Intensive Care Treatment Research Articles

Progressive Encephalomyelitis With Rigidity and Myoclonus With Glycine Receptor and GAD65 Antibodies: Case Report and Potential Mechanisms.

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a severe form of stiff-person spectrum disorder that can be associated with antibodies against surface antigens (glycine receptor (GlyR), dipeptidyl-peptidase-like-protein-6) and intracellular antigens (glutamate decarboxylase (GAD65), amphiphysin). We report clinico-pathologic findings of a PERM patient with coexisting GlyR and GAD65 antibodies. A 75-year-old man presented with myoclonus and pain of the legs, subsequently developed severe motor symptoms, hyperekplexia, a pronounced startle reflex, hallucinations, dysautonomia, and died 10 months after onset despite extensive immunotherapy, symptomatic treatment, and continuous intensive care support. Immunotherapy comprised corticosteroids, IVIG, plasmapheresis, immunoadsorption, cyclophosphamide, and bortezomib. Intensive care treatment and permanent isoflurane sedation was required for more than 20 weeks. CNS tissue revealed neuronal loss, astrogliosis and microgliosis, representing a pallido-nigro-dentato-bulbar-spinal degeneration pattern, specifically along GlyR and GAD expression sites. Neurons showed pSTAT1, MHC class I, and GRP78 upregulation. Inflammation was moderate and characterized by CD8+ T cells and single CD20+/CD79a+ B/plasma cells. Focal tau-positive thread-like deposits were detected in gliotic brainstem areas. In the spinal cord, GlyR, glycine transporter-2, and GAD67 expression were strongly reduced. A possible potentiating effect of pathogenic GlyR antibodies together with T cells directed against neurons may have led to the severe and progressive clinical course.

Severe cervical hematoma following central venous puncture under ultrasound guidance in a patient with acute myeloid leukemia: a rare case report

We report the case of a 56-year-old male diagnosed with acute myeloid leukemia who developed a severe cervical hematoma following an ultrasound-guided right internal jugular vein catheterization. Despite receiving platelet transfusions prior to the procedure, the patient experienced progressive hematoma enlargement, leading to respiratory distress. Further investigations, including carotid Computed Tomography Angiography (CTA), ruled out arterial injury, but thromboelastography revealed severe coagulation dysfunction. The patient subsequently developed cerebral hemorrhage and died despite intensive care interventions.

Intensive care due to myasthenia gravis: Risk factors and prognosis.

Exacerbation of myasthenia gravis (MG) with respiratory failure requires intensive care. We aimed to study the risk factors for intensive care unit admission for MG exacerbation and myasthenic crisis (MC) and the prognosis of people with MG (pwMG) thereafter. This retrospective study investigated patients in the Helsinki and Uusimaa hospital district during the years 2008-2021. PwMG (International Classification of Diseases, 10th revision code G70.0) were identified through a data repository search, followed by a chart review of patient records. Risk factors for intensive care due to MG exacerbation were evaluated as compared with the patients only treated in the outpatient clinic and those treated in the neurological ward for MG exacerbation. The outcomes of patients in intensive care for any reason were also compared with those of patients in intensive care for exacerbation of bronchial asthma. Of 577 pwMG, 35 (6.1%) needed intensive care for MG within a median of 5.3 months from diagnosis. The mean (±SD) age at MG diagnosis was higher in the intensive care group (60.5 [±16.1] years) compared to the outpatient (48.3 [±20.9] years; p < 0.001) and neurological ward groups (53.4 [±20.8] years; p = 0.044). Thymoma (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.19-19.43; p = 0.028) and female sex (OR 2.1, 95% CI 1.02-4.48; p = 0.045) were independent risk factors for intensive care. In-hospital mortality was 4% for MC patients. Six-month mortality after intensive care for MG exacerbation (14.3%) was twice that for asthma exacerbation (7.7%). Our study shows an increased risk of intensive care treatment for patients with late-onset MG, female sex or thymoma, occurring usually within 6 months from diagnosis, which emphasises the importance of early treatment choices.

