Duration Of Intensive Care Unit Research Articles

Improved Outcomes in Patients with 22q11.2 Deletion Syndrome and Diagnosis of Interrupted Aortic Arch Prior to Birth Hospital Discharge, a Retrospective Study.

Interruption of the aortic arch (IAA) is a rare but life-threatening congenital heart defect if not corrected in the neonatal period. IAA type B is highly correlated with 22q11.2 deletion syndrome (22q11.2DS); approximately 50% of patients with IAA type B also have 22q11.2DS (Peyvandi et al.; Goldmuntz et al.). Early identification and repair of IAA can prevent severe morbidity and death. However, IAA is challenging to identify prenatally, or even in the neonatal period. In this study, we examined infants with IAA, diagnosed during pregnancy and prior to discharge (PPTD) from the birth hospital vs. those diagnosed following discharge (FD) from the newborn nursery. Our goals were to determine: (1) if early diagnosis improved outcomes; and (2) if patients with IAA and without 22q11.2DS had similar outcomes. In total, 135 patients with a diagnosis of 22q11.2DS and IAA were ascertained through the 22q and You Center at the Children's Hospital of Philadelphia (CHOP). The examined outcomes included: timing of diagnosis; age at diagnosis (days); hospital length of stay (LOS); duration of intensive care unit (ICU) stay; mechanical ventilation (days); duration of inotrope administration (days); year of surgical intervention; birth hospital trauma level; and overall morbidity. These outcomes were then compared with 40 CHOP patients with IAA but without 22q11.2DS. The results revealed that the PPTD neonates had fewer days of intubation, inotrope administration, and hospital LOS when compared to the FD group. The outcomes between deleted and non-deleted individuals with IAA differed significantly, in terms of the LOS (40 vs. 39 days) and time in ICU (28 vs. 24 days), respectively. These results support the early detection of 22q11.2DS via prenatal screening/diagnostics/newborn screening, as IAA can evade routine prenatal ultrasound and postnatal pulse oximetry. However, as previously reported in patients with 22q11.2DS and congenital heart disease (CHD), patients with 22q11.2DS tend to fare poorer compared to non-deleted neonates with IAA.

Association between the participation of the plastic surgery department and qualitative prognoses in severe trauma patients: A retrospective observational study

Catastrophic incidents would necessitate the intervention of multiple specializations with plastic surgery (PS) as an indispensable area of expertise. In view of PS, prognostic assessment of trauma patients should be focused on the qualitative value rather than mortality because plastic surgeons rarely handled patients' vital signs in actual. Thus, we explored the association between the involvement of the PS department and qualitative prognoses for severe trauma patients. From November 2014 to December 2019, we enrolled total 529 trauma patients with an injury severity score (ISS) over 15 points. We set the prognostic factors that the rate of admission in intensive care unit (ICU), total or ICU duration of hospitalization, post-discharge progress and disability diagnosis which were regarded as qualitative prognoses. The analysis was performed with logistic regression analysis or regression analysis adjusted for age, sex, past medical history, cause of trauma, and frequency of operation. Among total of 529 patients, 290 patients in PS group and 239 patients in non-PS group were analyzed. In both groups, the under-65-year ages and male patients were significantly predominant. The rate of going home showed 2.082 times higher in PS group than non-PS group after adjusting for covariates, while there was no significant difference in diagnosis of disability. Meanwhile, overall prognoses were highly correlated with either higher ISS or lower Glasgow Coma Scale (GCS). In conclusion, higher severity generally affected to the severe trauma patient's prognoses, and the PS treatment only contributes to discharge disposition to home.

Admission Blood Glucose Level as a Predictor of Outcome in Intensive Care Patients: A Cross-Sectional Study.

In the Intensive care unit (ICU), hyperglycemia is often observed; commonly associated with pre-existing diabetes or pre-diabetes or in nondiabetic patients. This study aimed to assess the role of admission blood sugar levels with outcomes in ICU patients. A total of 100 patients above 18 years of age were included in the study. A detailed history regarding the patient's age, sex, and any chronic illness were taken. Heart rate, systolic blood pressure, and Glasgow coma scale (GCS) scores were recorded. Admission blood glucose level, blood urea, total leucocyte count, and serum electrolytes were measured; and the outcome was noted. The number of diabetics was significantly higher (65.5%) in the random blood sugar (RBS) ≥180 group. Hyponatremia was significantly associated with hyperglycemia. Patients with hyperglycemia had serum bicarbonate <18. A significantly greater number of patients with hyperglycemia had GCS scores of <8, and required mechanical ventilation. The duration of ICU stay and non-survivors were significantly higher in the hyperglycemia group. Random blood sugar at admission as a factor to assess outcome showed a sensitivity of 68.4 and specificity of 59.3 with a cut-off value of 197. Admission of random blood sugar was significantly associated with poor outcomes. More stringent surveillanceas well as routine blood glucose checks at the time of hospital admission should be emphasized.

