Mira, Maria Lourdes Cordero, Raphaël Lepecq, Christophe Girault, Carlos Candeias, Philippe Seguin, Carolina Paulino, Jonathan Messika, Alejandro G Castro, Jordi Valles, Luis Coelho, Ligia Rabello, Thiago Lisboa, Daniel Collins, Antonio Torres, Jorge Salluh, Saad Nseir
BACKGROUND: Ventilator-associated tracheobronchitis has been suggested as an intermediate process between tracheobronchial colonisation and ventilator-associated pneumonia in patients receiving mechanical ventilation. We aimed to establish the incidence and effect of ventilator-associated tracheobronchitis in a large, international patient cohort. METHODS: We did a multicentre, prospective, observational study in 114 intensive care units (ICU) in Spain, France, Portugal, Brazil, Argentina, Ecuador, Bolivia, and Colombia over a preplanned time of 10 months...
November 2015: Lancet Respiratory Medicine
H Helling, B Stephan, G Pindur
Activation of coagulation and inflammatory response including the complement system play a major role in the pathogenesis of critical illness. However, only limited data are available addressing the relationship of both pathways and its assessment of a predictive value for the clinical outcome in intense care medicine. Therefore, parameters of the coagulation and complement system were studied in patients with septicaemia and multiple trauma regarded as being exemplary for critical illness. 34 patients (mean age: 51...
2015: Clinical Hemorheology and Microcirculation
Ana D Sekulic, Sladjana V Trpkovic, Aleksandar P Pavlovic, Olivera M Marinkovic, Aleksandra N Ilic
BACKGROUND: The aim of this study was to determine which of the most commonly used scoring systems for evaluation of critically ill patients in the ICU is the best and simplest to use in our hospital. MATERIAL AND METHODS: This prospective study included 60 critically ill patients. After admittance to the ICU, APACHE II, SAPS II, and MPM II0 were calculated. During further treatment in the ICU, SOFA and MPM II were calculated at 24 h, 48 h, and 72 h and 7 days after admittance using laboratory and radiological measures...
2015: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Jingjing Zhao, Li Yao, Changqing Wang, Yun Sun, Zhongwu Sun
Patients who survive critical illness commonly suffer cognitive impairments. We aimed to study the effects of cognitive intervention to treat the long-term impairments observed among different populations of intensive care unit (ICU) survivors. The results showed that the intervention significantly suppressed the deterioration of cognitive function in these patients. Medical and neurological ICU survivors were more susceptible than post-anaesthesia ICU patients to severe cognitive damage. In the former, the deterioration of impairments can be slowed by cognitive intervention...
August 27, 2015: Neuropsychological Rehabilitation
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