Disorders In Intensive Care Unit Research Articles

Factors Influencing Stress Disorders in Intensive Care Unit (ICU) Patients After Liver Transplantation: A Cross-Sectional Study

Factors Influencing Stress Disorders in Intensive Care Unit (ICU) Patients After Liver Transplantation: A Cross-Sectional Study

The Glasgow Coma Scale and Full Outline of Unresponsiveness score evaluation to predict patient outcomes with neurological illnesses in intensive care units in West Bank: a prospective cross-sectional study.

Determining the clinical neurological state of the patient is essential for making decisions and forecasting results. The Glasgow Coma Scale and the Full Outline of Unresponsiveness (FOUR) Scale are commonly used tools for measuring behavioral consciousness. This study aims to compare scales among patients with neurological disorders in intensive care units (ICUs) in the West Bank. A prospective cross-sectional design was employed. All patients admitted to ICUs who met inclusion criteria were involved in this study. Data were collected from from An-Najah National University, Al-Watani, and Rafedia Hospital. Both tools were used to collect data. A total of 84 patients were assessed, 69.0% of the patients were male, and the average length of stay was 6.4 days. The mean score on the Glasgow Coma scale was 11.2 on admission 11.6 after 48 hours, and 12.2 on discharge. The mean FOUR Scale score was 12.2 on admission, 12.4 after 48 hours, and 12.5 at discharge. This study indicates that both the Glasgow Coma Scale and the FOUR scale are effective in predicting outcomes for neurologically deteriorated critically ill patients. However, the FOUR scale proved to be more reliable when assessing outcomes in ICU patients.

Assessment of drug-induced electrolyte disorders in intensive care units: a multicenter observational study.

Electrolyte disorder (ED) is frequently encountered critically ill patients during admission or admission to the intensive care unit (ICU). This study aimed to determine the frequency of ED encountered in ICU patients to evaluate the relationship of ED with drugs. This prospective, multicenter study was conducted in the medical and anesthesiology ICUs of two training and research hospitals and included patients with at least one ED during admission or hospitalization in the ICUs. The relationship between ED and the drug was evaluated by calculating the logistic probabilistic method scale (LPMS) and the expert panel's evaluation. The correlation between EDs and LPMS was determined using Kendal tau. A binary logistic regression model was preferred in the analysis of factors related to ED. Statistical significance was set as p < 0.05. A total of 117 patients were included in the study. A total of 165 EDs were detected, including at least one in 88 (75.2%) patients. According to the expert panel, 61 (21.7%) of EDs were drug-related, whereas according to the LPMS, 111 (39.6%) (p < 0.001). Mortality (50% vs. 13.7%) and mechanical ventilation rates (52.2% vs. 17.2%) were significantly higher in patients with ED (p < 0.001). Patients with ED had 8.352 times higher odds of exhibiting mortality (OR: 8.352, %95 CI: 1.598-43.648, p: 0.012) and need mechanical ventilation with higher odds of 3.229 (OR: 3.229 95% CI: 0.815-12.787 p: 0.045). Patient who required enteral or parenteral feeding were associated with an increased likelihood of exhibiting ED (respectively OR: 30.057, %95 CI: 2.265-398.892, p: 0.01, OR: 5.537, %95 CI: 1.406-21.800, p: 0.014). EDs are very common in the ICU. Dysnatremia was detected more commonly in other EDs. It has also been found that patients with ED are more often under mechanical ventilation, have more prolonged hospitalizations, and have higher mortality rates than patients without ED. The suitability of LPMS for assessing ED-drug relationships in the ICU context is questioned.

Dermatological manifestations in the intensive care unit of a third‐level hospital

AbstractBackgroundDermatologic diseases are common in patients being treated in intensive care units (ICU). However, due to the seriousness of the patient's condition, skin diseases take a backseat, although these are sometimes the cause of the greatest deterioration. Very few studies focusing on these dermatoses have been undertaken.ObjectivesThis study aimed to determine the prevalence and spectrum of dermatological disorders in patients treated in a medical ICU of a tertiary care centre.MethodsThis was a descriptive study conducted over a period of 8 months. All the patients admitted to the medical ICU were examined for the presence of any pre‐existing or newly developed dermatological disorder. Dermatological disorders were initially classified into infective and noninfective. Patients with dermatological findings were classified into two groups: those who survived and those who died; they were compared with each other with respect to age and sex distribution, length of ICU stay and dermatological findings.ResultsOut of 776 cases admitted to the ICU during the study period, dermatological disorders were observed in 164 (21.13%) cases. Life‐threatening dermatological disorders were seen in 3.05% of cases. Twenty‐nine (17.68%) patients with dermatological findings died. Among these cases, infectious dermatological disorders were significantly less common, while no significant difference was observed for reactive dermatological disorders.ConclusionsDermatological disorders in ICU are common and have a wide spectrum. They often need treatment and may be indicative of underlying potentially fatal systemic illness. Besides, a subset of cutaneous lesions may develop in response to various medical interventions, immunosuppression and immobility. Knowledge of such dermatoses is thus essential, both for the intensivist and dermatologist.