Prognostic Significance of Baseline Blood Glucose Levels and Glucose Variability in Severe Acute Kidney Injury: A Secondary Analysis from the RENAL Study.

Aim: To study the associations between baseline blood glucose levels (BGL), glycemic variability and clinical outcomes in patients with severe acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT). Methods: We performed a secondary analysis of the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. A multivariate Cox regression model was used to assess the association between baseline BGL, glycemic variability and clinical outcomes. The primary outcome was all-cause mortality, and secondary outcomes were duration of hospital and intensive care unit (ICU) stay. Results: Baseline BGL data were available in 1404 out of 1508 patients from the RENAL study. Among them, 627 patients died within 90 days of randomization. Compared to patients in the second quartile (BGL 5.8−7.2 mmol/L), patients in the first quartile (BGL < 5.8 mmol/L) had increased mortality rate (90-day HR 1.48; p = 0.001; 28-day HR 1.47; p = 0.042). However, there were no significant differences in ICU and hospital length of stay (LOS) (p = 0.82 and p = 0.33, respectively). Glycemic variability data were from 1345 out of 1404 patients who had data for BG values within 28 days. Higher coefficient of variation (CV) (HR 1.02; P trend = 0.002) and standard deviation value (SD) (HR 1.29; P trend = 0.027) were associated with higher risk of death at day 90. Conclusions: We identified a low BGL within the normal physiological range at baseline and greater CV and SD values as significant modifiable risk factors for mortality in severe AKI patients in ICU, which may be a target for intervention.

Injection of intravenous immunoglobulin (IVIg) for the treatment of Coronavirus induced cytokine storm

Background. COVID-19 disease is the cause of daily morbidity and mortality worldwide due to its high transmissibility and pathogenicity. To date, intravenous immunoglobulin (IVIg) injection has been used as one of the various treatments for this disease. This study aimed to determine the effect of IVIg injection on the treatment of patients with Coronavirus-induced cytokine storm. Methods. A total of 174 patients with COVID-19 were included in this study based on their clinical characteristics and laboratory findings and were divided into two groups of IVIg recipients and non-recipients according to the treatment they received. Statistical analysis was performed using SPSS version 22.0. A p-value less than 0.05 was considered statistically significant. Results. IVIg was used to treat merely 20 patients and Kaletra and hemoperfusion drugs were used more among IVIg recipient patients (P=0.003 and P=0.001, respectively). COVID-19-positive PCR tests were significantly more frequent among IVIg recipients (P=0.026). The polymorphonuclear neutrophil (PMN) count (P=0.007) and sodium level (P=0.007) were significantly higher in the IVIg recipient group on the first admission day. Moreover, INR levels in the IVIg recipient group were significantly lower on the seventh admission day (P=0.020). The median of total intensive care unit (ICU) duration of hospitalization among IVIg recipients was significantly higher (P=0.001). Conclusion. It seems that the use of IVIg in COVID-19 patients should be further investigated. Practical Implications. IVIg injection could decrease mortality and slightly increase the survival rate among COVID-19 patients.

791: IMPACT OF SEDATION WITH KETAMINE COMPARED TO BENZODIAZEPINES ON DELIRIUM IN THE INTENSIVE CARE UNIT

Introduction: The use of high-dose ketamine infusions for sedation has grown in popularity as an alternative to benzodiazepines in intensive care unit (ICU) patients. Currently, there is a paucity of literature describing the use of high-dose ketamine for sedation. The objectives of this study are to describe high-dose ketamine use in the ICU and its impacts on delirium compared to benzodiazepines. Methods: This is a single-center, retrospective cohort study of patients admitted to an ICU between 5/5/2018 and 12/1/2021. Neurocritical care and cardiovascular surgery patients were excluded. Patients included were mechanically ventilated for ≥ 48 hours and received either ketamine ≥ 1 mg/kg/hr or a benzodiazepine infusion (midazolam or lorazepam) for ≥ 24 hours during their index ICU stay. and baseline demographics, sedative drip information, CAM-ICU scores, hospital and ICU length of stay (LOS), duration of mechanical ventilation, and chloride disturbances were collected The primary outcome was the percentage of eligible ICU days CAM-ICU positive, and secondary outcomes included ICU LOS and duration of mechanical ventilation. Eligible ICU days were defined as days with a Richmond Agitation Sedation Scale score ≥ - 3, and a CAM-ICU positive day was defined as having one positive CAM-ICU score positive. Results: A total of 187 patients were included, with 70 and 117 patients in the ketamine and benzodiazepine groups, respectively. The mean age was 56.9 (14.7), and 64.2% were male. The percentage CAM-ICU positive days in the ICU was 68.1% for ketamine and 51.5% for benzodiazepines (p=0.15). The median ICU LOS in days was 20.1 (11.6, 38.9) for the ketamine arm compared to 15.9 (8.7, 26.0) for the benzodiazepine arm (p=0.069). The median duration of mechanical ventilation in days was 19.5 (7.4, 37.4) compared to 11 (6.1, 22.0) for ketamine and benzodiazepines respectively (p=0.053). Overall, 57.5% of ketamine arm patients and 44.1% of benzodiazepine arm patients died during hospitalization (p=0.17). Conclusions: Compared to benzodiazepine infusions, high-dose ketamine infusions did not result in a significantly different number of CAM-ICU positive ICU days, ICU LOS, or duration of mechanical ventilation.