Severe intoxication after yew (Taxus) ingestion-case report and literature review

Severe yew (Taxus) intoxication is a rare condition that can lead to life-threatening cardiac arrhythmia. The survival of patients requires highly specialized emergency and intensive care treatment. Systematic overview of the clinical picture and important treatment options. Case report of severe yew intoxication with subsequent literature review of comparable case reports. Analysis of 33case reports with a total of 37critically intoxicated patients from the years 2000-2024 from Europe and North America. Severe yew intoxications were almost exclusively the result of suicidal intent. Patients average age was 33 (± 14.5) years. The use of antiarrhythmic drugs and electrical stimulation of the heart often proved to be ineffective or deteriorating in its effect over time. The use of lipid emulsion and/or digoxin-specific Fab fragments has little evidence. The average duration of a clinically relevant arrhythmogenic effect was 22±11.7h. The management of yew intoxication is primarily limited to symptomatic treatment. The availability of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a "bridge-to-recovery" concept appears to be of utmost importance.

The management of new-onset atrial fibrillation in critical illness: an update on current therapeutic options.

New-onset atrial fibrillation (NOAF) is the most prevalent arrhythmia among critically ill patients, correlating with heightened morbidity and mortality rates. Current evidence for managing NOAF in this patient population is limited. Numerous meta-analyses have been conducted to assess the efficacy of atrial fibrillation treatments in acute settings, including rate or rhythm control strategies, anticoagulation, and intensive care interventions. The employment of β-blockers for rate control appears to confer greater benefits in critically ill patients. However, the advantage of anticoagulation remains ambiguous because of bleeding risks, which is partly attributed to the scarcity of evidence in the complex context of critical illness. Approximately one-third of patients with transient atrial fibrillation face recurrence within a year. Therefore, vigilant posthospitalization follow-up and monitoring should be considered for high-risk patients to detect atrial fibrillation recurrence. Long-term anticoagulation strategies should be tailored to individual patient profiles, weighing the risks of thromboembolism. Factors predicting atrial fibrillation recurrence include age, the burden of atrial fibrillation, and atrial size. There are significant knowledge gaps concerning NOAF in critically ill patients, highlighting the need for further research, particularly randomized clinical trials.

Obsessive-compulsive disorder with compulsive exercise leading to intensive care treatment in an adolescent male: a case report.

Obsessive-compulsive disorder (OCD) and eating disorders (ED) are compulsive disorders with overlapping symptoms. However, weight loss and over-exercise causing secondary medical complications are rarely seen in OCD. We report the case of a 15-year-old male who presented with atypical symptoms of OCD leading to severe medical compromise. Covid-19 related team sport restrictions led to compulsive exercise associated with intrusive thoughts. The onset of stress fractures limited exercise ability,prompting compensatory food restriction. Bradycardia, hypothermia and hypoglycaemia resulted from severe malnourishment and weight loss in the context of OCD. His weight was 85.8% of ideal body weight on admission, reflective of a weight 10-15 kg lower than his premorbid weight. During admission, he developed exercise-induced rhabdomyolysis with significantly elevated creatinine kinase and required intensive care unit treatment. Psychotropic medication included lamotrigine, olanzapine and high dose fluoxetine alongside cognitive-behavioural therapy. Medical stabilisation and weight restoration allowed discharge to an outpatient Child and Adolescent Mental Health Service. This atypical case of OCD highlights the potentially life-threatening risks associated with excessive exercise and malnutrition. This paper highlights the complexities of treatment in a patient who cannot adhere to bed rest and the differential diagnoses of anorexia nervosa, orthorexia nervosa and exercise addiction.

9396 Deciphering The Enigma: A Case Report On New-onset Graves Disease Presenting As Thyroid Storm In The First Trimester Of Pregnancy, Managed In The Intensive Care Setting

