Hospital Intensive Care Unit Research Articles

237 The effects of childhood obesity on length of stay in hospital and Pediatric Intensive Care Unit (PICU)

237 The effects of childhood obesity on length of stay in hospital and Pediatric Intensive Care Unit (PICU)

Early Life Stress, DNA Methylation of NR3C1 and HSD11B2 , and Oral Feeding Skill Development in Preterm Infants : A Pilot Study.

Early life stress exposure in preterm infants may alter DNA methylation of NR3C1 and HSD11B2 , disrupting neurobehaviors needed for oral feeding (PO) skill development. To (1) examine the feasibility of the study protocol; (2) describe early life stress, DNA methylation of NR3C1 and HSD11B2 , and PO skill development; and (3) explore the association between DNA methylation of NR3C1 and HSD11B2 and infant characteristics, early life stress, and PO skill development. We employed a longitudinal descriptive pilot study (N=10). Infant characteristics were collected from the infant's electronic medical record. Early life stress was assessed via the modified Neonatal Infant Stressor Scale. DNA methylation of NR3C1 exon 1F and HSD11B2 promoter regions was analyzed from the infant's buccal samples. PO skill development was evaluated using the Early Feeding Skills Assessment. Infants who experienced more acute and chronic stress during their neonatal intensive care unit hospitalization demonstrated higher DNA methylation at CpG 17 and 31 of the NR3C1 exon 1F and at CpG 4 and 28 of the HSD11B2 promoter regions. Infants with higher DNA methylation at these CpG sites also exhibited less optimal PO skill development and experienced longer transition from first to full PO. Our findings revealed relationships among early life stress, DNA methylation of NR3C1 and HSD11B2 , and PO skill development in preterm infants. Future research is warranted to examine the multiomics pathways whereby early life stress influences the phenotypes of infant outcomes.

Increased Incidence and Severity of Group A Streptococcal Infections in Children in Southeast Texas From June 2022 to May 2023.

Group A Streptococcus (GAS) infections can cause a range of disease manifestations and severity, including invasive infections that can lead to death. In 2022-2023, there was an increased number of cases of invasive GAS in the United States following a decline in 2020-2022. We investigated this surge at a 3-hospital system of children's hospitals in Southeast Texas. Cases of invasive GAS (n = 252) were retrospectively reviewed from peak periods of infection, beginning June 2019-May 2020 and continuing each successive year until May 2023. Cases were analyzed based on patient demographics, disease manifestations, coinfections, and hospital course. Isolates grown in culture were sequenced, and the emm types and genes associated with virulence were analyzed. Compared with previous years, June 2022-May 2023 had the largest number of invasive GAS cases (n = 154, 2022-2023; 34, 2021-2022; 12, 2020-2021; 52, 2019-2020). Compared with the previous 3 years, patients from 2022 to 2023 were more likely to present with complicated pneumonia (23.4% vs. 7.1%; P = 0.0009), require respiratory support (34.4% vs. 14.3%; P < 0.001), be admitted to the intensive care unit (29.2% vs. 16.3; P = 0.0235), and be infected with emm type 12 isolates (40.6% vs. 10.3%; P = 0.0030). In June 2022-May 2023, there was a 5-fold surge of invasive GAS infection cases in children at Texas Children's Hospital compared with the previous 3 years. These cases required greater intensive care unit hospitalization and respiratory support requirements due to higher rates of complicated pneumonia.

Bundling Procedures in Critically Ill Trauma Patients: Should It Be Done?

The precautions brought on by the COVID-19 pandemic led to the growing practice of bundling lines in patients requiring intubation. Our study aims to examine the effect of immediate bundled lines (IBL) on traumatic injuries. We hypothesized that severely injured patients may benefit from IBL. A retrospective review of all intubated trauma patients (1/2015-12/2020) at a Level I Trauma Center was conducted. Patients ≤18 years and those who died or were transferred prior to intensive care unit (ICU) admission were excluded. IBL was defined as placement of central venous catheter (CVC) and arterial line (AL) ≤4 hours after intubation. Delayed lines were any lines placed >4 hours after intubation. Primary outcome was time from intubation to CVC and AL. 728 patients were included. The majority received CVC and/or AL with 17.7% in a delayed fashion. Severe head injury (AIS ≥3) most often had immediate AL or delayed bundled lines (P < 0.001). IBL were more common with gunshot wounds (GSW) (P < 0.001) and blood transfusions (P < 0.001). IBL were associated with significantly lower GCS (P = 0.018) and higher median ISS. Multivariate logistic regression revealed severe/profound ISS, GSW, and pedestrian struck were predictive of IBL. Intubated trauma patients who presented with certain mechanisms (GSW, pedestrian struck), received blood transfusions, or exhibited severe/profound ISS may be more likely to receive IBL. IBL is not superior to either immediate AL or to no lines in terms of mortality. No lines had a significant effect on ICU LOS or hospital LOS, except in the setting of severe head injury.