Hemostasis disorders in intensive care unit in Assiut University Hospital: a prospective study

Abstracts Hemostasis disorders either bleeding or thrombosis that occur in intensive care unit (ICU) are common multifactorial problems that affect morbidity and mortality. Prompt identification and correct management improve ICU patient’s outcome. The aim of this study is to assess the incidence of hemostasis disorders among ICU patients and to establish a relationship between hemostasis disorders and outcome of ICU patients. A total of 350 patients were admitted to ICU during the study period. Hundred were excluded secondary to having one or more exclusion criterion; liver diseases (n=33), receiving anticoagulant agents (n=23), bleeding or coagulation disorders at time of admission (n=17), atrial fibrillation (n=12), nephrotic syndrome (n=8), inherited coagulation defects (n=7) and 10 patients were excluded due to incomplete data. A total of 240 patients were recruited in the study analysis. Eighty (33.3%) patients developed different form of hemostatic disorders during their hospital stay within ICU while 160 (66.7%) patients did not develop hemostatic disorders. On admission patients with hemostasis disorder had significantly longer INR (1.10 ± 0.19 vs. 1.05 ± 0.09, P=0.03) and D-dimer (2.32 ± 0.97 vs. 0.55 ± 0.28, P&lt;0.001) with lower fibrinogen level (77.56 ± 9.89 vs. 134.56 ± 10.98, P&lt;0.001). The most frequent form of hemostasis was thrombocytopenia (55%) with mean platelets count (90.87 ± 10.19 × 109/l) followed by pulmonary embolism (16.2%) and DIC (13.7%) with mean D-dimer (2.87 ± 1.11). There were another three patients were found to had thrombasthenia. Four patients developed DVT, three patients were diagnosed as Churg-Strauss syndrome, and two patients had acute limb ischemia. Causes of thrombocytopenia were HIT (4.5%), sepsis (70.5%) and drug-induced (25%). Patients with hemostasis disorders had significantly longer hospital stay (13.12 ± 5.76 vs. 7.01 ± 1.43 (days); P&lt;0.001) while patients without hemostasis disorders had significantly higher overall survival (19.25 (16.69–21.82) vs. 8.55 (8.11–8.98) days; P&lt;0.001) in comparison to those with hemostasis disorders.,In Conclusion, critically ill patients are vulnerable to develop different forms of hemostatic disorders that may seriously affect the outcome. ClinicalTrials.gov Identifier: NCT04179357

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.

Psychiatric management of Patients in intensive care units.

Psychiatric management of Patients in intensive care units.

Comparison between Continuous Regular Insulin Infusion and Single Dose Subcutaneous Long Acting Insulin Injection in Intensive Care Unit

Background: Stress-induced hyperglycemia is a common metabolic disorder in Intensive Care Unit (ICU) cases (30-60%) in diabetic and non-diabetic patients. It is related to increased rates of mortality and morbidity. Objective: The aim of the current work was to compare between glycemic control in single dose long-acting subcutaneous insulin glargine injection and standard continuous regular insulin infusion in the same critical case. Patients and methods: This prospective clinical study period was 72 hours for every patient and conducted on 111 patients aged 20-70 years with targeted blood glucose (BG) level ranging from 100 to 200 mg/dl using a different calculated dose of standard insulin infusion according to conventional sliding scale for the 1st 24hr of the study before conversion into insulin glargine single dose injection with 1-hour washout transition period. Results: APACHE II score was significantly higher in “Uncontrolled hyperglycemia” group in comparison to “Uncontrolled hypoglycemia” group (P=0.030) but insignificantly different between “Controlled” group and “Uncontrolled hyperglycemia” group and between “Controlled” group and “Uncontrolled hypoglycemia” group. Daily units of insulin and mean BG level at 1st day were significantly lower in “Uncontrolled hypoglycemia” group in comparison to “Controlled” group (P=0.002 and 0.002 respectively) and “Uncontrolled hyperglycemia” group (P=0.004 and 0.006 respectively) but insignificantly different between “Controlled” group and “Uncontrolled hyperglycemia” group. While mean BG level was insignificantly different among the three groups at 2nd day, it was insignificantly different between “Controlled” group and “Uncontrolled hyperglycemia” group at 3rd day. Conclusion: It could be concluded that the use of 100% conversion single dose of long-acting insulin glargine for control of hyperglycemia in critical ICU patients can be considered as an accepted good alternative to the classic use of continuous regular insulin infusion.