Abstract Disclosure: M. Zeb: None. S.W. Salari: None. A. Tiwari: None. A. Vadher: None. A. Dabaja: None. S. Kambhatla: None. Graves' disease, an autoimmune disorder characterized by hyperthyroidism, presents unique challenges when manifesting as thyroid storm during pregnancy. We report a case of a 27-year-old African American woman at 9 weeks gestation who presented with palpitations, agitation, and fever. On examination, she exhibited fever, tachycardia, tremors in hands, and mild bilateral exophthalmos. Thyroid function tests revealed markedly elevated free thyroxine and suppressed thyroid-stimulating hormone levels. Thyroid ultrasound confirmed diffuse thyroid enlargement with increased vascularity, consistent with Graves' disease. Pelvic ultrasound estimated the gestational age at 9 weeks and 2 days, with a serum β-hCG level of 135,037 mIU/mL. An electrocardiogram revealed sinus tachycardia, and a complete metabolic panel indicated mild hypokalemia. The Thyroid Stimulation Immunoglobulin (TSI) and Thyrotropin receptor antibodies were tested positive. The Burch-Warsofsky point score of 45, supported the diagnosis of thyroid storm. The patient received intensive care treatment including intravenous fluids, hydrocortisone, beta-blockers, Lugol’s iodine, propylthiouracil, and potassium replacement. Following treatment, thyroid function stabilized within 48 hours, and her hyperthyroid symptoms resolved. The patient was discharged on oral labetalol and propylthiouracil. Thyroid storm, characterized by severe manifestations of hyperthyroidism, is a rare but potentially life-threatening condition, especially during pregnancy. Prompt recognition and intervention are crucial due to associated maternal and fetal morbidity and mortality. A multidisciplinary approach, involving endocrinology, obstetrics, and critical care, is essential to optimize outcomes. The unique physiologic changes of pregnancy, such as increased thyroid hormone production and altered thyroid hormone-binding globulin levels, can complicate the diagnosis and management of hyperthyroidism. Our case underscores the importance of vigilance for thyroid dysfunction in pregnant women, even in the absence of prior thyroid disease. Additionally, the potential impact of hyperthyroidism and thyroid storm on pregnancy outcomes highlights the need for early recognition and intervention. Long-term management of Graves' disease during pregnancy may also require adjustment of antithyroid medication dosage and monitoring of thyroid function to maintain euthyroidism while minimizing fetal exposure to medication. Further research is warranted to refine diagnostic criteria, treatment protocols, and long-term management strategies for thyroid storm in pregnancy. Increased awareness among healthcare providers about the risks and management strategies for this rare but serious complication is also necessary. Presentation: 6/3/2024

Talking to Unconscious? - Therapeutic Communication During General Anaesthesia, Resuscitation and Therapy of Coma

There are numerous reports from patients concerning perceptions during deep unconsciousness, be it general anaesthesia, cardiopulmonary resuscitation or intensive care and coma treatment. These experiences can cause considerable traumatisation. The most stressful experience is apparently not feeling pain, but the lack of communication, i.e. being recognised and being able to express oneself. Although there are already indications of positive effects of positive communication during general anaesthesia, these findings have not yet markedly changed the way we deal with the unconscious.

Futile therapeutic nursing interventions in adult intensive care: A descriptive study.

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses' perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions.

Evaluation of Rockall and Blatchford Scores and Forrest Staging in Upper Gastrointestinal Bleeding

Objective: The study aimed to investigate the predictive value of Rockall and Blatchford scores and endoscopic Forrest staging in the need for transfusion and intensive care in upper gastrointestinal bleeding. Materials and Methods: This retrospective study was conducted on 294 patients with gastrointestinal bleeding who presented to the emergency department between January 1 and June 1, 2013. Results: The mean age of 294 patients was 58.73±21.30 years. The endoscopic diagnoses of the patients included peptic ulcer (43.5%, n=128), erosive gastritis (17.3%, n=51), and erosive bulbitis (12.6%, n=37). There was no statistically significant relationship between Forrest staging and Rockall and Blatchford scores (p=0.944, p=0.757). The need for blood transfusion was significantly more frequent in patients with a Rockall score of 5 and above and those with a high Blatchford score (p=0.004, p=0.001). Patients with a Rockall score of 5 and above were significantly more common among those referred to the intensive care unit (p=0.003). Conclusion: Pre-endoscopic Rockall and Blatchford scores and endoscopic Forrest staging can be used safely in predicting transfusion requirement, intensive care requirement, mortality risk, treatment and follow-up of patients with gastrointestinal bleeding, and thus may help to reduce health expenditures.

Clinical and laboratory-instrumental features of pneumonia caused by Mycoplasma pneumoniae in childhood

Mycoplasma pneumoniae is the most common causative agent of bacterial pneumonia among school-age children. The study analyzed the clinical cases of 460 children hospitalized with radiologically confirmed pneumonia in the period from 2022 to 2023. Pneumonia caused by Mycoplasma pneumoniae was detected in 198 patients. The diagnosis was confirmed by ELISA diagnostics and PCR diagnostics. Clinically, pneumonia of this pathogen proceeded without complications, did not require treatment in intensive care and intensive care. Mycoplasma pneumoniae is most often observed among preschool and school-age children. In this regard, an examination for Mycoplasma pneumoniae should be carried out in preschool and school-age children to identify the pathogen and timely prescribe antibacterial therapy.