P-1345. Risk Factors for Ceftriaxone Resistant E. coli or K. pneumoniae Infections in Floor Patients

Abstract Background In 2019, 1.3 million deaths worldwide were linked to antimicrobial resistant organisms. Resistant organisms are associated with poor outcomes including increased mortality and length of stay (LOS). Identification of local risk factors predisposing for resistant organisms can lead to rapid antimicrobial optimization. Patient Population Methods In this retrospective, single center, observational cohort study, floor patients with ceftriaxone (CRO) resistant E. coli or K. pneumoniae via broth microdilution were screened from January 2022 to October 2023. Exclusion criteria included urine isolates, extended spectrum beta-lactamase (ESBL) or CRO resistant E. coli or K. pneumoniae isolate within 6 months of index culture, and intensive care unit (ICU) admission at time of index culture. The primary outcome was to identify risk factors for CRO resistant E. coli and K. pneumoniae in floor patients. Secondary outcomes included 14-day all-cause mortality, ICU admission rate, hospital LOS, and 30-day readmission rate. A list of patients was generated via MedMined™. REDCap™ was used for data collection. All statistical analyses were performed using IBM SPSS™. Significance was defined at p&amp;lt; 0.05. Multivariate Logistical Regression Results 118 patients were included in the statistical analyses. The following risk factors found to be statistically significant were: fluoroquinolone (FQ) (p&amp;lt; 0.01), ceftriaxone (CRO) (p&amp;lt; 0.01), or sulfamethoxazole-trimethoprim (SMX-TMP) (p&amp;lt; 0.01) use within 90-days of index culture; chronic obstructive pulmonary disease (p=0.01); ventilator or tracheostomy use at admission (p=0.03); active hematologic malignancy (p=0.01); poor functional status at admission (p=0.02); percutaneous endoscopic gastrostomy tube at admission (p=0.01); admission from a skilled nursing facility (SNF) (p=0.01). The significant risk factors were included in the multivariate logistic regression. FQ use (95% CI 0.98-16.35, p=0.05), SMX-TMP use (95% CI 2.08-29.24, p&amp;lt; 0.01), hematologic malignancy (95% CI 1.40-129.36, p=0.02), and admission from a SNF (95% CI 1.29-36.27, p=0.02) were found to meet statistical significance. Conclusion FQ use and SMX-TMP use within 90-days of index culture, hematologic malignancy, and admission from a SNF were found to be independently associated with ceftriaxone resistance. Disclosures All Authors: No reported disclosures

The clinical features and outcomes of diabetes patients infected with COVID-19: a systematic review and meta-analysis comprising 192,693 patients

ObjectivesWe sought to explore the relevance of analyses that include critical laboratory parameters and drug treatment, clinical characteristics of diabetic patients who are infected with COVID-19, to the development of individualized treatment strategies for diabetic patients infected with COVID-19.MethodsWe searched Cochrane, Embase, FMRS, Pubmed, Springer, Web of Science databases for systematic reviews and meta-analyses to estimate the clinical characteristics and prognosis of confirmed covid-19 infections in patients with and without diabetes.ResultsOur meta-analysis included a total of 32 studies with 192,693 COVID-19 patients. Common comorbidities in the diabetic group were hypertension, cerebrovascular disease, chronic kidney disease and cardiovascular disease. We discovered that white blood cell count, neutrophil count, inflammatory marker levels, D-dimer, urea, precursor of the brain natriuretic peptide (Pro-BNP) increased and lymphocyte count, estimated glomerular filtration rate (eGFR), albumin decreased significantly in the diabetic group in laboratory test results. Compared with the non-diabetic group, the diabetic group had a higher incidence of complications in acute respiratory distress syndrome (ARDS), shock, acute heart injury, acute kidney injury and more regularly used oxygen therapy, invasive ventilation, non-invasive ventilation, continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO) treatment. Mortality and intensive care unit (ICU) hospitalization rates were highest in the diabetic group than in the non-diabetic group (p &amp;lt; 0.05).ConclusionDiabetic patients hospitalized with COVID-19 have an increased risk of death, lower discharge rates, and higher ICU admission rates. Their presence of hypertension, cerebrovascular disease, chronic kidney disease (CKD), higher levels of inflammatory markers. Multiple complications are all predictors of poor outcomes in people with diabetes. Our findings will help identify elevated risk factors in diabetics, which will benefit early prediction.

