Hospital Intensive Care Unit Research Articles

Factors Influencing Radiation Protection Behavior of Nurses in Intensive Care Units

Purpose : The purpose of this study was to identify the factors that influence the behavior of intensive care unit (ICU) nurses regarding radiation protection, and to provide basic data to improve radiation protection educational programs. Methods : This descriptive research study included 143 nurses working in ICUs. Data were collected through a self-reported structured questionnaire and analyzed using t-test, Pearson’s correlation coefficients, and hierarchical multiple regression analysis. Results : Radiation protection environment (<i>β</i>=.35, <i>p</i>=.001), radiation protection self-efficacy (<i>β</i>=.25, <i>p</i> =.002), type of hospital (<i>β</i>=-.25, <i>p</i>=.002) and experience in ICU (<i>β</i>=-.18, <i>p</i>= .022) affected the radiation protection behavior of ICU nurses. The total explanatory power of model was 60.0% (R<sup>2</sup>=.64, Adj. R<sub>2</sub>=.60, F=17.71, <i>p</i>＜.001). Conclusion : In order to enhance the standards of radiation protection behavior among intensive care unit nurses and improve radiation protection self-efficacy, educational and training programs should be developed. Additionally, administrative support should be considered to create environments with better radiation protection at the organizational level.

Impact of agitation status during intensive care on functional outcomes and mortality in patients with cardiovascular disease

Abstract Background Agitation in patients during intensive care is a frequent complication. Several studies have reported that restlessness and agitation are risk factors for prolonged intensive care unit (ICU) stay and poor prognosis. Since patients with cardiovascular disease (CVD) requiring intensive care are ageing and thereby easily affected by responses, including changes in mental status, optimal management of sedation and agitation statuses during ICU stay is considered crucial. However, the influence of different agitation levels during CVD treatment in the ICU on clinical outcomes after ICU discharge is still unclear. Purpose To investigate the associations of the agitation level during ICU stay with mortality after ICU admission and functional outcomes at hospital discharge. Methods We studied 2236 patients (mean age 67.8±0.3 years) who were admitted to the ICU of a university hospital for CVD treatment and whose highest Richmond Agitation-Sedation Scale (RASS) ≥0, measured daily during ICU stay. In addition to clinical characteristics, we investigated the incidence of all-cause mortality during hospitalization and after hospital discharge. We also measured functional outcomes at discharge among 1625 patients, including 6 minutes walk distance (6MWD), Mini-Cog test, and Patient Health Questionnaire-2 (PHQ-2) as physical, cognitive, and mental functions, respectively. In statistical analysis, patients were divided into three groups based on the highest RASS levels during ICU stay in each patient (Calm: RASS=0, Restless: RASS=1, Agitation: RASS≥2). Kaplan-Meier analysis with a log-rank test and the multivariate Cox proportional hazard model were used to clarify whether higher agitation levels were associated with all-cause mortality. Moreover, the differences between the agitation levels and functional outcomes at hospital discharge were compared using the analysis of covariance. Results During the median follow-up of 1.9 years, all-cause death occurred in 280 patients (12.5%), with an incidence rate of 5.57/100 person-years. The Restless and Agitation groups showed higher mortality than the Calm group (P<0.001), and higher agitation levels in the ICU were significantly associated with a higher rate of all-cause mortality (adjusted hazard ratio: 1.37, 95% confidence interval: 1.19–1.57, P<0.001). Furthermore, as compared with the Calm group, the Restless and Agitation groups showed significantly lower levels of 6MWD (all P<0.001) and Mini-cog (P=0.004 and P<0.001, respectively) and a higher PHQ-2 (all P<0.001), even after adjusting for clinical confounders. Conclusions Agitation during ICU stay in CVD patients was associated with low functional outcomes at hospital discharge and high mortality rate after discharge, irrespective of agitation level. Detailed information on the agitation status during intensive care may be an important indicator in developing management and treatment strategies for patients with CVD admitted to ICU.

