Longer Duration Of Intensive Care Unit Research Articles

Radiologically and clinically diagnosed acute pulmonary oedema in critically ill patients: prevalence, patient characteristics, treatments and outcomes

Background: Acute pulmonary oedema is a life-threatening syndrome diagnosed based on radiological and clinical findings. However, to our knowledge, no studies have investigated this syndrome in critically ill patients. Objective: To describe the prevalence of radiologically and clinically diagnosed pulmonary oedema (RCDPO) in critically ill patients, characteristics of diagnosed patients, and treatments and outcomes in this patient population. Methods: We conducted a retrospective study using natural language processing to identify all radiological reports of pulmonary oedema among patients who had been admitted to single tertiary intensive care unit (ICU) over a 1-year period (January 2015 to January 2016). We reviewed clinical data, discharge diagnosis, treatment and outcomes for such patients, and used multivariable logistic regression analysis to identify the association of RCDPO with various outcomes. Results: Out of 2001 ICU patients, we identified 238 patients (11.9%) with RCDPO. Patients with RCDPO were more acutely ill, had more chronic liver disease and had more chronic renal failure than critically ill patients who did not have RCDPO. They were typically admitted with acute cardiovascular disease; were more likely to receive invasive mechanical ventilation and continuous renal replacement therapy; had longer duration of ICU and hospital stay; were more likely to die in hospital; and, if discharged alive, were more likely to be admitted to a chronic care facility. In total, 46 RCDPO patients (19.3%) died in hospital. On multivariable analysis, only age and continuous renal replacement therapy were independently associated with mortality. In contrast, invasive mechanical ventilation was associated with a 2.5 times greater odds of radiological resolution. Conclusion: RCDPO affected about one in eight ICU patients. Such patients were sicker and had more comorbidities. The presence of RCDPO was independently associated with higher risk of death. Invasive mechanical ventilation was the only intervention independently associated with greater odds of radiological resolution.

The association between hyponatraemia and long-term functional outcome in patients with aneurysmal subarachnoid haemorrhage: A single centre prospective cohort study

To assess the association between hyponatraemia and long-term functional outcome and other relevant outcomes in patients with aneurysmal subarachnoid haemorrhage (aSAH) we conducted a prospective cohort study in a Neurosciences Intensive Care Unit (ICU) in Sydney, Australia. The primary exposure variable was hyponatraemia (Na+ <135 mmol/L). The primary outcome was favourable outcome, a score of 5–8 on the extended Glasgow Outcome Score (GOSe) at 12 months. We also measured mortality, the incidence of delayed cerebral ischaemia (DCI) and cerebral arterial vasospasm and duration of ICU and hospital admission. There were 200 participants, 111 (56%) developed hyponatraemia. Hyponatraemia was not associated with favourable outcome at 12 months (unadjusted odds ratio [OR] OR 1.31, 95% confidence interval [CI] 0.65–2.65, p = 0.56). The result was similar after adjustment for baseline covariates (adjusted OR 0.60, 95% CI 0.16–1.99, p = 0.43). There was no association between hyponatraemia and the incidence of DCI (OR 0.95, 95% CI 0.46 to 2.0, p > 0.99) nor cerebral arterial vasospasm (OR 1.4, 95% CI 0.8 to 2.5, p = 0.27). Those who developed hyponatraemia had a longer median duration of ICU admission (17 days, interquartile range [IQR] 12 to 20, compared to 13 days, IQR 8–21, p = 0.02) and longer median duration of hospital admission (24 days, IQR 21–30, compared to 22 days IQR 14–31, p = 0.05). While hyponatraemia is common following aSAH, it is not associated with worse long-term functional outcome, increased rate of DCI, nor cerebral arterial vasospasm. Hyponatraemia in patients with aSAH was associated with longer duration of ICU and hospital admission.

Blood purification therapy prolongs the duration of intensive care unit stay to 14 days or more

In the intensive care unit (ICU), severely ill or injured patients who undergo specific treatments, including artificial ventilation and blood purification (BT), may require a longer duration of ICU stay than patients not receiving specific treatments.

Analysis of early results of 43 children with aortic arch lesion after operation

Objective To analyze the clinical data of aortic arch lesions after operation in order to provide better operation and decrease the mortality and shorten the duration of intensive care unit(ICU) treatment. Methods Forty-three children with aortic arch lesions including 26 male and 17 female in Fuwai Angiocardiopathy Hospital between Jan.and Sep.2012 were enrolled.The ages ranged from 29 days to 10 years old with the median age of 6 months and the weight ranged from 3.2 kg to 38.0 kg with the median weight of 6.0 kg.Nine cases were simple aortic arch lesions, while 34 cases were associated with 2 or more complex cardiac anomalies.The cases were divided into groups according to the age and residence time in ICU. Results The median duration of mechanical ventilation was 23 hours and the median duration of residence time in ICU was 3 days.There were 3 postoperative deaths.Infants younger than 6 months needed more time of mechanical ventilation and longer ICU stay than children older than 6 months.The single factor analysis revealed that young age, low weight, combined with complex cardiac anomalies, and long time of cardiopulmonary bypass and mechanical ventilation were risk factors of prolonged stay in ICU.Postoperative complications occurred in 15 cases: 12 cases had the pulmonary infection, 5 cases had systemic capillary leak syndrome, 2 cases had tracheal stenosis, and 2 cases had low cardiac output syndrome.Extracorporeal membrane oxygenation support and cardiopulmonary resuscitation were guarantees of successful operation of low cardiac output syndrome. Conclusions Outcomes of repair of aortic arch lesion were good, so timely operation should be preformed for aortic arch lesions infants with asso-ciated cardiac anomalies, but there is risk of operation and infants need longer duration of ICU stay and tend to have more postoperative complications.The preliminary experiences suggested that it would be better for the children older than 6 months with aortic arch lesion to undertake operation as they tend to have less postoperative complications. Key words: Congenital heart disease; Aortic arch lesion; Coarctation of aorta; Interrupted aortic arch; Posto-perative complication; Risk factor

Pharmacological and nonpharmacological management of delirium in critically ill patients.

Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system.