P-2144. Candida auris skin colonization and the risk of subsequent C. auris bloodstream infection in two teaching hospitals

Abstract Background Candida auris, an emerging yeast that can cause outbreaks of severe infections in healthcare facilities, has shown an increased spread since the start of the COVID-19 pandemic. This study aimed to investigate the relative risk of subsequent C. auris bloodstream infection (BSI) in patients colonized on their skin by C. auris. Methods In this retrospective study, we included all inpatients hospitalized from January 2021 to December 2023, in Intensive Care Units (ICUs) or internal medicine wards of two distant teaching hospitals (Athens: Attikon University Hospital, Thessaloniki: AHEPA University Hospital), who were screened for skin colonization by C. auris and did not have a history of infection or colonisation by C. auris. The axilla and groin served as sampling sites. Screening was performed by selective media and species identification by MALDI-TOF. Patients were followed up for C. auris BSI and relative risk (95% confidence interval) was estimated after adjustment for ICU hospitalization, duration of hospitalization, age and sex. Results Of 1445 patients screened, 403 (27.9%) were colonized by C. auris (17.8% non-ICU, 82.2% ICU patients). Among them, 45 (3.1%) subsequently developed C. auris BSI. Skin C. auris colonization was associated with more than a 4-fold higher risk of subsequent C. auris BSI, after adjusted for ICU hospitalization, age, sex and duration of hospital stay [RR (95%CI): 4.27 (2.13-8.57)]. Conclusion C. auris skin colonization increases significantly the risk of developing C. auris BSI. This underscores the significance of public health monitoring and containment strategies for C. auris. Adhering to infection control protocols is crucial, and healthcare providers should take this into account when deciding on initial treatment, although more comprehensive genome-wide data are necessary to confirm horizontal transmission. Disclosures All Authors: No reported disclosures

‘Striving to achieve control’. Registered nurses’ experiences of palliative care quality during the COVID-19 pandemic – a qualitative study

BackgroundProviding quality palliative care during a pandemic was challenging. Both specialist and community healthcare services cared for patients that faced life-threatening illness and who were influenced by the restrictions of the COVID-19 pandemic. Little knowledge has yet been provided on how registered nurses (RNs) experienced the palliative care quality during the COVID-19 pandemic. The aim of this study was to explore RN’s experiences of providing palliative care quality during the COVID-19 pandemic.MethodsThis qualitative study had a descriptive design. Semi-structured individual interviews were conducted between November 2021 and January 2022 with 18 RNs who worked in intensive care units in hospitals, dementia care or palliative care units in nursing homes in Norway during the pandemic. Data were analysed by using qualitative content analysis. The study was conducted and reported according to the COREQ’s checklist.ResultsAnalysis of the data resulted in an overall theme: ‘Striving to achieve control’. This theme comprised six categories: (1) when the toolbox does not fit; (2) protective equipment—social distance and opportunities for closeness; (3) unpredictable workday; (4) the right person to the right assignment at the right time; (5) presence and absence of relatives and friends; and (6) situations that required creativity. RNs had various experiences regarding how the quality of care was perceived; being worse, preserved, or in some cases even better than before the pandemic.ConclusionsThe provision of quality palliative care was experienced by RNs as challenging during the pandemic. The pandemic forced them to be creative and to strive for control to provide the best palliative care possible given the situation. The results of this study may contribute to important knowledge for leaders, policy makers and RNs to learn from the COVID-19 pandemic and planning for future pandemics or crises. Especially to optimise factors perceived by RNs to be important for the palliative care quality, related to the specific situation and care context, to include the perspectives of those involved and take into consideration the time perspective of the pandemic.