A comparison of single and double arterial cannulation for cardiopulmonary bypass for acute type A aortic surgery: A single center, retrospective observational study.

Background: Acute type A aortic dissection (ATAAD) is a cardiovascular emergency and has high mortality and morbidity. We retrospectively compared the effects on outcomes of single arterial cannulation via axillary artery (AAC) with double arterial cannulation via axillary and femoral artery (DAC) in patients who underwent cardiopulmonary bypass (CPB) for ATAAD.Methods: Between January 2017 and May 2021, four hundred 29 patients who underwent aortic arch repair with circulatory arrest for ATAAD were divided into AAC group (n = 283) and DAC group (n = 146). The propensity score-matched (PSM) analysis were performed to compare the characteristics and outcomes of the groups.Results: After PSM (n = 137 in each), the DAC group had a longer duration of CPB (229 vs 244, p = 0.011), aortic cross-clamp time (121 vs 149, p < 0.001), durations of Intensive Care Unit (ICU) stay (7 vs 8, p = 0.014) and hospital stay (19 vs 25, p < 0.001) compared with AAC group. The incidences of dialysis (21% vs. 31%, p = 0.073), postoperative stroke (9% vs 15%, p = 0.143), ECMO support (2% vs 7%, p = 0.077), in-hospital mortality (7% vs 14%, p = 0.071) and follow-up mortality (10% vs 19%, p = 0.059) showed no significant difference between two groups. Multivariate logistic regression analysis showed postoperative ECMO (OR: 16.69, 95% CI: 1.78-156.29; p = 0.014) or stroke (OR: 11.34, 95% CI: 2.64-48.72; p < 0.001) were associated with in-hospital mortality. Univariate Cox regression results showed stroke history (OR: 4.61, 95% CI: 1.90-11.16; p = 0.001), aortic valvuloplasty (OR: 0.21, 95% CI: 0.07-0.59; p = 0.003), postoperative ALT day1 (OR: 1.00, 95% CI: 1.00-1.00; p = 0.008), ECMO (OR: 16.30, 95% CI: 4.78-55.61; p < 0.001), tracheotomy (OR: 3.78, 95% CI: 1.08-13.20; p = 0.037), postoperative stroke (OR: 4.61, 95% CI: 1.90-11.16; p < 0.001) and re-exploration for bleeding (OR: 3.52, 95% CI: 1.01-12.27; p = 0.048) were associated to follow-up mortality.Conclusions: For surgical treatment of ATAAD with CPB when compared to double axillary and femoral artery, single axillary cannulation was associated with shorter durations of CPB and ACC as well as ICU and hospital stays but no with significant difference in mortality.

The role of inflammatory parameters in the prediction of postoperative delirium in patients undergoing coronary artery bypass grafting.

In this study, we aimed to evaluate the association of pre-operative and early postoperative inflammatory parameters with postoperative delirium in patients operated on for coronary artery bypass grafting. The data of 1 279 cardiac surgery patients operated on between June 2014 and March 2020 were analysed retrospectively. Among these, 777 (61.2%) patients operated on for isolated coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled. Two groups were formed. The patients who developed postoperative delirium were placed in group 1 (n = 187) and the patients with uneventful postoperative follow up (n = 590) were enrolled in group 2. Pre- and early postoperative mean platelet volume, C-reactive protein level, erythrocyte sedimentation rate, platelet- to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were elevated in group 1 (p = 0.0001). The APACHE II score and duration of hospital and intensive care unit stay were significantly elevated in group 1 (p < 0.05). An early-stage neurological event was observed in eight patients (4.3%) in group 1 and 12 patients (2%) in group 2, which was not statistically significantly different between the groups (p = 0.09). In-hospital mortality was observed in three patients (1.6%) in group 1 and five patients (0.8%) in group 2, which did not show a statistically significant difference (p > 0.05). In univariate and multivariate regression analysis, the pre-operative platelet-to-lymphocyte ratio (p = 0.013), mean platelet volume (p = 0.0001) and erythrocyte sedimentation rate (p = 0.002) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Also, the postoperative platelet-to-lymphocyte ratio (p = 0.0001), neutrophil-to-lymphocyte ratio (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Pre- and early postoperative inflammatory parameters were observed to be predictors of postoperative delirium in patients operated on for coronary artery bypass grafting.