Prevalence of Suicidal Ideation in Patients With COVID-19 Admitted to a Hospital in Qazvin, Iran

Background and Objectives: Many patients with COVID-19 show long-term physical and mental symptoms. This study aims to determine the prevalence of suicidal ideation in patients with COVID-19 hospitalized in a hospital in Qazvin, Iran. Methods: This is a cross-sectional study. The study population consists of all patients with COVID-19 admitted to Bou Ali Sina Hospital in Qazvin city. A two-part questionnaire was used to collect data; the first part surveys demographic characteristics, history of death due to COVID-19 in relatives, history of underlying disease, days of hospitalization, history of intubation, and history of hospitalization in intensive care units. The second part was the Beck Scale for Suicide Ideation. The collected data were analyzed in SPSS software, version 23 using ANOVA and logistic regression analysis. Results: Participants were 206 patients with COVID-19. The data showed that 12.8% of patients had high suicidal ideation. Younger patients were at a high risk of suicide (Mean age: 31.96±12.59 years) (P<0.001). In addition, patients who were single (P<0.001) and had a history of death due to COVID-19 in relatives or friends had higher suicidal ideation (P=0.005). Conclusion: About 12.8% of patients with Covid-19 admitted to the study hospital had a high suicidal ideation. There is no considerable difference between the prevalence of suicidal ideation reported in this study and the data reported for the general population of Iran before the pandemic.

Designing Intensive Care Unit Windows in a Mediterranean Climate: Efficiency, Daylighting, and Circadian Response

Hospital intensive care units (ICUs) frequently experience inadequate lighting conditions, with low daytime and excessive nighttime illuminance, which can negatively affect patient recovery and the work performance of health personnel. This study examines the impact of window design parameters—specifically, window-to-wall ratio (WWR) and window position—and interior surface reflectance on visual comfort, lighting performance, energy consumption, and human well-being in intensive care units (ICUs) in Mediterranean climates, according to orientation. Using dynamic lighting metrics, such as daylight autonomy (DA) and circadian stimulus autonomy (CSA), this research quantifies the influence of these design factors. The results suggest that a WWR of 25% is optimal for achieving sufficient DA and CSA values, with centered window configurations preferred for uniform daylight distribution and circadian stimulus. This study further emphasizes the significance of interior reflectance, recommending bright coatings to maximize outcomes, while advising against dark finishes, particularly in north-facing rooms or with smaller WWRs. Although Seville shows slightly better performance than Barcelona, the proposed configurations are effective across both locations, highlighting the prioritization of window sizing, positioning, and reflectance over Mediterranean geographical differences. These findings offer practical guidance for ICU design to enhance natural lighting, supporting patient recovery and overall well-being through improved circadian alignment.

The association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study.

Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay. This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD). This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises. The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η2: 0.025, ONSD left eye p:.935, Partial η2: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η2: 0.009, Systolic Pressure p:.435, Partial η2: 0.043, Diastolic Pressure p:.128, Partial η2:0.103, Saturation p:.103, Partial η2: 0.113 and Respiratory rate p:.071, Partial η2:0.130). This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy. Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.

Analysis of perinatal outcomes in pregnant women with the resolution of placenta previa in the second trimester