The effect of early mobilization on complications after chronic subdural hematoma surgery

Aims: Chronic subdural hematoma is a common condition in the elderly population that often requires hospitalization. While some patients are discharged without surgery, others require surgical intervention due to symptoms such as loss of strength and consciousness. Preventing postoperative complications is as important as the surgical procedure itself. Early mobilization facilitate patients’ return to routine daily life, thereby reducing complications associated with immobility. This study will examine the effect of early mobilization on postoperative complications. Methods: This study included 34 patients diagnosed with chronic subdural hematoma who underwent surgical intervention at our institution between 2020 and 2024. Data collection encompassed findings from preoperative and postoperative neurological examinations, comorbid conditions, the extent of midline shift, time to postoperative mobilization, duration of intensive care unit stay, length of ward stay and overall hospitalization, as well as the incidence of postoperative complications. Patients in satisfactory general condition commenced oral feeding on the morning following surgery and were monitored under controlled conditions. The patients were divided into two groups: those who were mobilized and those who were not. These groups were then compared in terms of time to mobilization, postoperative complications, length of hospital stay, and mortality rates. Results: A comparison of postoperative complications between mobilized and non-mobilized patients revealed a significantly lower incidence of complications in the mobilized group (p&lt;0.001). Analysis of intensive care unit (ICU) stay duration (p&lt;0.001) and total hospital length of stay (p&lt;0.001) also indicated that both ICU and overall hospital stays were significantly shorter in the mobilized group. Mortality rates were notably higher in the non-mobilized group (p=0.005). Furthermore, when analyzing only the mobilized group, patients who experienced postoperative complications had a significantly later mobilization time compared to those without complications (p=0.041). A strong, positive correlation was also found within the mobilized group between the timing of mobilization and total hospital stay duration. Conclusion: Early mobilization following chronic subdural hematoma surgery facilitate patients' reintegration into daily activities. Additionally, these measures minimize complications associated with immobilization and significantly reduce the length of hospitalization.

Incidence of Thrombotic Complications in COVID-19 Patients and the Impact of Antithrombotic Therapy on ICU Mortality.

Aim We aimed to determine the incidence of thrombotic complications and outcomes of critically ill COVID-19 patients admitted to the intensive care unit (ICU) and evaluate the association between combined antithrombotic therapy and mortality in ICU patients admitted for COVID-19 pneumonia. Methods We retrospectively collected data of adult critically ill patients with COVID-19 admitted to the ICU in a major hospital in Dubai during the COVID-19 pandemic. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of major complications, such asthrombotic complications during the ICU stay. The study population was classified into two groups based on the type of prophylactic anticoagulant and antiplatelet therapy received. Results The study included 257 ICU patients admitted with COVID-19 pneumonia. The mean duration of their ICU stay was 24.95 days, ranging from one day to 327 days. The primary outcome was in-hospital mortality. In our study, 151 patients (58.7%) suffered in-hospital mortality. Secondary outcomes included the incidence of major complications during the ICU stay. A total of 202 patients (78.6%) presented with acute respiratory distress syndrome. Ninety-nine (38.5%) of the patients had progressed to acute kidney injury. Thirty-three patients (12.8%) had various thrombotic complications. Three of these (9%) had venous thrombosis, and 30 patients (91%) had arterial thrombosis. Ischemic stroke was the major thrombotic complication of COVID-19 (36.3% of overall thrombotic events, n = 12), followed by myocardial infarction (27.2%; n = 9) and pulmonary embolism (21.2%; n = 7). Out of 257 COVID-19 ICU patients, 73 patients (28.4%) received both anticoagulants and antiplatelet therapy, and 183 patients (70.8%) received only anticoagulant therapy. We compared the mortality of COVID-19 ICU patients who received anticoagulants alone to those with added antiplatelets. The application of combined antiplatelet and anticoagulants as thromboprophylaxis for COVID-19 ICU patients was not associated with a significant reduction in mortality (P = 0.868).Peak serum levels of D-dimer significantly correlatewith the length of ICU stay (rho= 0.137, P = 0.031). Peak D-dimer level during the ICU stay was statistically significantly higher in non-survivors (mean = 11.87) compared to survivors (mean = 8.59) (P < 0.001). D-dimer on ICU admission had a good prognostic value for ICU patients with COVID-19 infection (P = 0.018). Conclusion The incidence of thrombotic complications among COVID-19 pneumonia patients admitted to ICU is remarkably high, which reinforces the recommendation to apply thrombosis prophylaxis strictly to all ICU patients admitted with COVID-19. The application of combined antiplatelets with anticoagulants as thromboprophylaxis for COVID-19 ICU patients was not associated with a significant reduction in ICU mortality.D-dimer has a significant correlation with prognosis and length of ICU stay of COVID-19 patients.

Severe sepsis-associated acute kidney injury and outcomes: a longitudinal cohort study.