DETERMINANTS INFLUENCING LENGTH OF ICU STAY IN RENAL TRANSPLANT RECIPIENTS UNDERGOING GENERAL ANAESTHESIA

Background: In this study, we wantedto evaluate the duration of intensive care unit (ICU) stay in renal transplant recipients and identify the perioperative factors affecting the duration of ICU stay. Materials And Methods: This was a hospital basedprospective cohort study conducted among 76 patients who presented with renal transplantationto the Department ofAnaesthesiology and Intensive Care Unit, Max Super Speciality Hospital, Mohali of Punjab State, from May 2018 toApril 2019after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Longer ICU stay was associated with pleural effusion and left ventricular hypokinesia(p value &lt;0.05). No significant association was found between other clinical conditions and duration of ICU stay.Longer ICU stay was associated if duration of dialysis is longer and thrice a week dialysis. This was statistically significant (p value &lt;0.05).Higher mean serum lactate levels were associated with longer ICU stay (p value &lt;0.05).Longer ICU stay was found in those who had lower mean arterial pressure, higher systolic blood pressure and lower urine output. This was found to be statistically significant. Longer ICU stay was associated with low blood pH, higher serum lactate and lower urine output during post-operative period. This was found to be significant Conclusion:There were certain factors which affected the duration of ICU stay – Older age, higher ASA grades, longer duration of dialysis, and higher frequency of dialysis.Among the perioperative parameters- preoperative mean serum lactate levels, intraoperative lower mean arterial pressure, lower systolic blood pressure and lower urine output, post-operative low blood pH, higher serum lactate and lower urine output were associated with longer duration of ICU stay.

Incidence, Outcomes and Risk Factors of Recurrent Ventilator Associated Pneumonia in COVID-19 Patients: A Retrospective Multicenter Study.

Background: High incidence of ventilator associated pneumonia (VAP) has been reported in critically ill patients with COVID-19. Among these patients, we aimed to assess the incidence, outcomes and risk factors of VAP recurrences. Methods: We conducted an observational retrospective study in three French intensive care units (ICUs). Patients admitted for a documented COVID-19 from March 2020 to May 2021 and requiring mechanical ventilation (MV) for ≥48 h were included. The study main outcome was the incidence of VAP recurrences. Secondary outcomes were the duration of MV, ICU and hospital length of stay and mortality according to VAP and recurrences. We also assessed the factors associated with VAP recurrences. Results: During the study period, 398 patients met the inclusion criteria. A total of 236 (59%) of them had at least one VAP episode during their ICU stay and 109 (46%) of these patients developed at least one recurrence. The incidence of VAP recurrence considering death and extubation as competing events was 29.6% (IC = [0.250−0.343]). Seventy-eight percent of recurrences were due to the same bacteria (relapses). Patients with a VAP recurrence had a longer duration of MV as compared with one VAP and no VAP patients (41 (25−56) vs. 16 (8−30) and 10 (5−18) days; p < 0.001) and a longer ICU length of stay (46 (29−66) vs. 22 (12−36) and 14 (9−25) days; p < 0.001). The 90-day mortality was higher in the recurrence group as compared with the no VAP group only (31.2 vs. 21.0% (p = 0.021)). In a multivariate analysis including bacterial co-infection at admission, the use of immunosuppressive therapies and the bacteria responsible for the first VAP episode, the duration of MV was the only factor independently associated with VAP recurrence. Conclusion: In COVID-19 associated respiratory failure, recurrences affected 46% of patients with a first episode of VAP. VAP recurrences were mainly relapses and were associated with a prolonged duration of MV and ICU length of stay but not with a higher mortality. MV duration was the only factor associated with recurrences.