Symptomatic bradycardia in tuberculosis-related giant bullae (vanishing lung syndrome): A case report

Rationale: Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use. The occurrence of giant bullae can also be linked to infections, particularly tuberculosis in tropical countries. Patient concerns: A 26-year-old male complained of weakness, severe vomiting, and reduced breathlessness when lying on the left side. He had a history of pulmonary tuberculosis two years ago. Diagnosis: Symptomatic bradycardia in tuberculosis-related giant bullae. Interventions: The patient was recommended to undergo an elective bullectomy, but he decided not to proceed with the procedure. Atropine sulfate was administered to alleviate symptoms of bradycardia, while a standardized anti-tuberculosis regimen were started for the next six months. Outcomes: Following 7 days of intensive care treatment involving antituberculosis medications and atropine sulfate, the patient achieved hemodynamic stability, opting against bullectomy despite residual symptoms of dyspnea. Subsequent six months of antituberculosis therapy notably alleviated symptoms without requiring bullectomy. Lessons: Increasing intrathoracic pressure can also be caused mechanically by giant bullae. Cardiac symptoms in vanishing lung syndrome are reversible and can be alleviated once the underlying cause is addressed. In this case, symptomatic bradycardia was reduced only with tuberculosis treatment without bullectomy intervention.

Building a High-Level Isolation Unit in Rwanda and Establishing a Training Program for the Medical Management of Patients With High-Consequence Infectious Diseases.

Rwanda is a country in East Africa, a region characterized by highly mobile populations and outbreaks of high-consequence infectious diseases occurring on a regular basis. To increase the level of outbreak preparedness in the region, the Rwandan government and the German Ministry of Health signed a joint agreement to construct a new high-level isolation unit in Rwanda, the first in East Africa, and implement a training program for Rwandan healthcare workers to equip them with the necessary skills and knowledge for medical management of patients under high-level isolation conditions, including intensive care treatment. To better understand the scope and format of the planned training program, a needs assessment was performed based on findings from a standardized survey of 4 intensive care units in Rwanda as well as observations from 2 members of a German high-level isolation unit who completed clinical internships at Rwandan hospitals. In this case study, we describe the necessary steps to promote the sustainability and capabilities of the new high-level isolation unit in Kigali and ensure the successful implementation of the training program.

Clinical Significance of the Control CT Rotterdam Score Compared With the Admission CT Rotterdam Score in Patients With Isolated Severe Traumatic Brain Injury in the Intensive Care Unit.

The Rotterdam scale is one of the most commonly used radiological scales for evaluating and predicting outcomes in traumatic brain injury (TBI) cases. Given the evolving nature of TBI, our study is designed to compare the Rotterdam score of computed tomography (CT) findings upon admission (Rotterdam score I) with the score after 72 hours (Rotterdam score II) of treatment in the trauma intensive care unit (ICU). A retrospective observational study was conducted on 54 patients who received intensive care treatment for isolated severe TBI over five years. We included severe TBI patients with no age restrictions who required admission to the ICU within 12 hours of the onset of trauma. An initial Rotterdam CT score was obtained via a CT head scan within four hours of the trauma, followed by a control CT head scan 72 hours after ICU admission. It was essential to have documentation on the clinical and laboratory treatment course and access to radiological CT diagnostics. Receiver operating characteristic (ROC) curves were employed in this study to evaluate the accuracy of diagnostic tests, such as the Rotterdam score. The ROC curves provided a graphical representation of the tests' diagnostic performance, which helped assess their effectiveness. There was a significant difference (p < 0.001) in the diagnostic scores of CT scans upon admission (Rotterdam score I) and control CT scans after 72 hours (Rotterdam score II) in the total sample. The Rotterdam score I was notably higher, 3.6 (±0.8), in patients requiring neurosurgical intervention compared to those who did not, 2.8 (±0.9), with significance (p = 0.003). The Rotterdam score I demonstrated a substantial predictive value for unfavorable outcomes (p = 0.048), as did the Rotterdam score II after the 72-hour mark (p = 0.006). The control Rotterdam score 72 hours after admission predicts mortality in isolated TBI patients more significantly than the Rotterdam score determined at the patient's admission to the intensive care unit.

