Function In Intensive Care Unit Patients Research Articles

Evaluation of brain nerve function in ICU patients with Delirium by deep learning algorithm-based resting state MRI.

The purpose of this study was to explore the value of resting-state magnetic resonance imaging (MRI) based on the brain extraction tool (BET) algorithm in evaluating the cranial nerve function of patients with delirium in intensive care unit (ICU). A total of 100 patients with delirium in hospital were studied, and 20 healthy volunteers were used as control. All the subjects were examined by MRI, and the images were analyzed by the BET algorithm, and the convolution neural network (CNN) algorithm was introduced for comparison. The application effects of the two algorithms were analyzed, and the differences of brain nerve function between delirium patients and normal people were explored. The results showed that the root mean square error, high frequency error norm, and structural similarity of the BET algorithm were 70.4%, 71.5%, and 0.92, respectively, which were significantly higher than those of the CNN algorithm (P < 0.05). Compared with normal people, the ReHo values of pontine, hippocampus (right), cerebellum (left), midbrain, and basal ganglia in delirium patients were significantly higher. ReHo values of frontal gyrus, middle frontal gyrus, left inferior frontal gyrus, parietal lobe, and temporal lobe and anisotropy scores (FA) of cerebellums (left), frontal lobe, temporal lobe (left), corpus callosum, and hippocampus (left) decreased significantly. The average diffusivity (MD) of medial frontal lobe, superior temporal gyrus (right), the first half of cingulate gyrus, bilateral insula, and caudate nucleus (left) increased significantly (P < 0.05). MRI based on the deep learning algorithm can effectively improve the image quality, which is valuable in evaluating the brain nerve function of delirium patients. Abnormal brain structure damage and abnormal function can be used to help diagnose delirium.

Critical illness myopathy and trajectory of recovery in acute kidney injury requiring continuous renal replacement therapy: a prospective observational trial protocol

IntroductionAcute kidney injury requiring renal replacement therapy (AKI-RRT) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. Continuous RRT (CRRT) non-selectively removes large...

Effects of abdominal massage on gastrointestinal function in ICU patients: a meta-analysis

Abstract Objective To evaluate the effects of abdominal massage on gastrointestinal function in the intensive care unit (ICU) patients. Methods Randomized controlled trials about the effects of abdominal massage on gastrointestinal function in ICU patients were included from multiple electronic databases: PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, China Academic Journals Full-Text Database (CNKI), Wanfang Database, and CQVIP, until November 2018. Studies were selected according to inclusion and exclusion criteria, extracting data and assessing. Data were analyzed by RevMan 5.3. Results Nine studies with 720 patients were included. The results of meta-analysis in the intervention group were as follows: abdomen circumference: mean difference (MD)=-4.22, 95% confidence interval (CI)=(-6.20, -2.24), P&lt;0.00001; abdominal distension: MD=0.34, 95% CI=(0.22, 0.52), P&lt;0.00001; gastric residual: MD=-41.51, 95% CI=(-55.86, -29.15), P=0.001; gastric retention: MD=-0.23, 95% CI (-0.30, -0.15), P&lt;0.00001; and vomiting: MD=0.12, 95% CI=(0.04, 0.35), P=0.0001. Conclusions Abdominal massage is effective in reducing abdominal distension, gastric residual, and vomiting. When the intervention period was &lt;7 days, abdominal massage could not reduce the abdominal circumference in ICU patients, and when the intervention period was equal to 7 days, abdominal massage could reduce the abdominal circumference in ICU patients.

Effect of Modafinil on Cognitive Function in Intensive Care Unit Patients: A Retrospective Cohort Study.

Modafinil therapy, a nonamphetamine cognition-enhancing agent, holds the potential to improve recovery from cognitive impairment after intensive care unit (ICU) admission. To date, however, there is a paucity of data on modafinil use in the ICU setting. The purpose of this study was to explore the role of modafinil for improvement in cognition in ICU patients. This retrospective cohort study evaluated a total of 60 ICU patients with any ventilatory support who started on modafinil during their ICU stay from January 1, 2010, to March 19, 2016. The requirements of opioids and sedatives, as well as the lowest and average scores of the Glasgow Coma Scale (GCS) and Riker Sedation-Agitation Scale (SAS), were recorded during 48 hours before and after the start of modafinil therapy in 6-hour periods. The average daily modafinil dose of 170 mg was given for a median duration of 9days. Modafinil administration was associated with a small, nonsignificant increase in GCS by 0.34 points after controlling for age, baseline severity of illness, and changes in sedation and analgesia over time (95%CI, -0.34 to 0.73 points; P = .0743). No major modafinil-associated adverse effects were observed. Modafinil administration did not significantly improve cognitive function in ICU patients within 48 hours of initiation. However, because of lack of robust evidence, the impact of modafinil on overall patient outcomes in the ICU remains unclear and needs further investigation.