Effects of systemic antibiotics in early onset ventilator-associated pneumonia in trauma patients: A single-centre retrospective cohort study

Background: Ventilator-associated pneumonia is one of the commonest complications encountered in intubated patients: its incidence ranges from 20% to 60%, with higher incidences seen in patients with polytrauma. Ventilator-associated pneumonia can result in poor neurological outcomes upon discharge, longer duration of mechanical ventilation and prolonged intensive care unit stays. The use of systemic antibiotics has been proposed as one method to reduce this complication. However, its effectiveness remains to be determined, and concerns about bacterial resistance hinder its use. This study aims to evaluate the effects of systemic antibiotics on early ventilator-associated pneumonia prevention. Methods: This is a single-centred retrospective cohort study, using data in the local trauma registry from 2015 to 2020. Patients aged ⩾18 years who suffered from injury to the head or trunk and were intubated within 12 h of hospitalization were evaluated for early ventilator-associated pneumonia to determine the effectiveness of systemic antibiotics on the incidence of ventilator-associated pneumonia and to identify other risk factors for ventilator-associated pneumonia in patients suffering from trauma. Result: A total of 250 patients were recruited; 59 of them met the criteria for early onset ventilator-associated pneumonia. Early use of broad-spectrum antibiotics with potent anaerobic coverage was found to be protective for early onset ventilator-associated pneumonia (adjusted odds ratio = 0.228, p = 0.044). Increasing age and severe thoracic or abdominal injury were also found to be strong non-modifiable predictors for the development of early onset ventilator-associated pneumonia. Conclusion: Use of systemic antibiotics with potent anaerobic coverage within 3 h of injury was found to prevent early onset ventilator-associated pneumonia in those intubated within 12 h of injury. However, a large-scale randomized control trial may be needed to further evaluate its benefit and its potential side effects, most notably the risk of antibiotic resistance.

Measures of Structural Racism Predict ICU Admission Following Intensive Chemotherapy for AML

INTRODUCTION: Recent observational studies have revealed that real-world complications of intensive chemotherapy for frontline treatment of acute myeloid leukemia (AML) far exceed those reported in clinical trials. A 2017 analysis of over 40,000 AML patients found that 26% of patients who received induction chemotherapy were admitted to the intensive care unit (ICU), with increased mortality for non-white patients (Halpern, JAMA Oncology 2016). In a newly created Chicago AML registry (Abraham, Blood 2022), higher ICU admission rate was noted following induction chemotherapy for non-white patients. The current study aims to i) describe treatment complications based on race/ethnicity and ii) examine structural racism (SR) measures as risk factors for ICU admission following intensive chemotherapy in a diverse real-world patient population. METHODS: Using the Chicago AML registry, we compared ethnoracial differences in treatment complications including infections, thrombosis, renal or liver dysfunction (defined as peak creatinine >1.5 g/dL or peak bilirubin >1.2 mg/dL), respiratory failure requiring ventilatory support and hemodynamic instability needing pressor support. We then examined associations of race/ethnicity and previously published measures of census tract disadvantage, affluence, and segregation (referred to as SR measures) with ICU admission. These structural barriers were examined alongside known predictors of treatment mortality including disease characteristics and comorbidities. Additional outcomes included duration of ICU stay and mortality. RESULTS: In this cohort of 573 patients who underwent intensive induction chemotherapy for AML, 30-day complications differed based on race/ethnicity. Renal dysfunction was highest in non-Hispanic black (NHB) patients with an incidence of 27.8% with 6% initiating dialysis compared to 17.6% of non-Hispanic white (NHW) and 11.3% of Hispanic patients with 2% needing dialysis. Hepatotoxicity was highest in Hispanic patients (64%) vs. NHB (51%) and NHW (47%). Infectious complications were highest in NHB with microbiologically documented infections in 50.6% compared to 39.7% in NHW and 32.6% in Hispanic. Venous thrombosis occurred in 14.5% of NHB patients, compared to 14.7% of NHW and 13.3% Hispanic patients. In total, 141 (24.6%) patients required ICU admission during intensive induction with rates differing significantly by race and ethnicity (p = 0.014). Average length of stay in the ICU was 7.8 days for NHB patients, 6.7 days for NHW and 6.0 days for Hispanics. Due to low 30-day mortality, we were unable to detect differences between ethnoracial groups. Mechanical ventilation was utilized in 32% of NHB compared to 26% of NHW and 20% of Hispanic patients admitted to the ICU. Vasopressor were required in 31% of NHB patients vs. 27% of NHW patients. Predictors of ICU admission in our dataset included non-white race, unmarried status, living in a neighborhood with lower % of NHW residents, and WBC > 50,000/µL at diagnosis. Additional census tract variables including higher disadvantage and lower affluence conferred nonsignificant risk. Interestingly, comorbidities, ELN Score and baseline creatinine > 1.5 g/dL were not predictors of ICU admission. CONCLUSIONS: In a real-world population of AML patients, we show variation in the spectrum of treatment complications based on race/ethnicity. Moreover, with detailed individual and neighborhood socioeconomic position (SEP) data, measures of SR predicted ICU admission following induction chemotherapy. Other significant predictors include marital status - an individual measure of SEP, and hyperleukocytosis, which may indicate delay in medical presentation. High comorbidity index did not predict increased rate of ICU admission similar to prior studies (Tawfik, J Geriatr Oncol, 2016), while renal dysfunction was a non-significant predictor. Collectively our results suggest that there is a need to incorporate individual and neighborhood SR measures to identify patients at risk of clinical decline when stressed with intensive therapies. An algorithmic approach to identify 'high risk’ patients based on clinical/molecular and structural factors could prompt more detailed assessment of fitness prior to initiation of chemotherapy and directly influence leukemia outcome disparities. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Factors Influencing Length of Stay in The Intensive Care Unit after Coronary Artery Bypass Graft in Duhok City – Kurdistan Region