Objective: To investigate perinatal outcomes of pregnant women with the resolution of placenta previa in the second trimester. Methods: This study was a retrospective cohort study, which included singleton pregnant women who received prenatal care and delivered at Peking University Third Hospital from January 1st 2019 to December 31st 2020. A total of 403 pregnant women diagnosed with placenta previa by ultrasound at 20-24 weeks of gestation and the placental position returned to normal before delivery were included in the study group, and 403 pregnant women with normal placental position matched 1∶1 were the control group. The primary outcome was postpartum hemorrhage rate, and secondary outcomes included postpartum bleeding volume, severe hemorrhage complications, blood transfusion, drug application, the application of instrument or surgical hemostasis measures, gestational week of delivery, and neonatal outcomes. The perinatal outcomes were analyzed by univariate and multivariate logistic regression methods. Results: (1) Compared with the control group, the incidence of postpartum hemorrhage [10.4% (42/403) vs 17.6% (71/403)], postpartum hemorrhage volume (median: 375 vs 400 ml), the proportion of postpartum hemorrhage≥500 ml [18.6% (75/403) vs 30.5% (123/403)], and the proportion of application of instrument or surgical hemostasis measures [1.7% (7/403) vs 4.5% (18/403)] in the study group were increased, and the differences were statistically significant (all P<0.05). Neonatal outcomes, including birth weight, small for gestational age, hospitalization in neonatal intensive care unit and incidence of neonatal asphyxia, were compared between the two groups, and there were no statistically significant differences (all P>0.05). (2) In pregnant women with vaginal delivery, the postpartum hemorrhage rate [31.7% (66/208) vs 17.5% (39/223)], postpartum hemorrhage volume (median: 390 vs 380 ml), the proportion of instrument or surgical hemostasis measures [3.8% (8/208) vs 0.4% (1/223)] of the study group were higher than those of the control group, and the differences were statistically significant (all P<0.05). There was no significant difference in the rate of postpartum hemorrhage between the study group and the control group who gave birth by cesarean setion (P=0.545), but the proportion of postpartum hemorrhage≥500 ml in the study group and the control group were 29.2% (57/195) and 20.0% (36/180), and the difference was statistically significant (P=0.039). (3) The results of multivariate analysis showed that compared with the control group, the risk of postpartum hemorrhage (aOR=2.042, 95%CI: 1.313-3.175), the application of drugs (aOR=1.684, 95%CI: 1.142-2.484) and the application of instruments or surgical hemostasis measures (aOR=2.696, 95%CI: 1.089-6.675) were significantly increased in the study group (all P<0.05). Among women who delivered vaginally, the risk of postpartum hemorrhage in the study group was 2.021 times greater than that in the control group (95%CI: 1.269-3.220; P=0.003). Conclusion: In women with placental previa in the second trimester of pregnancy, even if the placental position returns to normal before delivery, it is still a high risk factor for postpartum hemorrhage, especially in vaginal delivery.

Evaluation of Plasma-Lyte Versus Lactated Ringer's in Surgical Intensive Care Unit Trauma Patients as Fluid Resuscitation.

In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer's (LR) has shown benefit over NS, plasma-lyte (PL) with a higher osmolarity and different electrolyte formulation is hypothesized to be superior. We performed a retrospective observational cohort study over 37 months at a tertiary hospital. Inclusion criteria were hospitalization in the surgical intensive care unit (SICU), trauma indication, ≥18 years old, and received either PL or LR. All PL administrations and every fifth patient with LR as resuscitation were included in order to match the sample size in each group. Primary outcomes were SICU length of stay (LOS), hospital LOS, and mortality. Secondary outcomes were biomarker changes from baseline. There were 113 patients in both PL and LR groups. The PL arm had higher APACHE II scores (16 vs 13, P = .033) and were more likely ventilated (39.3% vs 20.4%, P = .002) compared to LR. Median hospital LOS (12.0 vs 8.0, P < .001) and SICU LOS (6.0 vs 3.0, P < .001) are significantly longer in PL group compared to the LR group. However, there was no difference in in-hospital mortality (5.3% vs 3.5% P = .519) and SICU mortality (9.7% vs 5.3%, P > .208) between PL and LR. Overall, PL use was associated with prolonged hospital and SICU LOS. PL use did not demonstrate mortality benefit. However, patients were more critically ill in PL group based on higher APACHE II scores and higher rates of mechanical ventilation, which could be contributing to these unfavorable outcomes.