Determination of irisin and nitric oxide levels in patients with metabolic impairments in intensive care unit

Objective: The newly discovered myokine irisin has been proposed to affect physical activity. However, clinical and functional studies on the association of irisin with muscle mass, and metabolic status remain controversial. The nitric oxide is a molecule produced by the endothelium and in a variety of additional cells, including skeletal muscle. The aim of the study was to determine irisin and nitric oxide (NO) levels in physically inactive patients with severe acute metabolic disorders in intensive care unit. Material and Method: Total of 80 subjects were divided into 3 groups: healthy control (n=20), cerebrovascular disease (including hemi and paraplegic patients) (n=40), pulmonary disease (PD) (n=20). Plasma irisin levels were analyzed using a commercial ELISA kits. The total serum nitrate and nitrite was measured using a Nitrate/Nitrite Colorimetric Assay Kit. Results: We have found significantly higher irisin levels (322.8±20.4 ng/ml) in patients with cerebrovascular disease (p=0.0001) and (302.6±40.2 ng/ml) in patients with PD (p=0.01) compared to (171.4±10.5 ng/ml) control subjects. In addition, higher NO levels were observed (42.42±1.9 μM) in patients with cerebrovascular disease (p&lt;0.001) and (44.36±2.7 μM) in patients with PD (p&lt;0.001), compared to (27.65±0.7 μM) control subjects. Discussion: Observation of higher levels of irisin and NO in critically ill intensive care unit patients may indicate the protective roles of these agents against serious metabolic impairments.

Development and Validation of a Clinical Prediction Model for Sleep Disorders in the ICU: A Retrospective Cohort Study.

BackgroundSleep disorders, the serious challenges faced by the intensive care unit (ICU) patients are important issues that need urgent attention. Despite some efforts to reduce sleep disorders with common risk-factor controlling, unidentified risk factors remain.ObjectivesThis study aimed to develop and validate a risk prediction model for sleep disorders in ICU adults.MethodsData were retrieved from the MIMIC-III database. Matching analysis was used to match the patients with and without sleep disorders. A nomogram was developed based on the logistic regression, which was used to identify risk factors for sleep disorders. The calibration and discrimination of the nomogram were evaluated with the 1000 bootstrap resampling and receiver operating characteristic curve (ROC). Besides, the decision curve analysis (DCA) was applied to evaluate the clinical utility of the prediction model.Results2,082 patients were included in the analysis, 80% of whom (n = 1,666) and the remaining 20% (n = 416) were divided into the training and validation sets. After the multivariate analysis, hemoglobin, diastolic blood pressure, respiratory rate, cardiovascular disease, and delirium were the independent risk predictors for sleep disorders. The nomogram showed high sensitivity and specificity of 75.6% and 72.9% in the ROC. The threshold probability of the net benefit was between 55% and 90% in the DCA.ConclusionThe model showed high performance in predicting sleep disorders in ICU adults, the good clinical utility of which may be a useful tool for providing clinical decision support to improve sleep quality in the ICU.

Prospective Randomized Study on the Effects of Improved Sleep Quality After Craniotomy on Melatonin Concentrations and Inflammatory Response in Neurosurgical Intensive Care Patients

Sleep disorders in intensive care units after a craniotomy can decrease melatonin secretion and increase the inflammatory stress response. The aim of this study was to investigate the influence of improving sleep quality via eye patches and earplugs on melatonin secretion and inflammatory mediator release. The study enrolled 41 patients who underwent craniotomy. Patients were randomized into 2 groups. "Group Intervention" received a sleep-promoting intervention with eye patches and earplugs to provide light and noise isolation, while "Group Control" received standard care. Blood levels of C-reactive protein and interleukin 1 and interleukin 6 along with urine levels of 6-sulphatoxymelatonin (aMT6) were measured preoperatively (baseline) and on postoperative days 1 and 3. Sleep quality was assessed with the Richards-Campbell Sleep Questionnaire. Sleep quality was higher in the intervention group (Richards-Campbell score:80.61 ± 11.96 vs. 33.50 ±16.32; P < 0.001). Urine aMT6 levels increased significantly in the intervention group in spot urine samples from 10.15 (5.38-14.40) ng/mL at baseline to 14.52 (6.24-29.11) and 11.51 (7.88-29.05) ng/mL on postoperative days 1 and 3. They also increased in 24-hour urine samples from 25.73 (8.24-52.73) ng/mL at baseline to 35.38 (11.48-95.65) and 39.18 (2.36-125.23) ng/mL on postoperative days 1 and 3 (P= 0.001 and P= 0.005, respectively). The aMT6 concentration did not change significantly in the control group. The C-reactive protein concentrations increased postoperatively compared with baseline concentrations in both groups (P= 0.001 and P < 0.001). Melatonin secretion significantly increased as a result of improving postoperative sleep quality by noise and light isolation in neurosurgical intensive care unit patients after craniotomy.