Background: Long stays in the Intensive Care Unit (ICU) following coronary artery bypass graft (CABG) surgery are associated with higher hospital mortality, poor long-term prognosis, prolonged hospital admissions, and consequently, excessive cost and resource use. This study aimed to identify the individual and perioperative risk factors influencing ICU length of stay after coronary artery bypass graft surgery at Azadi Heart Center in Duhok city. Patients and Methods: This comparative cross-sectional study reviewed the medical records of 230 patients who underwent CABG surgery from 1st January 2019 to 31st December 2020. The patients were divided into two groups based on their length of stay in the ICU. The usual stay group (ICU length of stay &lt; 72 h), and the prolonged stay group (ICU length of stay ≥ 72 h). Results: Among the 230 patients studied, 53 (23.04%) patients had an ICU length of stay ≥ 72 hours and 177 (76.96%) patients had an ICU length of stay &lt; 72 hours and the mean duration of ICU stay was 2.45 days, ranging from 1 to 13 days. This study found that the factors increasing the ICU length of stay after CABG were; preoperative myocardial infarction (MI), elevated preoperative WBC counts, prolonged cardiopulmonary bypass (CPB) time, prolonged intubation, reintubation, reoperation, readmission, arrhythmia, receiving inotropic agents in the ICU, cardiac, pulmonary, and wound complications, and a higher postoperative troponin level. Conclusion: This study showed&nbsp;pre-, intra-, and post-operative clinical and surgical risk factors affect prolonged ICU stays

Abstract 11576: Association Between Pre-Operative Right Heart Catheterization Parameters and Outcomes in Isolated Coronary Artery Bypass Grafting

Objective We evaluate the association between pre-operative right heart catheterization variables and outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: All patients undergoing isolated CABG at our institution from 2013-2021 who also underwent pre-operative right heart catheterization &lt;14 days prior to isolated CABG were retrospectively queried. The primary outcome was operative mortality. Secondary outcomes were post-operative myocardial infarction, stroke, need for dialysis, duration of intensive care unit (ICU) stay, and duration of inotropic support. Results: Seventy-eight patients were analyzed. The incidence of operative mortality was 8(10.3%). The incidence of the secondary outcomes was 7(9.0%) for myocardial infarction, 5(6.4%) for stroke, and 4(5.1%) for need of dialysis. The median duration of ICU stay and inotropic support were 4[3.0, 7.8] and 2[1.3, 4.0] days respectively. On multivariable regression, central venous pressure was significantly associated with operative mortality (odds ratio (OR) 1.14, 95%CI 1.02-1.27, p=0.02) and duration of inotropic support (OR 1.02, 95%CI 1.00-1.03, p=0.04). Preoperative cardiac index was also significantly inversely associated with duration of ICU stay (OR 0.72, 95%CI 0.62-0.84, p&lt;0.001) and inotropic support (OR 0.76, 95%CI 0.63-0.92, p&lt;0.01). Conclusion Despite inclusion of cardiogenic shock in STS-PROM, baseline central venous pressure and cardiac index are independently associated with operative mortality, inotrope requirement and duration of ICU stay in patients undergoing isolated CABG. Assessment of pre-operative right heart function by right heart catheterization should be considered in this high-risk population to guide pre-operative optimization and intra-/post-operative decision-making.