A retrospective study utilized MIMIC-IV database to explore the potential association between triglyceride-glucose index and mortality in critically ill patients with sepsis

Triglyceride-glucose (TyG) index has emerged as a novel biomarker for detecting insulin resistance (IR) and has been proven to be associated with various diseases. However, its correlation with the prognosis of severe sepsis remains unraveled. This retrospective cohort study utilized patient records from the Medical Information Mart for Intensive Care (MIMIC-IV, version 2.2) to examine the outcomes of patients with sepsis. The primary outcomes were hospital mortality and intensive care unit (ICU) mortality. The correlation between the TyG index and outcomes was evaluated through the Kaplan-Meier method, the Log-rank test, and univariate and multivariate Cox regression analyses. Additionally, restricted cubic spline (RCS) regression analysis was employed to delve into the nonlinear relationship between baseline TyG index and outcomes, with trend significance assessed through quartile levels. Subgroup analyses were conducted to evaluate the consistency of the TyG index’s prognostic value across various influencing factors. The study included 1,742 patients with sepsis requiring intensive care. The in-hospital mortality rate was 19.75% (344/1,742), and the ICU mortality rate was 14.75% (257/1,742). Cox regression analysis revealed that, in comparison to the first quartile (Q1), patients in the fourth quartile (Q4) had a 63% higher risk of in-hospital mortality (HR 1.63 [95% CI 1.22 to 2.18], P < 0.01) and a 79% higher risk of ICU mortality (HR 1.79 [95% CI 1.28 to 2.51], P < 0.001). Model 3 showed that ICU mortality risks for Q4, Q3, and Q2 were 240%, 75%, and 33% higher, respectively (HR 3.40 [95% CI 2.24 to 5.16], P < 0.001; HR 1.75 [95% CI 1.16 to 2.63], P = 0.007; HR 1.33 [95% CI 1.20 to 1.53], P < 0.001). RCS regression analysis identified a nonlinear association between the TyG index and mortality (overall P < 0.001; P for nonlinearity < 0.001, with an inflection point at 8.9). Subgroup analysis showed that the effect size and direction were consistent across different subgroups, suggesting the stability of the results. This study demonstrates that a higher TyG index is significantly associated with increased in-hospital and ICU mortality risk in critically ill sepsis patients, with evidence of non-linear correlation. Therefore, the TyG index helps identify the mortality prognosis of sepsis patients in the ICU.

Postoperative fever and clinical outcomes after endoscopic surgery for spontaneous intracerebral hemorrhage: a retrospective database study

BackgroundSpontaneous intracerebral hemorrhage (SICH) is a severe stroke with high mortality and disability rates. Endoscopic surgery is an increasingly widely used minimally invasive method for the treatment of SICH. However, the impact of fever on patient outcomes remains unclear.MethodsWe retrospectively included patients aged 18 years or older with supratentorial SICH confirmed by CT, who underwent endoscopic hematoma evacuation within 48 h of symptom onset. The primary outcome was the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included hospital and neurosurgical intensive care unit (NSICU) stays, and perioperative complications. We analyzed the association between postoperative fever (highest temperature within 24 h after surgery) and these outcomes using multivariate analysis, generalized additive models, and segmented regression analysis.ResultsOf the 56 patients, 38 had favorable outcomes (mRS ≤ 3) and 18 had unfavorable outcomes (mRS > 3) at 3 months. A threshold effect at 38.2 °C was observed between postoperative body temperature and clinical outcomes. The mean age was 56 years (SD = 9) for the > 38.2 °C group and 58 years (SD = 8) for the ≤ 38.2 °C group, with a similar proportion of male patients (63% vs. 69%, P = 0.635). Patients with postoperative fever had larger hematoma volumes (65 vs. 56 mL; P = 0.008). Other characteristics were similar between the groups. Postoperative fever (> 38.2 °C) was independently associated with a 4.99-fold increased risk of unfavorable outcomes (95% CI = [1.13 to 25.90]; P = 0.040), which remained significant after excluding patients with postoperative complications (adjusted RR = 16.03, 95% CI = [1.69 to 417.24]; P = 0.033). The association was consistent across subgroups with different Glasgow Coma Scale scores, hematoma volumes, and intraventricular extension. Postoperative fever was also associated with longer NSICU stays (3.1 vs. 2.3 days; P = 0.023), longer hospital stays (17.2 vs. 13.6 days; P = 0.010), more residual hematoma, and greater edema volume. Different antipyretic therapies did not affect outcomes.ConclusionsThis study identifies a temperature threshold (38.2 °C) associated with poor outcomes in SICH patients undergoing endoscopic surgery. Further research is needed to mitigate postoperative fever and improve patient outcomes.