Sepsis-associated acute kidney injury (SA-AKI) is common among patients admitted to the intensive care unit (ICU) with sepsis. This study aimed to demonstrate an association between an episode of SA-AKI and progression to dialysis dependence, with a view to identifying a cohort who may be suitable for intensive nephrology follow-up. Design: Retrospective data-linkage cohort study. Alice Springs Hospital ICU, 10-bed regional facility, housed in a 200-bed regional hospital, located in Central Australia. All patients admitted with a diagnosis code associated with sepsis between 2015 and 2017. Primary outcome was a composite measure comprising death or initiation of maintenance dialysis within 5 years of the index case of sepsis leading to ICU admission. The unadjusted risk of the composite outcome was significantly higher in the SA-AKI group (odds ratio (OR) 3.22, 95% confidence interval (CI) 1.81-5.74, P < 0.01). This effect remains after adjustment for age, illness severity and co-morbidities (adjusted OR (aOR) 2.64, 95% CI 1.22-5.68, P = 0.01). Progression to maintenance dialysis was the primary driver of this effect (OR 7.56, 95% CI 2.23-25.65, P = 0.02), although it was modified by the effect of confounders (aOR 7.3, 95% CI 0.7-75.94, P = 0.10). These results demonstrate an association between an index episode involving SA-AKI and the composite outcome in a defined population. Identification of this group may allow intensive nephrology follow-up and secondary prevention with the goal of mitigating the risk of progression of disease with significant economic and personal benefits.

Clinical features and factors associated with outcomes of antibody-negative autoimmune encephalitis in patients requiring intensive care

Background and objectivesAntibody-negative autoimmune encephalitis (AE) is a form of encephalitis characterized by the absence of detectable autoimmune antibodies, despite immunological evidence. However, data on management of patients with antibody-negative AE in the intensive care unit (ICU) are limited. This study aimed to explore the characteristics and subtypes of antibody-negative AE, assess the effects of immunotherapy, and identify factors independently associated with poor functional outcomes in patients requiring intensive care.MethodsThis retrospective, single-center study analyzed consecutive adult patients diagnosed with antibody-negative AE and admitted to the ICU of a large tertiary hospital between 2019 and 2023. Multivariate regression analysis was used to identify factors linked to poor functional outcomes six months after ICU admission, as defined by a modified Rankin Scale score of 3–6. Generalized linear mixed models were applied to evaluate the effect of immunotherapy on longitudinal changes in the Clinical Assessment Scale in Autoimmune Encephalitis and modified Rankin Scale scores.ResultsOf the 1220 patients with severe encephalitis admitted to the ICU, 107 were diagnosed with antibody-negative AE and included in the analysis. Six months after ICU admission, 67 patients (62.6%) had poor functional outcomes, including 28 deaths (26.2%). Factors independently associated with poor outcomes were high-dose corticosteroid therapy (odds ratio [OR] 8.734, 95% confidence interval [CI] 2.483–30.717), older age at onset (OR 1.063, 95% CI 1.028–1.099), acute respiratory failure at ICU admission (OR 10.931, 95% CI 2.062–57.751), and dyskinesia/dystonia (OR 14.109, 95% CI 1.336–148.957). The generalized linear mixed model also indicated that high-dose corticosteroid therapy was associated with poorer longitudinal outcomes.ConclusionsWhile high-dose corticosteroids are frequently used to treat AE, their risks may outweigh their benefits in severe antibody-negative AE cases. Older patients and those with dyskinesia/dystonia or respiratory failure, may require more careful monitoring and timely intervention for improved outcomes. However, prospective validation of these findings is necessary to confirm their applicability and guide future treatment strategies.

Association between D-dimer to lymphocyte ratio and in hospital all-cause mortality in elderly patients with sepsis: a cohort of 1123 patients.