Risk factors for ventilator-associated pneumonia due to multi-drug resistant organisms after cardiac surgery in adults

BackgroundVentilator-associated pneumonia (VAP) is one of the most common intensive care unit (ICU)-acquired infections, which can cause multiple adverse events. Due to bacterial mutation and overuse of antimicrobial drugs, multidrug-resistant organisms (MDRO) has become one of the major causes of postoperative VAP infections in cardiac patients. Therefore, this study aims to explore the risk factors for VAP with MDRO following cardiac surgery in adults.MethodsThe clinical data of adult VAP patients following cardiac surgery in the hospital from Jan 2017 to May 2021 were analyzed retrospectively, and the patients were divided into the MDRO VAP group and the non-MDRO VAP group. Univariable and multivariable logistic regression analyses were performed on risk factors in patients with MDRO VAP. The species and drug sensitivity of pathogens isolated from the VAP patients were also analyzed.ResultsA total of 61 VAP cases were involved in this study, with 34 cases in the MDRO VAP group (55.7%) and 27 cases in the non-MDRO VAP group (44.3%). Multivariable logistic regression analysis showed that independent risk factors for MDRO VAP included preoperative creatinine clearance rate (CCR) ≥ 86.6ml, intraoperative cardiopulmonary bypass (CPB) time ≥ 151 min, postoperative acute kidney injury (AKI) and nasal feeding. Gram-negative bacilli were the main pathogens in VAP patients (n = 54, 90.0%), with the highest rate of Acinetobacter baumannii (n = 24, 40.0%). Additionally, patients with MDRO VAP had a significantly longer postoperative intensive care unit (ICU) duration and higher hospitalization costs than non-MDRO VAP patients, but there was no notable difference in the 28-day mortality rate between the two groups.ConclusionBased on implementing measures to prevent VAP, clinicians should pay more attention to patients with kidney disease, longer intraoperative CPB time, and postoperative nasal feeding to avoid MDRO infections.

Haematological predictors of poor outcome among COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa.

Studies from Asia, Europe and the USA indicate that widely available haematological parameters could be used to determine the clinical severity of Coronavirus disease 2019 (COVID-19) and predict management outcome. There is limited data from Africa on their usefulness in patients admitted to Intensive Care Units (ICUs). We performed an evaluation of baseline haematological parameters as prognostic biomarkers in ICU COVID-19 patients. Demographic, clinical and laboratory data were collected prospectively on patients with confirmed COVID-19, admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between March 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curves were used to explore the association of haematological parameters with COVID-19 severity and mortality. A total of 490 patients (median age 54.1 years) were included, of whom 237 (48%) were female. The median duration of ICU stay was 6 days and 309/490 (63%) patients died. Raised neutrophil count and neutrophil/lymphocyte ratio (NLR) were associated with worse outcome. Independent risk factors associated with mortality were age (ARR 1.01, 95%CI 1.0-1.02; p = 0.002); female sex (ARR 1.23, 95%CI 1.05-1.42; p = 0.008) and D-dimer levels (ARR 1.01, 95%CI 1.002-1.03; p = 0.016). Our study showed that raised neutrophil count, NLR and D-dimer at the time of ICU admission were associated with higher mortality. Contrary to what has previously been reported, our study revealed females admitted to the ICU had a higher risk of mortality.

Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes

ObjectivesTo extract data from clinical information systems to automatically calculate high-resolution quality indicators to assess adherence to recommendations for low tidal volume. DesignWe devised two indicators: the percentage of time under mechanical ventilation with excessive tidal volume (>8mL/kg predicted body weight) and the percentage of patients who received appropriate tidal volume (≤8mL/kg PBW) at least 80% of the time under mechanical ventilation. We developed an algorithm to automatically calculate these indicators from clinical information system data and analyzed associations between them and patients’ characteristics and outcomes. SettingsThis study has been carried out in our 30-bed polyvalent intensive care unit between January 1, 2014 and November 30, 2019. PatientsAll patients admitted to intensive care unit ventilated >72h were included. InterventionUse data collected automatically from the clinical information systems to assess adherence to tidal volume recommendations and its outcomes. Main variables of interestMechanical ventilation days, ICU length of stay and mortality. ResultsOf all admitted patients, 340 met the inclusion criteria. Median percentage of time under mechanical ventilation with excessive tidal volume was 70% (23%–93%); only 22.3% of patients received appropriate tidal volume at least 80% of the time. Receiving appropriate tidal volume was associated with shorter duration of mechanical ventilation and intensive care unit stay. Patients receiving appropriate tidal volume were mostly male, younger, taller, and less severely ill. Adjusted intensive care unit mortality did not differ according to percentage of time with excessive tidal volume or to receiving appropriate tidal volume at least 80% of the time. ConclusionsAutomatic calculation of process-of-care indicators from clinical information systems high-resolution data can provide an accurate and continuous measure of adherence to recommendations. Adherence to tidal volume recommendations was associated with shorter duration of mechanical ventilation and intensive care unit stay.

Comparative effectiveness of real-time ultrasound-guided tracheostomy and anatomic landmark percutaneous dilatational tracheostomy: a retrospective cohort study.