High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry

IntroductionApplication of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes. MethodsThe institutional Severely Injured Patients’ Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined. ResultsA consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257).This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS. ConclusionIn the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.

Analysis of poor work postures during morning care operations of intensive care unit nurses: a field research

BackgroundPoor working postures in morning care operations contribute significantly to work-related muscle fatigue and low back pain among ICU (Intensive Care Unit, ICU) nurses. However,there are few field studies on the relationship between Poor working postures and work-related muscle fatigue, low back pain among ICU nurses.ObjectiveThis study aims to assess the frequency and degree of posture hazards associated with poor working postures during morning care operations of ICU nurses.MethodsTwo ICUs in a Grade-A tertiary hospital in Hunan Province were randomly selected for the field study in May–June 2021 research. The image data of the participating nurses’ morning care work postures were collected by observation method and image recording method, and the postural hazard level was assessed by the two-person interpretation method of the work posture analysis system. The mean and standard deviation, frequency and percentage were used for the basic statistical description, and the general linear model multivariate Hotelling’s T2 test was used to calculate the Hotelling’s T2 and F statistics to explore the pattern of change in the postural hazard score curves.ResultsA total of 45 nurses were observed during morning care operations, resulting in 47.8 h of video data and 34,428 effective static operation posture pictures. Among these pictures, 21,166 (61.5%) depicted poor working postures. Nurses spent up to 7 min and 30 s maintaining a challenging posture during oral care, with the highest postural hazard score (M = 2.2, SD = 0.3) observed during defecation care. Each patient requires a total of 25–30 min of oral care per day.The Hotelling’s T2 test indicated that the change curve of the postural hazard score in each step revealed the largest second-order F value, F = 52.931, P < 0.001.DiscussionICU nurses frequently adopt poor working postures during morning care operations. Further research should focus on optimizing safe working postures to prevent or minimise detrimental occupational hazards resulting from poor working postures.Research on occupational low back pain among ICU nurses can help them work more efficiently, and thereby improving their nursing level.

Prognostic Role of Temperature Oxygenation Perfusion Sugar (TOPS) score in Outborn Transported Neonates in a Tertiary Care Center—A Prospective Cohort Study

Background Neonatal outcomes are affected by the acute physiologic derangements of neonatal vitals, such as temperature, blood sugar (GRBS), perfusion, and oxygenation. The aim was to correlate the temperature oxygenation perfusion sugar (TOPS) score of outborn neonates transported with the morbidity and mortality during hospitalization in the neonatal intensive care unit (NICU). Methods Five hundred transported neonates were enrolled in this prospective cohort study by scoring TOPS vitals within an hour of NICU admission, and the outcomes were assessed after 72 hours of hospitalization. Results Among 500 neonates, hypoglycemia, hypoperfusion, hypoxemia, and hypothermia were found in 13%, 32%, 30%, and 37%, respectively. One hundred five (21%) neonates did not survive. Hypoxemia (82%) was the most common parameter, followed by hypoperfusion (78%) among the nonsurvivor neonates. Neonates with a TOPS score of zero survived, whereas neonates with a TOPS score of four had 100% mortality. TOPS SCORE’s overall sensitivity and specificity were reported at 87% and 84%, respectively, with 59% positive and 96% negative predictive values. TOPS score ≥2 had a receiver operating characteristic (ROC) curve at 0.91. Hypoxemia (82%) was the most sensitive parameter to predict mortality, followed by poor perfusion (77%). Conclusion The prognostication of mortality in transported neonates can be assessed by the TOPS score, as mortality notably increases with an increase in the TOPS score. A TOPS score of ≥2 was a good predictor of morbidity and mortality in transported neonates.