The D-dimer to lymphocyte ratio (DLR), a novel inflammatory biomarker, had been shown to be related to adverse outcomes in patients with various diseases. However, there was limited research on the relationship between the DLR and adverse outcomes in patients with infectious diseases, particularly those with sepsis. Therefore, this study aimed to explore the association between the DLR and in hospital all-cause mortality in elderly patients with sepsis. A total of 1123 patients admitted in intensive care unit (ICU) were included in this study. The patients were categorized into quartiles (Q1-Q4) based on their DLR values. The primary outcomes included hospital mortality and ICU mortality. Kaplan-Meier analysis was conducted to compare all-cause mortality among the four DLR groups. The association between DLR and all-cause mortality in patients with sepsis was further elucidated using the receiver operating characteristic (ROC) curve and Cox proportional hazards regression analysis. The study included participants with a median age of 75 (65-84) years, with 707 (63.0%) being male. The rates of hospital mortality and ICU mortality were 33.7% and 31.9%, respectively. Kaplan-Meier analysis highlighted a significantly increased risk of all-cause mortality among patients with elevated DLR values (log-rank p < 0.001). ROC curve analyses revealed that DLR had a stronger ability to predict hospital mortality and ICU mortality in patients with sepsis than D-dimer or Lym. Multivariable Cox proportional hazards analyses revealed DLR as an independent predictor of hospital death [per 1 SD increase in DLR: HR (95% CI): 1.098 (1.020-1.181); p = 0.013] and ICU death [per 1 SD increase in DLR: HR (95% CI): 1.095 (1.017-1.180); p = 0.017] during the hospital stay. A higher DLR value was associated with hospital and ICU all-cause death in elderly patients with sepsis. This finding demonstrated that the DLR could be a convenient and useful prognostic marker for sepsis prognosis.

Prevalence of and risk factors analysis for post-intensive care syndrome among survivors of critical care during 3-month longitudinal follow-up.

Patients discharged from the intensive care unit (ICU) can experience post-intensive care syndrome (PICS), which is comprised of cognitive, physical and psychological impairments. The objective of this study was to identify the prevalence of and risk factors associated with all three domains of PICS at the first and third month after ICU discharge. A prospective descriptive-analytic study was conducted in two ICUs of a Chinese university hospital. We used the Healthy Aging Brain Care Monitor Self-Report Chinese version, a scale from 1 to 57, with 57 indicating the worst outcome, to comprehensively assess PICS at the first and third month follow-ups after patients left the ICU. We performed an analysis of stepwise multiple linear regression to explore the relationship between risk factors and PICS. We enrolled 654 and 584 participants at the first- and third-month follow-ups, respectively. More than 60% of patients experienced different degrees of PICS, with the most severe impairment being in the physical domain. We classified risk factors associated with PICS, categorized as patient-related, disease-related, and ICU-related factors. Among these risk factors, only being the main income provider for the family, the diagnosis of digestive system disease, trauma and the number of invasive catheters at ICU discharge significantly predicted PICS at both follow-ups. ICU-related risk factors should be given greater attention, given their potential for modification. The prevalence and severity of PICS were high in this population after their ICU stay. ICU nurses and medical staff members should collaborate to pay more attention to the comprehensive risk factors and implement targeted preventive measures. ICU staff must have a holistic view of PICS and a comprehensive understanding of its risk factors to proactively evaluate patients at high risk of PICS upon admission to the hospital.

Efficacy of serum lactate/albumin ratio as a prognostic biomarker in patients with ventilator-associated pneumonia

Aims: This study aims to evaluate the efficacy of the serum lactate/albumin ratio (LAR) as a prognostic marker in patients with ventilator-associated pneumonia (VAP) who are hospitalized in the intensive care unit (ICU). Methods: This single-center retrospective observational clinical study was conducted between January 1, 2022, and October 1, 2024. The study group comprised 58 patients admitted to the ICUs of Malatya Training and Research Hospital, Turkiye, with intubation but without a diagnosis of pneumonia at the time of admission. These patients were diagnosed with VAP 48 hours after intubation. The serum LAR was calculated within the first 24 hours after admission to the ICU and correlated with mortality and morbidity. Results: The mean age of the patients was 68 years, with the majority being over 65 years of age. Of the 58 patients included in the study, 43 (74.1%) ultimately succumbed to their illness. The LAR of those who died in the study was significantly higher than that of those who survived. The LAR was identified as a reliable predictor, exhibiting a sensitivity of 83.7% and a specificity of 60% when a cutoff value of 1.13 was applied. The survival time of patients with a LAR of ≤1.13 was significantly longer than that of patients with a ratio of &gt;1.13. Conclusion: In our study, the mortality prediction performance of the LAR in patients with VAP was superior to that of the serum lactate level or serum albumin level alone. Therefore, the LAR may be a useful and readily available prognostic factor for early risk stratification of VAP patients.