Geriatric patients with acute kidney injury in the intensive care unit: the effect of vitamin B12 and albumin levels on survival

Objectives: Acute kidney injury (AKI) is a common and critically important clinical entity in geriatric age group. In addition, higher mortality rates are seen in cases requiring intensive care treatment. We have aimed to investigate the effect of vitamin B12 and albumin levels on mortality in critically ill geriatric patients with AKI. Methods: Geriatric patients hospitalised in the Intensive Care Unit with a diagnosis of AKI between 07.01.2014-07.01.2015 were retrospectively screened and included in the study. Two groups were formed from discharged and exited patients. General characteristics and laboratory values of the patients were scanned from the hospital archives and recorded. Statistically significant intergroup differences in terms of demographic characteristics, and biochemical values were determined by statistical analysis. Results: A total of 103 patients, including 53 females were enrolled in the study, while 72.2% of the patients had prerenal AKI. The mortality rate was 47.57% in all patients. There was no difference between groups in terms of mortality rates, etiologic factors and KDIGO staging. Vitamin B12 was high and albümin was low the group who succumbed to death. In addition, mortality rates increased by 10% for every 100 units increase in vitamin B12 value and decreased by 22% for every 10 units increase in albumin value. Conclusions: We have determined that an increase in albumin levels during clinical follow-up decreased mortality rates and an increase in vitamin B12 levels directly increased mortality rates. Hypoalbuminemia and high vitamin B12 levels were found to be independent predictive factors for mortality in AKI.

Online Survey Study on the Needs of Former Intensive-Care Patients for the Development of a User-Friendly App.

The aim of this online-survey study is the development and evaluation of a mobile health application specifically designed to meet the needs of individuals who have previously undergone intensive-care treatment. User acceptance and perception play a crucial role in refining and optimizing the app's features and functionalities. By actively incorporating suggestions and insights from users, the goal is to enhance the overall usability and better cater to the diverse needs of individuals in post-intensive care recovery. This iterative approach ensures that the application remains responsive to the evolving requirements of its target audience. Overall, the emphasis is on creating a user-centric and adaptive tool for former intensive care patients, to develop a user-friendly mobile app.

Clinical Presentation of Enterovirus D68 in a Swiss Pediatric University Center.

Enterovirus D68 (EV-D68) is responsible for millions of infections. In the last decade, there has been an increase in the number of children requiring hospital or critical care admission due to severe respiratory illness. Nevertheless, the epidemiological and clinical importance of EV-D68 infections remains unclear. We aimed to determine the local prevalence of EV-D68 infection in pediatric patients and to characterize its clinical presentation and disease burden compared with non-EV-D68 enterovirus and human rhinovirus (RV) infections. We performed a retrospective single-center study of children presenting with respiratory symptoms and positive respiratory panel polymerase chain reaction for EV/RV from November 2018 to December 2019. We tested EV/RV positive specimens with an EV-D68-specific polymerase chain reaction to discriminate EV-D68, non-EV-D68 and RV and compared their respective clinical presentation, outcomes and treatment. We identified 224 patients (median age 21 months), of which 16 (7%) were EV-D68 positive. They presented with cough (88%), wheezing (62%) and dyspnea (75%). EV-D68 infection had an odds ratio regarding pediatric respiratory severity-score of 11.6 relative to non-EV-D68 [confidence intervals (CI): 3.51-41.14], and of 9.9 (CI: 3.75-27.95) relative to RV. The fitted logistic regression showed that the odds of intensive care were 5 times more likely with EV-D68 than RV infection (CI: 1.32-19.28; P = 0.001). Patients with EV-D68 infections were more likely to receive medical support in the form of supplementary oxygen, antibiotics and steroids. EV-D68 infection is associated with higher morbidity and a higher likelihood of intensive care treatment than non-EV-D68 and RV infections.

Necrotizing Fasciitis in Iv Drug Abuser by Oil Injection: A Case Report

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can result in fast tissue loss, necrosis, and potentially fatal acute sepsis. Diabetes, cancer, alcohol abuse, and chronic liver and renal disease are all risk factors for NF. Our case was a 50 years old male with IV drug abuse that inject oil in his arms and admitted by diagnosis of Necrotizing Fasciitis and perform serial surgery and antibiotic therapy for him to save his life and his arm. NF is a rare bacterial inflammation (infection) that can destroy the skin and underlying tissues (connective tissue, subcutaneous fat, muscles, and muscle membranes). The disease can be very dramatic, with shock and damage to internal organs. In this case report, serial debridement with adequate antibiotherapy followed by reconstructive surgeries were made. An early diagnosis remains challenging and crucial for salvaging the affected area. Necrotizing fasciitis is a life-threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. The management of infected tissues requires a rapid diagnosis, immediate aggressive surgical management and an extended debridement. In some cases, early amputations of the affected tissues and maximum intensive care treatment, in case of sepsis, are required. Due to a rising number of cases we aimed to report this case.