Assessment of Nosocomial Infection Rates and Preventive Strategies in the Intensive Care Unit at Rwanda Military Hospital: A Retrospective Analysis

Abstract: Background: Nosocomial infections, occurring &gt;48 hours after admission without evidence of pre-existing incubation, pose a significant challenge in intensive care units (ICUs), particularly for patients with prolonged hospital stays. In the 21st century, these infections affect approximately 10% of hospitalized patients, with higher rates observed in ICU settings. They contribute to extended hospitalization, disability, and economic burden. This study aims to evaluate the effectiveness of preventive measures in controlling nosocomial infections at Rwanda Military Hospital's ICU. Materials and Methods: A retrospective analysis was conducted on patients admitted to the ICU at Rwanda Military Hospital from January 2019 to December 2020. Data on nosocomial infections were retrieved from OpenClinic HMIS software, ICU registries, and patient files. Statistical analysis was performed using Microsoft Excel 21 and SPSS 21. Findings: Among 531 ICU admissions during the study period, 18% were identified with nosocomial infections. The infection rate was slightly higher in males (20%) compared to females (16.5%), with Enterobacteriaceae bacteria being the most common pathogens identified (35%). Conclusions: Nosocomial infections remain prevalent in our ICU setting, highlighting the importance of adherence to infection prevention guidelines. Poor implementation of these guidelines emerges as a significant risk factor for nosocomial infections. Key words: Nosocomial infection, Hospital-acquired infections, healthcare-associated infections, infection control, hand hygiene, multidrug resistance, antibiotic resistance, preventive guidelines.

Method to apply temporal graph analysis on electronic patient record data to explore healthcare professional–patient interaction intensity: a cohort study

AimInteractions between patients and healthcare professionals (HCP) during hospital admissions are complex and difficult to interrogate using traditional analysis of electronic patient record (EPR) data. The objective of this study...

Emergency surgery for traumatic brain injury in geriatric patients

Objectives: Verify the sociodemographic profile of an elderly victim of trauma due to a fall who is admitted to the ICU of a public reference hospital to determine whether there are relationships between his age, comorbidities, length of stay, complications and clinical results. A retrospective analytical study with a quantitative approach was carried out between April and October 2014 in the Intensive Care Unit (ICU) of the Hospital de Base do Distrito Federal, administered by the State Department of Health of the Federal District, DF. Using the TrakCare® computerized medical record, sociodemographic data were found on elderly people hospitalized between the fall of July 2012 and July 2014, including mechanisms of trauma, comorbidities, length of stay, use of invasive devices, vasoactive and sedative drugs, complications and clinical internships. Results: The sample was made up of 52 elderly people, the majority of whom were men and the injury was a fall in height. Lung infection, septic shock, use of blood products and acute renal failure were the main complications. Despite the high mortality observed in the study, the majority of elderly people survived the traumatic event. Male sex, traumatic brain injury (TBI), pulmonary septic shock and dialysis were the main causes of mortality. Conclusion: Falling in height, fractures and severe TBI were extremely common, and most patients had more than one complication during hospitalization. No significant difference was found between age and mortality.