Early urea-to-creatinine ratio to predict rapid muscle loss in critically ill patients with sepsis: a single-center retrospective observational study

BackgroundPatients with sepsis in the intensive care unit (ICU) often experience rapid muscle loss. The urea-to-creatinine ratio (UCR) is thought to reflect muscle breakdown (creatinine) and catabolism (urea) and is commonly used to assess nutritional and metabolic status. This study aimed to investigate whether changes in UCR (ΔUCR) can predict the development of rapid muscle loss in patients with sepsis.MethodsThis retrospective observational study was conducted in a university ICU between 2014 and 2021, involving adult patients (≥ 18 years) diagnosed with sepsis. The primary outcome was the incidence of rapid muscle loss during ICU hospitalization. Changes in the cross-sectional muscle area at the third lumbar vertebra (L3SMA) were measured using CT images to evaluate muscle loss. Rapid muscle loss was defined as a change in ΔL3SMA greater than 2% per day. Multivariable logistic regression was used to examine the association between UCR or ΔUCR and rapid muscle loss. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of UCR or ΔUCR for rapid muscle loss.ResultsOf the 482 patients, 141 (29.2%) experienced rapid muscle loss during their ICU stay. Multivariable logistic regression analysis revealed that ΔUCR was significantly associated with an increased risk of rapid muscle loss, with an odds ratio (OR) of 1.02 [95% CI: 1.01, 1.02]. The AUC for ΔUCR in predicting rapid muscle loss was 0.76 [95% CI: 0.68–0.83], with a threshold value of 19.4 µmol urea/µmol creatinine for ΔUCR.ConclusionThe results demonstrate that ΔUCR is independently associated with rapid muscle loss in patients with sepsis and the AUC of the ROC curve for the ability of ΔUCR to predict rapid muscle loss was 0.76. Though additional prospective data are needed, our results suggest that ΔUCR may be useful in the early identification of critically ill patients with sepsis at risk of rapid muscle loss.

Association Between the Ultrasound Evaluation of Muscle Mass and Adverse Outcomes in Critically Ill Patients: A Prospective Cohort Study.

Computed tomography (CT)-derived low muscle mass is associated with adverse outcomes in critically ill patients. Muscle ultrasound is a promising strategy for quantitating muscle mass. We evaluated the association between baseline ultrasound rectus femoris cross-sectional area (RF-CSA) and intensive care unit (ICU) mortality. Secondary outcomes were the determinants of RF-CSA, and the diagnostic performance of RF-CSA after adjustment for body size. A prospective, single-center, observational cohort study was conducted in 3 ICUs (general, neuroscience, coronavirus disease-2019 [COVID-19]) of a university-affiliated hospital. Consecutive, mechanically ventilated patients with predicted length of stay >72 hours were included. RF-CSA was assessed at the dominant leg by ultrasound. Association with ICU mortality was tested using multivariable logistic regression. Diagnostic performance of RF-CSA was compared after adjustment by sex (CSA-sex), body surface area (CSA-BSA), and squared height (CSA-H2). A total of 316 patients were enrolled: age 69 [60-76], 211 men and 183 ICU survivors. Older age (odds ratio, OR [95% confidence interval, CI], 1.03 [1.01-1.05]), the type of ICU (neuroscience: 0.82 [0.38-1.79], COVID-19: 4.1 [2.01-8.38]), a higher modified Nutrition and Rehabilitation Investigators Consortium (NUTRIC) score (1.43 [1.21-1.70]), and a lower RF-CSA (0.41 [0.29-0.58]) were associated with ICU mortality. Baseline RF-CSA was lower in women, with higher nutritional risk, older age, and larger body size. Unadjusted RF-CSA had an area under the receiver operating characteristic (ROC) curve for ICU mortality of 0.720 [0.663-0.776], and this value was not significantly different from that of CSA-sex, CSA-BSA, and CSA-H2 (P = .1487). Low baseline RF-CSA was associated with increased ICU mortality. Admission RF-CSA was lower in women, with high nutritional risk, in older subjects and with lower body size. Absolute muscle mass was significantly associated with mortality, with no significant increase in this relationship when adjusting for sex or body size.

Evaluation of the Bacterial Infections and Antibiotic Prescribing Practices in the Intensive Care Unit of a Clinical Hospital in Romania.