The role of ultrasound during various airway procedures has been in the spotlight in recent years. This study reconsiders the potential role and effectiveness of ultrasound use during percutaneous dilatational tracheostomy in intensive care patient population. This study aims to assess the impact of real-time ultrasound (US) use on complication rates and procedural success in percutaneous dilational tracheostomy (PDT) opened with forceps dilatation technique using anatomical landmarks. In this study, 59 patients who had undergone PDT in the intensive care unit (ICU) were reached. Written-electronic files and intensive care follow-up forms of the patients were reviewed retrospectively. The patients were divided into two groups: 44 patients in Group G (anatomical landmark PDT) and 15 patients in Group U (real-time US PDT). Demographic data, duration of intubation and ICU stay, discharge status, procedural characteristics and postoperative complications of the patients were determined. A total of 59 patients were analyzed. The mean age of the patients was 74.9±11.7 years, the mean tracheostomy duration was 33.3±20 days, and the mean duration of ICU stay was 60±45 days. Complications occurred in 62.7% of all patients. Minor bleeding was present in five (8.5%), moderate bleeding in 13 (22%), and major bleeding in 11 (18.6%) patients. In addition, pneumothorax was observed in one patient, misplacement of the tracheostomy cannula and emphysema in one patient, and esophageal injury in three patients. A total of 50 (84.7%) patients died, and nine (15.3%) patients continued to be treated in the ICU. Bleeding, hypoxemia, hypercapnia, tracheostomy opening time duration, and the number of attempts for the successful procedure were significantly higher in Group G than Group U (p<0.05). A negative correlation was found between the groups regarding the duration of tracheostomy (p = 0.001) and tracheostomy opening technique (p = 0.001). The use of real-time ultrasound in percutaneous tracheostomies opened under elective conditions in the ICU reduces the complications of hypoxemia, hypercapnia and bleeding by dwindling the duration of the procedure and the number of attempts than the conventional technique.

Flail chest injury—changing management and outcomes

PurposeThe purpose of this study was to assess trends in management of flail chest injuries over time and to determine impact on patient outcomes.MethodsA retrospective review of data from a prospectively collated database of all trauma patients admitted to a level 1 trauma service in Victoria was conducted. All trauma patients admitted to the hospital between July 2008 and June 2020 with an Abbreviated Injury Scale (AIS) code for flail chest injury were included.ResultsOur study included 720 patients, mean age was 59.5 ± 17.3 years old, and 76.5% of patients were male. Length of ICU stay decreased on average by 9 h each year. Regional anaesthesia use increased by 15% per year (0% in 2009 to 36% in 2020) (p < 0.001). Surgical stabilisation of rib fractures increased by 16% per year (2.9% in 2009 to 22.3% in 2020) (p = 0.006). The use of invasive ventilation decreased by 14% per year (70% in 2008 to 27% in 2020) (p < 0.001), and invasive ventilation time decreased by 8 h per year (p = 0.007).ConclusionOver the past decade, we have seen increasing rates of regional anaesthesia and surgical rib fixation in the management of flail chest. This has resulted in lower requirements for and duration of invasive mechanical ventilation and intensive care unit stay but has not impacted mortality in this patient cohort.

Effect of aspirin in preventing deep vein thrombosis (DVT) after lumbar canal spinal stenosis surgeries: a double-blind parallel randomized clinical trial

Background: Deep vein thrombosis (DVT) is a great postoperative challenge in all orthopaedic surgeries. To the authors’ knowledge, this study is the first to evaluate the efficacy of aspirin administration in the prevention of DVT in patients undergoing lumbar spinal surgery. Methods: In this double-blind parallel randomized clinical trial, a total of 126 candidates (age 40 yr and older) were admitted between June 2021 to December 2021. Patients were randomly assigned to the intervention chemoprophylaxis group (41 patients receiving 325 mg aspirin) and controls. The DVT occurrence was recorded by clinical features (Well’s criteria), Doppler lower limbs ultrasound, and D-dimer levels in all participants at baseline (24 hr before the time of surgery) and 2, 6, and 12 wk after surgery in postoperative visits. Results: The mean age of the participants was 63.72±6.87 yr. Baseline demographic values were similar in both groups (P&gt;0.05). The mean follow-up duration was 6.11±2.33 mo. No cases of DVT or abnormal findings on Doppler ultrasound were observed in either group. The mean duration of hospitalization or intensive care unit (ICU) admission was similar between the two groups. Mean baseline D-dimer levels were significantly higher in the intervention group compared with the controls (P=0.047), while it was similar in both groups 3 mo after the operation (P=0.13). Conclusions: In the current study, no case of DVT was observed in either study group. These data do not support the use of aspirin as an anticoagulant for DVT prophylaxis following regular lumbar spinal surgeries. Level of Evidence: Level II.