C-reactive protein/albumin ratio versus lactate/albumin ratio as an outcome predictor for patients with sepsis and septic shock in hospital stay

Background &amp; Objective: Pre-emptively identifying individuals at risk of developing sepsis and septic shock remains challenging. In septic patients, the Lactate/Albumin Ratio (LAR) and C-reactive protein (CRP)/Albumin ratio (CAR) have been suggested to be promising prognostic indicators for prediction of intensive care unit (ICU) mortality. We compared the prognostic values of CAR and LAR in patients with sepsis and septic shock. Methodology: Eighty adult patients diagnosed with sepsis and admitted to the ICUs of Ain Shams University Hospitals, were included in this observational prospective study. CRP levels, serum lactate, serum albumin, complete blood count (CBC), procalcitonin levels, and SOFA scores were assessed upon admission, with subsequently observing 28-day mortality among the selected patients. Results: CAR values were comparable between the mortality and survival groups (P = 0.807). However, LAR values were significantly elevated in the mortality group vs the survival group (P = 0.044). ROC analysis for mortality indicated that LAR had an AUC of 0.633 at a cutoff value &gt; 0.68, achieving sensitivity and specificity of 89.4% and 21.2%, respectively. In contrast, CAR had an AUC of 0.484 at a cutoff value ≥ 1.54, with sensitivity and specificity values of 63.8% and 57.6%, respectively. Length of ICU stay (P &lt; 0.001), duration of mechanical ventilation (P &lt; 0.001), cardiovascular support (P &lt; 0.001) and the need for renal replacement therapy (P &lt; 0. 039), were increased in the mortality group compared to the survival group. Conclusion: Lactate/albumin ratio is superior and more reliable bio-marker predictor compared to C-reactive protein (CRP)/albumin ratio for ICU mortality. Abbreviations: CAR - C-reactive protein/albumin ratio; CRP - C-reactive protein; ICU - intensive care unit; LAR - Lactate/Albumin Ratio; Keywords: Albumin; CRP To Albumin Ratio; Lactate; Lactate to Albumin Ratio; Mortality; Sepsis; Septic Shock; SOFA; Survival Citation: Abdou K, Mounir M, Abdelmohsen S, Salem S, Ali A. C-reactive protein/albumin ratio versus lactate/albumin ratio as an outcome predictor for patients with sepsis and septic shock in hospital stay. Anaesth. pain intensive care 2023;28(5):901−907; DOI: 10.35975/apic.v27i5.2571 Received: July 29, 2024; Reviewed: August 23, 2024; Accepted: August 28, 2024

Evaluation of the mental health status of intensive care unit healthcare workers at the beginning of COVID-19 pandemic.

During pandemic periods, mental health issues are highly prevalent, particularly among healthcare workers who are at a higher risk of developing psychiatric disorders. The aim of this study is to evaluate the mental health status of the intensive care unit (ICU) healthcare workers, who play a vital role in managing the COVID-19 pandemic, in terms of the quality of sleep, levels of depressive and anxiety symptoms, stress and to determine the factors that affect their mental health. The research was conducted in April 2020 and incorporated a total of 79 participants working in an university hospital ICUs in Turkey. Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale 42 (DASS-42), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied. Among the participants, 58 individuals comprising 73.4% of the cohort were working in the ICUs, managing patients infected with COVID-19. Those working in ICUs with COVID-19 patients had significantly higher DASS-S, BAI, and BDI scores. Doctors' BDI scores were significantly lower compared to both nurses and other healthcare workers. Participants exhibiting COVID-19 symptoms manifested significantly higher BAI scores in compared to those without such symptoms. Healthcare workers involved in ICUs with COVID-19 patients were more significantly affected psychologically, doctors had lower depressive symptoms as compared to other healthcare workers. In addition, individuals with COVID-19 symptoms demonstrated significantly higher levels of anxiety. The findings of our study emphasize the significance of providing psychological support to healthcare workers throughout pandemics.