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly

MethodsDue to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further factors that cause prolonged inpatient stays.A study of the data from the TraumaRegister DGU® from 2016–2020 was performed. Inclusion criteria were an age of over 64 years, intensive care treatment in the GAS-region, and an Injury Severity Score (ISS) of at least 16 points. All patients who were above the 80th percentile for the average length of stay or average intensive care stay of the study population were defined as so-called long-stay patients. This resulted in a prolonged inpatient stay of > 25 days and an intensive care stay of > 13 days. Among other, the influence of the cause of the accident, injury patterns according to body regions, the occurrence of complications, and the influence of numerous clinical parameters were examined.ResultsA total of 23,026 patients with a mean age of 76.6 years and a mean ISS of 24 points were included. Mean ICU length of stay was 11 ± 12.9 days (regular length of stay: 3.9 ± 3.1d vs. prolonged length of stay: 12.8 ± 5.7d) and mean inpatient stay was 22.5 ± 18.9 days (regular length of stay: 20.7 ± 15d vs. 35.7 ± 22.3d). A total of n = 6,447 patients met the criteria for a prolonged length of stay. Among these, patients had one more diagnosis on average (4.6 vs. 5.8 diagnoses) and had a higher ISS (21.8 ± 6 pts. vs. 26.9 ± 9.5 pts.)Independent risk factors for prolonged length of stay were intubation duration greater than 6 days (30-fold increased risk), occurrence of sepsis (4x), attempted suicide (3x), presence of extremity injury (2.3x), occurrence of a thromboembolic event (2.7x), and administration of red blood cell concentrates in the resuscitation room (1.9x).ConclusionsThe present analysis identified numerous independent risk factors for significantly prolonged hospitalization of the geriatric polytraumatized patient, which should be given increased attention during treatment. In particular, the need for a smooth transition to psychiatric follow-up treatment or patient-adapted rehabilitative care for geriatric patients with prolonged immobility after extremity injuries is emphasized by these results.

Intensive care treatment in acute pulmonary embolism in Germany, 2016 to 2020: a nationwide inpatient database study

BackgroundPulmonary embolism (PE) is a potentially life-threatening condition. Admission and treatment in the intensive care unit (ICU) is an important element in critically ill PE patients. ObjectivesWe aimed to identify risk factors for ICU admission and differences in patient profiles regarding risk factors and comorbidities between PE patients who had to be admitted to an ICU and those who were treated in a normal ward without ICU. MethodsWe used the German nationwide inpatient sample to analyze all hospitalizations of PE patients in Germany from 2016 to 2020 stratified for ICU admission. ResultsOverall, 484,859 hospitalized PE patients were treated in German hospitals from 2016 to 2020. Among these, 92,313 (19.0%) were admitted to ICU. Patients treated in ICU were younger (69.0 [IQR, 58.0-78.0] vs 72.0 [IQR, 60.0-80.0] years; P < .001) and had higher prevalence of cardiovascular risk factors and comorbidities. In-hospital case fatality rate was elevated in PE patients treated in ICU (22.7% vs 10.7%; P < .001), and ICU admission was independently associated with increased in-hospital case fatality (odds ratio [OR], 2.54; 95% CI, 2.49-2.59; P < .001). Independent risk factors for ICU admission comprised PE with imminent or present decompensation (OR, 3.30; 95% CI, 3.25-3.35; P < .001), hemodynamic instability (OR, 4.49; 95% CI, 4.39-4.59; P < .001), arterial hypertension (OR, 1.20; 95% CI, 1.18-1.22; P < .001), diabetes mellitus (OR, 1.16; 95% CI, 1.14-1.18; P < .001), obesity (OR, 1.300; 95% CI, 1.27-1.33; P < .001), surgery (OR, 2.55; 95% CI, 2.50-2.59; P < .001), stroke (OR, 2.86; 95% CI, 2.76-2.96; P < .001), pregnancy (OR, 1.45; 95% CI, 1.21-1.74; P < .001), heart failure (OR, 1.74; 95% CI, 1.71-1.77; P < .001), atrial fibrillation/flutter (OR, 1.69; 95% CI, 1.66-1.73; P < .001), chronic obstructive pulmonary disease (OR, 1.21; 95% CI, 1.18-1.24; P < .001), and renal failure (OR, 1.92; 95% CI, 1.88-1.95; P < .001). ConclusionICU treatment is an important element in the treatment of PE patients. Besides hemodynamic compromise, cardiovascular risk factors, stroke, pregnancy, and cardiopulmonary as well as renal comorbidities were independent predictors of ICU admission. Necessity of ICU admission was afflicted by increased case fatality.