The black box revelation: monitoring gastrointestinal function.

The gastrointestinal tract comprises diverse functions. Despite recent developments in technology and science, there is no single and universal tool to monitor GI function in intensive care unit (ICU) patients. Clinical evaluation is complex and has a low sensitivity to diagnose pathological processes in the abdomen. We performed a MEDLINE and Pubmed search connecting abdominal assessment and critical care. Based on these findings we defined the following major categories of monitoring and diagnostic measures: clinical investigation; assessment of motility and digestive function; microbiome monitoring; perfusion monitoring; laboratory biomarkers and hormonal function; intra-abdominal pressure measurement; and imaging techniques. Only a few of these monitoring and assessment tools have found their way into clinical practice, as most of them have one or more significant objections preventing broad implementation in daily clinical practice. Further research should be directed to reaffirm and define the use of current techniques to ascertain their validity and usefulness to monitor gastrointestinal function in ICU patients.

P248 Measuring physical recovery in the critical care population: development of the Chelsea critical care physical assessment tool (CPAx)

IntroductionThe secondary physical effects of critical illness, for example, muscle atrophy, can be detrimental to functional outcome and quality of life in critical care survivors. To minimise these problems early...

Modeling Serum Creatinine in Septic ICU Patients

Serum creatinine is a metabolite assumed to be constantly produced by the normally functioning muscle mass and is a good measure for monitoring daily renal function in the intensive care unit (ICU). High serum creatinine levels or an abnormal departure from normal pre-disease basal levels are indices of acute renal failure (ARF). Septic ICU patients develop multi-organ failure and ARF is often an important complication. In order to attempt to substitute artificially for the failing renal function, septic ARF patients often undergo hemodialytic procedures until kidney damage resolves. The present work details the structure of a model describing observed creatinine serum concentration (CSC) variations, depending on the time-varying septic insult to renal function in ICU patients, as well as the estimation of its parameters. CSC determinations were routinely obtained from 12 patients, of whom six underwent continuous dialysis procedures and six did not. The model incorporates a delay term τ, to be estimated, which expresses the number of days between the beginning of sepsis and ICU admission, allowing, in this way, a general representation of the time course of renal function depending on the history of sepsis. In order to take into account the effect of dialysis, a linear CSC elimination rate was added in those days when dialysis therapy was actually administered. Estimates of the model's structural parameters were computed for each patient by means ordinary least squares and were then compared across dialysis groups.

The Operative Treatment of Hernia in Infants and Young Children

<h3>Introduction</h3> The secondary physical effects of critical illness, for example, muscle atrophy, can be detrimental to functional outcome and quality of life in critical care survivors. To minimise these problems early physiotherapy in the Intensive Care Unit (ICU) is advocated. However, research to identify the optimal rehabilitation strategy is hindered by lack of an ICU specific objective measure of physical recovery. Current measures are either impairment specific, thus not capturing the full picture, or their validity is unproven in this population. <h3>Aim</h3> To develop a measurement tool to assess physical recovery in the heterogeneous general adult critical care population. <h3>Method</h3> <h3>Face/content validity</h3> The initial tool was developed in a clinical setting by specialist physiotherapists and is called the Chelsea Critical Care Physical Assessment tool (CPAx). It is a pictorial composite of 10 numerical evaluations of pertinent functions and impairments. It was tested for face and content validity with a content validity index questionnaire (CVIQ), a subsequent focus group and a repeat CVIQ. <h3>Inter-rater reliability</h3> Five physiotherapists using the CPAx regularly all assessed the same two patients. Data were analysed for intra-class correlation co-efficient (ICC) and internal consistency. <h3>Construct validity</h3> A dual centred cohort study of 32 ICU patients was completed. Treating physiotherapists assessed patients using the CPAx thrice weekly. Additionally, biceps and quadriceps strength, cough peak flow (CPF) and components of the AusTOMs scores (a physiotherapy outcome measure) were tested by a researcher blinded to the CPAx scores. Correlation co-efficients were then used to analyse the data. <h3>Results</h3> <h3>Face/content validity</h3> Pre and post focus group CVIs were 0.67 (p&gt;0.05) and 0.83 (p&lt;0.05), respectively. <h3>Reliability</h3> Reliability was strong with internal consistency of 0.98 and ICC 0.902 (95% CI 0.799 to 0.969; p=&lt;0.001). <h3>Construct validity</h3> Pilot data showed strong positive correlations (0.744–0.922, p&lt;0.01), between the CPAx, muscle strength and AusTOMs scores. Data were insufficient to analyse CPF results. <h3>Conclusion</h3> Preliminary data show that the CPAx is a reliable and valid measure of physical function in ICU patients. It can now be used as an outcome measure for physiotherapy research and has potential to act as a predictor of functional outcome in the ICU population.