End-Plate Disorders in Intensive Care Unit.

Even if nerves and muscles are the principal targets of intensive care unit-acquired weakness, the neuromuscular junction may be as well involved. In intensive care units, neuromuscular blocking agents are classically used, and side effects are possible. Sepsis, immobilization, and denervation which are common in intensive care units may be the cause of neuromuscular junction disorders and participate to the pathophysiology of weakness. We propose here a review of end-plate disorders in intensive care units to highlight their mechanisms and propose diagnosis tools.

Newer Immunotherapies for the Treatment of Acute Neuromuscular Disease in the Critical Care Unit.

PURPOSE OF REVIEW: In this review, we discuss current treatment options for commonly encountered neuromuscular disorders in intensive care units. We will discuss epidemiology, pathophysiology, and acute and chronic treatment options for myasthenia gravis, Guillain-Barré syndrome, West Nile virus, Botulism, and amyotrophic lateral sclerosis. Eculizumab is the newest immunomodulator therapy approved by the Food and Drug Administration in treatment of myasthenia gravis, shown to improve long-term functional outcomes. Edaravone is the newest therapy in management of amyotrophic lateral sclerosis, shown to slow functional deterioration. Efgartigimod showed great promise in a phase 2 safety and efficacy trial in the treatment of stable generalized myasthenia gravis. Eculizumab was found to be safe in a small phase 2 trial for use in Guillain-Barré syndrome. Currently, therapies such as plasma exchange, intravenous immunoglobulins, and steroids remain the mainstay of treatment in the ICU for many neuromuscular disorders. While there are some newer immunotherapies available, few have been studied in the acute setting. However, with the advent of new immunotherapies and biologics, changes in these approaches may be on the horizon.

Relationship between social support, resilience, self-esteem and post-traumatic stress disorder in intensive care unit nurses

Objective: To investigate the correlation between social support, resilience, self-esteem and post-traumatic stress disorder (PTSD) in intensive care unit (ICU) nurses. Methods: A total of 717 ICU nurses from 24 provinces conducted these questionnaires (Chinese version of Impact of Event Scale-Revised(IES-R), Social Support Rate Score(SSRS), Cannor-Davidson Resilience(CD-RISC) and Self-Esteem Scale(SES)). There were 101 males and 616 females, with an average age of (30±5) years. With the aim to investigate PTSD impact factors, the ICU nurses were divided into the PTSD positive group (IES-R>35) and PTSD negative group (IES-R<35). The correlation between IES-R and other scales were analyzed with linear regression analysis. Results: In this investigation, 414 nurses were screened with PTSD and 303 nurses without. IES-R score was negatively correlated with SSRS, CD-RISC and SES (r=-0.275, -0.202, -0.709, all P<0.05). Multivariate regression analysis showed that ICU clinical experience was an independent risk factor for PTSD, and SES Score, SSRS Score and physical health status were protective factors. SES partially mediated the association of SSRS with IES-R, and the mediating effect were 51.5%. The area under characteristic curve (ROC) showed that SSRS score, CD-RISC score, SES score and PTSD risk score Logit (P) for prediction of PTSD was 0.629, 0.604, 0.831 and 0.848, respectively. Conclusions: Social support, physical health and self-esteem are protective factors of PTSD, while ICU clinical experience is a risk factor. SES partially mediated the association of SSRS with IES-R.

A population-based observational study of patients with pulmonary disorders in intensive care unit.