Characteristics and Outcomes of Patients Admitted to Intensive Care Units in an Academic Hospital Northern Iran

Background: Identifying risk factors that predict mortality in the intensive care unit (ICU) can lead to improved management of critically ill patients and help reduce mortality rates. Objectives: This study aimed to identify the prevalence and risk factors that potentially contribute to predicting mortality in the ICU. Methods: This cross-sectional study was conducted in the general ICU of an academic hospital in northeastern Iran from April 2019 to March 2023. Demographic and clinical data were retrieved from medical records, including age, gender, marital status, residency, length of stay in the ICU, level of consciousness, duration of mechanical ventilation (MV), and co-morbidities. The outcomes were categorized as death or discharge. Results: Out of 8,650 admitted patients, 62.8% were discharged, and 37.2% died. The factors significantly associated with death included age (59.24 ± 21.9 years vs. 49.63 ± 23.32 years, P &lt; 0.0001), female gender (42.7% vs. 57.3%, P &lt; 0.0001), marital status (41.1% married vs. 58.9% unmarried, P &lt; 0.0001), length of stay in the ICU (5.99 ± 9.09 days vs. 4.13 ± 6.55 days, P &lt; 0.0001), Glasgow Coma Scale (GCS) of 3 - 5 (87.9% vs. 12.1%, P &lt; 0.0001), duration of MV (4.86 ± 8.69 days vs. 1.09 ± 4.85 days, P &lt; 0.0001), and co-morbidities (44.7% vs. 55.3%, P &lt; 0.0001), which were confirmed by logistic regression analysis. Conclusions: The prevalence of death in the ICU was 37.2%. Age, co-morbidities, cerebral vascular accident (CVA), GCS, duration of MV, and marital status were significantly associated with mortality.

Noise in a UK intensive care unit: a retrospective cohort study

Excessive noise in hospital Intensive care units (ICU) has been associated with adverse health effects and human factor impacts acknowledged to negatively affect both patients and healthcare providers. Aims: Evaluation of the acoustic environment of the Royal Liverpool University Hospital (RLUH) ICU versus WHO and UK guidelines. Methods: Noise measurements were taken from a six-bedded bay within the RLUH ICU between 15th June and 1st July 2022. This audit focussed on noise data &gt; 87dBA, in accordance with the national exposure limit established by UK Noise Regulations. A retrospective review of relevant patients' records was conducted to identify potential noisy events during the audit period. Results: The highest and lowest LAeq value was 77.9 and 63.5dBA, respectively. All LAeq and LAmax noise measurements recorded exceeded recommended guidelines. Noise fell below recommended daytime guidelines less than 1% of the time. The top potential causes of noise were patient repositioning/personal care, medication administration and suctioning. Conclusion: Noise levels in the RLUH ICU considerably exceed national and international guidelines. These findings highlight the need to address noise pollution in the ICU setting. Hospital staff and policy makers should consider implementing strategies and interventions for noise reduction in ICUs.

Nosocomial carbapenem-drug resistant Acinetobacter baumannii, related factors and clinical outcomes in Northeast Iran

Background and objectivesNosocomial infections, including drug-resistant Acinetobacter baumannii infections, continue to impact the health of hospitalized patients. This study sought to determine the prevalence of these infections and assess the associated risk factors and clinical outcomes in Gorgan, Iran.MethodsA retrospective cross-sectional study was conducted on 143 infected patients with Acinetobacter baumannii in two educational hospitals in Gorgan city, Iran between 2016 and 2018. Patient information including age, gender, reason and duration of hospitalization, background of diseases, type of sample culture, symptoms, laboratory findings, prescribed antibiotics, and antibiogram were collected and analyzed. The Logistic regression and survival statistical methods were used by software of SPSS 26.ResultsA total of 37 patients (25.87%) died during hospitalization. The less than one year and 45–65 years age groups demonstrated more deaths (29.7%; p-value < 0.001). Being single (not being married) was found to be a risk factor in increasing the chance of death among patients (OR = 2.154, 95% CI: 1.02–4.53; p = 0.048). Hospitalization in intensive care units (ICUs) was a risk factor for the death of patients (OR = 4.655, 95% CI: 7.6–83.2). The resistance to carbapenems was reported to be an important risk factor for the death of patients.ConclusionsAcinetobacter baumannii infections, particularly those resistant to carbapenems, are a significant risk for patients in ICUs and can lead to higher mortality rates.