Introduction: Healthcare-associated infections (HAIs) are associated with increased mortality, antimicrobial resistance, and high antibiotic use. Methods: The characteristics of bacterial resistance and antibiotic consumption in the intensive care unit (ICU) of a clinical hospital in Romania were evaluated. Demographic data of patients, identified bacteria, antibiotics administered, and their sensitivity profiles were collected and analyzed. Results: One hundred and twenty-five patients, with a median age of 68 years, mostly male (60%), were included in the study. More than one-third of the patients died. The deceased patients were older (median age of 74 years), had longer hospitalization (median of 9 days) and bacteria detected (55.3%), and had higher antibiotic consumption than the discharged patients. The most frequent bacteria identified in our cohort were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in deceased patients and Klebsiella pneumoniae, Escherichia coli, Staphylococcus hemolyticus, and Enterococcus faecalis in the survived group. The top three antibiotics used were ceftriaxone, metronidazole, and meropenem. Resistance to antibiotics was observed in 44.3% of the deceased group and 37.5% of patients who were discharged (χ2 = 5.5, p = 0.0628). Discussion: A positive monotonic association was observed between the number of hospitalization days and the number of antibiotic doses, with a higher correlation coefficient for deceased patients (0.6327, p < 0.0001) than in survived group (0.4749, p < 0.0001). Conclusions and Future Trends: This study provides a real picture of HAIs, the characteristics of bacteria, and the consumption of antibiotics in an ICU of a clinical hospital in Romania. The data obtained are similar to those from other international studies, but further studies are needed to reflect the real situation in Romania.

Appropriateness and inappropriate medication predictors of stress ulcer prophylaxis in the intensive care unit.

Preventive drugs for stress ulcers are widely and unreasonably used in the Intensive Care Unit (ICU). This study aims to examine the appropriate utilization of medications for stress ulcer prophylaxis (SUP) and identify factors that contribute to the inappropriate use of these medications in the ICU of the Second Hospital of Shanxi Medical University. Patient cases admitted to the ICU during the period from May 2022 to May 2023 were extracted from the hospital's information management system. Single-factor analysis and multivariate logistic regression model analysis were performed using the SPSS to identify factors associated with inappropriate medication for prophylaxis. The efficacy of this predictive model was assessed through the use of the Receiver Operating Characteristic Curve (ROC), while the Hosmer test was utilized to evaluate the model fit. This study included a total of 651 patient cases that met the inclusion criteria. Among these cases, 48.39% were found to have received inappropriate medication of SUP. The analysis revealed a significant association between inappropriate medication and partial transfer to departments (P < 0.05), as well as the use of anticoagulants (P = 0.009) in the prophylaxis group. In the non-prophylaxis group, the multifactorial logistic analysis indicated a significant correlation between inadequate prescriptions and partial transfer to departments (P < 0.05), as well as the presence of artificial airways (P < 0.01). There is a notable prevalence of inappropriate SUP in the ICU of this hospital. Attention should be paid to the SUP of some patients transferred to the department, the use of anticoagulants and the presence of artificial airway.

Impact of Country Income Level on Outcomes in Patients with Acute Brain Injury Requiring Invasive Mechanical Ventilation: A Secondary Analysis of the ENIO Study.

Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI. A secondary analysis was performed on a registry of critically ill patients with ABI admitted to 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Patients were classified as high-income country (HIC) or MIC. The primary outcome was ICU mortality. Secondary outcomes were days to first extubation, tracheostomy, extubation failure, ICU length of stay, and hospital mortality. Multivariable analyses were adjusted for clinically preselected covariates such as age, sex, body mass index, neurological severity, comorbidities, and ICU management. Extubation and tracheostomy outcomes were also adjusted for arterial blood gas values and ventilatory settings. Of 1512 patients (median age = 54years, 66% male), 1170 (77%) were from HICs, and 342 (23%) were from MICs. Median age was significantly lower in MICs [35 (range 26-52) vs. 58 (range 45-68) years in HICs]. Neurosurgical procedures (47.7% vs. 38.2%) and decompressive craniectomy (30.7% vs. 15.9%) were more common in MICs, whereas intracranial pressure monitoring (12.0% vs. 51.5%) and external ventricular drain (7.6% vs. 35.6%) were less common. Compared with HICs, patients from MICs had 2.27 times the odds of ICU mortality [p = 0.009, 95% confidence interval (CI) 1.22-4.21]. Frequency of extubation failure was lower in MICs but not significant after adjustment. Patients from MICs had 3.38 times the odds of tracheostomy (p ≤ 0.001, 95% CI 2.28-5.01), 5.59days shorter mean ICU stay (p < 0.001, 95% CI - 7.82 to - 3.36), and 1.96 times the odds of hospital mortality (p = 0.011, 95% CI 1.17-3.30). In an international registry of patients with ABI requiring invasive mechanical ventilation, MICs had higher odds of ICU mortality, tracheostomy placement, and hospital mortality compared with HICs, which may be due to difference in neurocritical care resources and management.