Background/AimsOnly a few epidemiologic studies on the patients with pulmonary disorders admitted to intensive care unit exist. We investigated the characteristics and clinical outcomes of the patients with severe pulmonary disorders.MethodsThe sample cohort database of National Health Insurance Sharing Service from 2006 to 2015 was used. Operational definition of critically ill patients was adults who were either admitted to intensive care unit for at least 3 days or expired within first 2 days in the unit. The pulmonary disorder group comprised of critically ill patients with respiratory disease as the main diagnosis.ResultsAmong the 997,173 patients, 12,983 (1.3%) in 383 intensive care units were categorized as critically ill. Patients in the pulmonary disorder group tended to have more comorbidities or disabilities. The length of hospital stay and duration of mechanical ventilation were longer in the pulmonary disorder group. Overall mortality and re-admission were higher in the pulmonary disorder group, with adjusted incidence rate ratios of 1.22 (95% confidence interval, 1.18 to 1.27) and 1.26 (95% confidence interval, 1.17 to 1.36), respectively. After adjustment by Cox regression, the pulmonary disorder group was an independent risk factor for in-hospital mortality.ConclusionsIn critically ill patients with pulmonary disorder, the use of healthcare resources was higher, and their clinical outcomes were significantly worse than the non-pulmonary disorder group.

The association between body mass index and outcomes in patient with sepsis and acute respiratory failure

Background: Patients with increased body mass indices (BMIs) often present practicalproblems during their management for acute medical disorders in intensive care units. Somestudies suggested obese patients have longer ICU stays but lower in-hospital mortality rates.This study considers the effect of BMI on outcomes in patients with sepsis and respiratoryfailure.Methods: The electronic medical records of patients hospitalized between 2010 and2016 with sepsis who required mechanical ventilation were reviewed to collect demographiccharacteristics, clinical information including BMI subcategory, management requirements,and outcomes, such as mortality, ICU length of stay (LOS), and hospital LOS.Results: This study included 312 adult patients. The mean age was 59.1 ± 16.3 years;57.4% were men. The mean BMI was 29.3 ± 10.7 kg/m2. The median APACHE II score was14, 46.2 % of the patients had pulmonary infections, and 34.9% had extrapulmonary infections.The overall mortality was 42.6%. The mean LOS was 12.4 ± 11.8 days in the ICU and16.6 ± 13.6 days in the hospital. The mortality rates were 38.5% in underweight patients (BMI&lt;18.5kg/m2), 51.1% in normal weight patients (BMI 18.5–24.9 kg/m2), 38.5% in overweightpatients (BMI 25–29.9 kg/m2), and 40.2% in obese patients (BMI &gt;30 kg/m2). Body mass indexdid not have an independent effect on mortality after adjusting for age, gender, and APACHEII scores; however, overweight patients required more mechanical ventilation days and had anincreased LOS in the ICU and the hospital.Conclusions: This study demonstrates that patients with sepsis requiring mechanicalventilation have a high mortality rate and that BMI did not have an effect on mortality. Aprospective study which considers differences in clinical characteristics, managementrequirements, complications, and inflammatory parameters in different BMI subcategories isneeded. Overweight patients had an increased ICU and hospital LOS.

Therapy to improve sleep quality in ICU patients

Patients in intensive care units (ICU) are at risk of sleep disorders. Patients in Intensive Care Unit (ICU) with a history of cardiovascular disease, for example Coronary Heart Disease if have poor sleep quality can affect the healing process. This study aims to identify and analyze the positive effects of using Eyemask, Earplug and Dhikr Therapy on sleep quality in ICU patients. The research methods used are literature reviews on national and international articles published in the last 5-10 years. The use of Eye Mask and Ear Plug therapy and Dhikr Therapy can be applied as a supportive therapy for patients with sleep disorders in intensive care unit(ICU).

Treatment of acute brain cerculation disorders in intensive care unit (review of recommendations and instructions)

Treatment of acute brain cerculation disorders in intensive care unit (review of recommendations and instructions)

Acid based disorders in intensive care unit: a hospital-based study

Background: Acid base disorders are common in the ICU patients and pose a great burden in the management of the underlying condition.Methods: Identifying the type of acid-base disorders in ICU patients using arterial blood gas analysis This was a retrospective case-controlled comparative study. 46 patients in intensive care unit of a reputed institution and comparing the type of acid-base disorder amongst infectious (10) and non-infectious (36) diseases.Results: Of the study population, 70% had mixed acid base disorders and 30% had simple type of acid base disorders. It was found that sepsis is associated with mixed type of acid-base disorders with most common being metabolic acidosis with respiratory alkalosis. Non-infectious diseases were mostly associated with metabolic alkalosis with respiratory acidosis. Analysis of individual acid base disorders revealed metabolic acidosis as the most common disturbance.Conclusions: These results projected the probability of acid bases disorders in various conditions and help in the efficient management. Mixed acid base disorders are the most common disturbances in the intensive care setup which is metabolic acidosis with respiratory alkalosis in infectious diseases and metabolic acidosis is the most common simple type of acid base disorder.

Challenges in high-sensitive troponin assay interpretation for intensive therapy.

Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation.