Mean Intensive Care Unit Length Of Stay Research Articles

Effect of Tele-ICU on Clinical Outcomes of Critically Ill Patients

Despite its implementation in several countries, there has not been a randomized clinical trial to assess whether telemedicine in intensive care units (ICUs) could improve clinical outcomes of critically ill patients. To determine whether an intervention comprising daily multidisciplinary rounds and monthly audit and feedback meetings performed by a remote board-certified intensivist reduces ICU length of stay (LOS) compared with usual care. A parallel cluster randomized clinical trial with a baseline period in 30 general ICUs in Brazil in which daily multidisciplinary rounds performed by board-certified intensivists were not routinely available. All consecutive adult patients (aged ≥18 years) admitted to the participating ICUs, excluding those admitted due to justice-related issues, were enrolled between June 1, 2019, and April 7, 2021, with last follow-up on July 6, 2021. Remote daily multidisciplinary rounds led by a board-certified intensivist through telemedicine, monthly audit and feedback meetings for discussion of ICU performance indicators, and provision of evidence-based clinical protocols. The primary outcome was ICU LOS at the patient level. Secondary outcomes included ICU efficiency, in-hospital mortality, incidence of central line-associated bloodstream infections, ventilator-associated events, catheter-associated urinary tract infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation, and rate of patients with oxygen saturation values under that of normoxemia, assessed using generalized linear mixed models. Among 17 024 patients (1794 in the baseline period and 15 230 in the intervention period), the mean (SD) age was 61 (18) years, 44.7% were female, the median (IQR) Sequential Organ Failure Assessment score was 6 (2-9), and 45.5% were invasively mechanically ventilated at admission. The median (IQR) time under intervention was 20 (16-21) months. Mean (SD) ICU LOS, adjusted for baseline assessment, did not differ significantly between the tele-critical care and usual care groups (8.1 [10.0] and 7.1 [9.0] days; percentage change, 8.2% [95% CI, -5.4% to 23.8%]; P = .24). Results were similar in sensitivity analyses and prespecified subgroups. There were no statistically significant differences in any other secondary or exploratory outcomes. Daily multidisciplinary rounds conducted by a board-certified intensivist through telemedicine did not reduce ICU LOS in critically ill adult patients. ClinicalTrials.gov Identifier: NCT03920501.

Economic burden of respiratory syncytial virus disease in Latin America: A systematic review

ABSTRACT This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications. The primary direct medical resources reported were medical services, diagnostics tests and procedures, and length of stay (LOS). Direct total costs per patient ranged widely from $563 to $19,076. Direct costs are, on average, 98% higher than indirect costs. Brazil reported a higher total cost per patient than Colombia, El Salvador, México, Panamá, and Puerto Rico, while for indirect costs per patient, El Salvador and Panamá had higher costs than Brazil, Colombia, and Mexico. The mean LOS in the general ward due to RSV was 6.9 days (range 4 to 20 days) and the mean Intensive Care Unit LOS was 9.1 days (range 4 to 16 days). In many countries of the LAC region, RSV represents a considerable economic burden on health systems, but significant evidence gaps were identified in the region. More rigorous health economic studies are essential to better understand this burden and to promote effective healthcare through an informed decision-making process. Vaccination against RSV plays a critical role in mitigating this burden and should be a priority in public health strategies.

The intervention of artificial intelligence to improve the weaning outcomes of patients with mechanical ventilation: Practical applications in the medical intensive care unit and the COVID-19 intensive care unit: A retrospective study.

Patients admitted to intensive care units (ICU) and receiving mechanical ventilation (MV) may experience ventilator-associated adverse events and have prolonged ICU length of stay (LOS). We conducted a survey on adult patients in the medical ICU requiring MV. Utilizing big data and artificial intelligence (AI)/machine learning, we developed a predictive model to determine the optimal timing for weaning success, defined as no reintubation within 48 hours. An interdisciplinary team integrated AI into our MV weaning protocol. The study was divided into 2 parts. The first part compared outcomes before AI (May 1 to Nov 30, 2019) and after AI (May 1 to Nov 30, 2020) implementation in the medical ICU. The second part took place during the COVID-19 pandemic, where patients were divided into control (without AI assistance) and intervention (with AI assistance) groups from Aug 1, 2022, to Apr 30, 2023, and we compared their short-term outcomes. In the first part of the study, the intervention group (with AI, n = 1107) showed a shorter mean MV time (144.3 hours vs 158.7 hours, P = .077), ICU LOS (8.3 days vs 8.8 days, P = .194), and hospital LOS (22.2 days vs 25.7 days, P = .001) compared to the pre-intervention group (without AI, n = 1298). In the second part of the study, the intervention group (with AI, n = 88) exhibited a shorter mean MV time (244.2 hours vs 426.0 hours, P = .011), ICU LOS (11.0 days vs 18.7 days, P = .001), and hospital LOS (23.5 days vs 40.4 days, P < .001) compared to the control group (without AI, n = 43). The integration of AI into the weaning protocol led to improvements in the quality and outcomes of MV patients.

2650. Characteristics of In-Hospital Care and Immediate Post-Discharge Care Status among Older Adults Hospitalized with Respiratory Syncytial Virus Infection, Seasonal Influenza, Acute Myocardial Infarction, and Stroke in the US

Abstract Background Despite increased recognition of the morbidity, mortality, and economic burden of respiratory syncytial virus (RSV) in adults, few studies have documented the status of post-discharge care after RSV hospitalization. This study assessed in-hospital and immediate post-discharge care status in older adults hospitalized with RSV in the US and compared it with other serious medical conditions (influenza, acute myocardial infarction (AMI), and stroke) that have long-standing disease prevention efforts. Methods This retrospective cohort study used data from Premier Healthcare Database between January 1, 2015, to December 31, 2019. Adults aged ≥ 65 years hospitalized due to primary diagnosis of RSV, influenza, AMI, or stroke were included. Discharge statuses were used to categorize the levels of immediate post-discharge care as shown in Figure 1. Descriptive statistics and Sankey diagrams were used to summarize the four cohorts. Results Overall, 2,559 RSV, 174,826 influenza, 208,448 AMI, and 274,102 stroke hospitalizations were identified with similar mean patient ages of 79.8, 76.8, 76.3, and 78.0 years, respectively. Almost all patients ( &amp;gt; 90%) had underlying comorbidities. The mean inpatient length of stay (LOS) was similar in the four cohorts (4.0, 4.4, 3.7, and 4.1 days, respectively), but the prevalence of mechanical ventilator use varied, i.e., 0.4%, 13.7%, 5.9%, and 1.4%, respectively. Intensive Care Unit (ICU) admissions during RSV hospitalizations were infrequent (3.0%) as compared to influenza (16.8%), AMI (24.5%), and stroke (20.5%). The mean ICU LOS for these four cohorts were 2.3, 2.8, 1.7, and 1.7 days in the same order. Immediately following discharge, moderate care was required for 23.9%, 22.9%, 14.1%, and 17.5% of RSV, influenza, AMI, and stroke hospitalizations, respectively. Elevated care was considerably more frequent for stroke hospitalizations (48.1%) than RSV (18.8%), influenza (21.4%), and AMI (19.3%) hospitalizations (Figure 2). Conclusion Older adults discharged from RSV hospitalizations require considerable care with needs comparable to influenza and AMI discharges. Given the substantial care requirements of RSV hospitalizations in older adults, focus on disease prevention efforts for RSV are needed. Disclosures Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds Jennifer Judy, MS, PhD, Pfizer: Stocks/Bonds Kari Yacisin, M.D., Pfizer: Employee|Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: EB is an employee of Pfizer, the sponsor of this study|Pfizer: Stocks/Bonds Poorva Sardana, MSc, Pfizer Inc: Contracted Research Neha Agrawal, MA, Pfizer Inc: Contracted Research Anchita Goswami, MSc, Pfizer Inc: Contracted Research Manvi Sharma, RPh, MBA, PhD, Pfizer Inc: Contracted Research

Impact of emergency department-based intensive care unit on outcomes of decompensating boarding emergency department patients.

Emergency department (ED) boarding, or remaining in the ED after admission before transfer to an inpatient bed, is prevalent. Boarding patients may decompensate before inpatient transfer, necessitating escalation to the intensive care unit (ICU). We evaluated the impact of an ED-ICU on decompensating boarding ED patients. This is a retrospective single-center observational study. We identified decompensated boarding ED patients necessitating critical care before departure from the ED from October 2012 to December 2021. An automated query and manual chart review extracted data. Three cohorts were defined: pre-ED-ICU implementation (Group 1), post-ED-ICU implementation with ED-ICU care (Group 2), and post-ED-ICU implementation with inpatient ICU admission without ED-ICU care (Group 3). Primary outcome was ICU length of stay (LOS). Secondary outcomes included hospital LOS, in-hospital mortality, and ICU admissions with ICU LOS<24hours. Between-groups comparisons used multiple regression analysis for continuous variables, χ2 tests and multivariable logistic regression analysis for binary variables, and follow-up contrasts for statistically significant omnibus tests. A total of 1123 visits met inclusion criteria: 225 in Group 1, 780 in Group 2, and 118 in Group 3. Mean ICU LOS was shorter for Group 2 than Group 1 or 3 (47.4vs 92.3vs 103.9hours, P<0.001). Mean hospital LOS was shorter for Group 2 than Group 1 or 3 (185.1vs 246.8vs 257.3hours, P<0.01). In-hospital mortality was similar between groups. The proportion of ICU LOS<24hours was lower for Group 2 than Group 1 or 3 (16.5vs 27.1vs 32.2%, P<0.01). For decompensating boarding ED patients, ED-ICU care was associated with decreased ICU and hospital LOS, similar mortality, and fewer short-stay ICU admissions, suggesting ED-ICU care is associated with downstream resource preservation.

The effect of trauma advanced practice nurse programme at a Level I regional trauma centre in mainland China.

Trauma is the fifth-leading cause of death in China. Despite the establishment of the Chinese Regional Trauma Care System (CRTCS) in 2016, advanced trauma nurse practice has not been incorporated. This study aimed to identify the roles and responsibilities of trauma advanced practice nurse (APN), and to investigate the impact on patient outcomes in a Level I regional trauma centre in mainland China. A single-centre pre- and post-control design was used. The trauma APN programme was established based on multidisciplinary experts' consultation. A retrospective study was conducted on all Level I trauma patients over a period of 5 years, spanning from January 2017 to December 2021, with a sample size of 2420. The data were divided into two comparison groups: a pre-APN programme (January 2017-December 2018; n = 1112) and post-APN programme (January 2020-December 2021; n = 1308). A comparison analysis was conducted to evaluate the effectiveness of trauma APN who were integrated into the trauma care team, with a focus on patient outcomes and time-efficiency indicators. The certification of the regional Level I trauma centre resulted in a 17.63% increase in the number of trauma patients. The integration of advanced practice nurses (APN) into the trauma care system led to significant improvements in time-efficiency indicators, with the exception of advanced airway establishment time (p < 0.05). The average emergency department length of stay (LOS) decreased 21%, from 168 to 132 min (p < 0.001); additionally, the mean intensive care unit LOS decreased by nearly 1 day (p = 0.028). Trauma patients who were treated by trauma APN had a higher likelihood of survival, with an odds ratio of 1.816 (95%CI: 1.041, 3.167; p = 0.033), compared to patients who received care prior to the implementation of the trauma APN program. A trauma APN programme has the potential to enhance the quality of trauma care in the CRTCS. This study elucidates the roles and responsibilities of trauma advanced practice nurses (APN) in a Level I regional trauma centre in mainland China. Trauma care quality was significantly improved after the application of a trauma APN programme. In regions with inadequate medical resources, the utilization of advanced practice trauma nurses can enhance the quality of trauma care. In addition, trauma APN can provide a trauma nursing education programme within the regional centres as a strategy to augment the proficiency of regional trauma nursing. No patient or public contribution, the research data all from trauma data bank.

Burden of illness associated with overweight and obesity in patients hospitalized with COVID-19 in the United States: analysis of the premier healthcare database from April 1, 2020 to October 31, 2020

BackgroundSARS-CoV-2 (COVID-19) continues to be a major public health issue. Obesity is a major risk factor for disease severity and mortality associated with COVID-19.ObjectiveThis study sought to estimate the healthcare resource use and cost outcomes in patients hospitalized with COVID-19 in the United States (US) according to body mass index (BMI) class.MethodsRetrospective cross-sectional study analyzing data from the Premier Healthcare COVID-19 database for hospital length-of-stay (LOS), intensive care unit (ICU) admission, ICU LOS, invasive mechanical ventilator use, invasive mechanical ventilator use duration, in-hospital mortality, and total hospital costs from hospital charge data.ResultsAfter adjustment for patient age, gender, and race, patients with COVID-19 and overweight or obesity had longer durations for mean hospital LOS (normal BMI = 7.4 days, class 3 obesity = 9.4 days, p < .0001) and ICU LOS (normal BMI = 6.1 days, class 3 obesity = 9.5 days, p < .0001) than patients with normal weight. Patients with normal BMI had fewer days on invasive mechanical ventilation compared to patients with overweight and obesity classes 1–3 (6.7 days vs. 7.8, 10.1, 11.5, and 12.4, respectively, p < .0001). The predicted probability of in-hospital mortality was nearly twice that of patients with class 3 obesity compared to patients with normal BMI (15.0 vs 8.1%, p < .0001). Mean (standard deviation) total hospital costs for a patient with class 3 obesity is estimated at $26,545 ($24,433–$28,839), 1.5 times greater than the mean for a patient with a normal BMI at $17,588 ($16,298–$18,981).ConclusionsIncreasing levels of BMI class, from overweight to obesity class 3, are significantly associated with higher levels of healthcare resource utilization and costs in adult patients hospitalized with COVID-19 in the US. Effective treatment of overweight and obesity are needed to reduce the burden of illness associated with COVID-19.

772: COMBINATION THERAPY WITH ANTIPSYCHOTIC MEDICATIONS FOR INTENSIVE CARE UNIT DELIRIUM

Introduction: Antipsychotic medications continue to be frequently prescribed by clinicians in the intensive care unit (ICU) for the management of acute delirium symptoms, despite inconclusive data. The purpose of this study is to determine if a treatment strategy using a combination of antipsychotic medications reduces the time patients spend in delirium compared with monotherapy. Methods: This was a single-center, retrospective, cohort study of patients 18 years or older. Patients were identified through chart review between January 1, 2020 to July 31,2021 who scored positive on Confusion Assessment Method for the ICU (CAM-ICU) and received antipsychotic therapy. Patients were excluded if they received any antipsychotics prior to hospital admission. Study outcomes included duration of delirium, ICU length of stay (LOS), hospital LOS, overall mortality, occurrence of adverse events (AEs), and whether antipsychotics were continued at hospital discharge. Results: A total of 84 patients were included, of these 38 and 46 received combination therapy and monotherapy, respectively. There were no significant differences in baseline characteristics between groups, except mean Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly higher in the monotherapy group (18.4 vs. 13.6, p< 0.01). Mean duration of delirium was not significantly different between the monotherapy and combination therapy groups (9.4±8.7 days vs. 9.8±8.3 days, p=0.84). Mean hospital LOS (20.7±12.7 days vs 20.9±12.2 days, p=0.95), ICU LOS (14.3±10.5 days vs 13.9±10.5 days, p=0.87), and occurrence of AEs were not significantly different. A significant difference in mortality was found between monotherapy and combination therapy (30.4% vs. 10.5%, p=0.03). Antipsychotics were continued at hospital discharge in 63% of the monotherapy and in 44.7% of the combination therapy group. Conclusions: In patients with ICU delirium, there was no difference in duration of delirium among patients receiving monotherapy compared to combination therapy with antipsychotics, though they may be sicker and have a higher mortality. Patients commonly remain on antipsychotics at hospital discharge, the implications of which warrant further study.

790: ALCOHOL WITHDRAWAL MANAGEMENT IN THE INTENSIVE CARE UNIT: A RETROSPECTIVE PRE-PROTOCOL ANALYSIS

Introduction: Alcohol withdrawal syndrome (AWS) has been associated with increased hospital and intensive care unit (ICU) length of stay (LOS), longer duration of mechanical ventilation (MV), higher incidence of delirium and hospital acquired infections, higher health care costs and increased mortality. It has been well defined in the literature that standardized protocols for treatment of AWS are associated with improved outcomes; however, to date there is no universally accepted standard of care. The goal of this study was to characterize the management and associated outcomes of patients treated for AWS in the ICU prior to implementation of a standardized AWS treatment protocol. Methods: A single center retrospective analysis of the management of AWS in the ICU was performed. Patients 18 years of age and older admitted to the ICU between 2012 and 2018 who developed AWS based on International Classification of Diseases, Ninth and Tenth Revision codes and administration of at least one dose of a benzodiazepine were included. Outcomes assessed included benzodiazepine utilization, need for and duration of mechanical ventilation, incidence of delirium and hospital acquired infections, ICU and hospital LOS and mortality. Results: A total of 163 medical and surgical patients were included in the analysis. Mean total lorazepam equivalents required during ICU admission was 64 mg (SD 135.9 mg) which amounted to an average daily lorazepam equivalent of 9.45 mg (SD 12 mg) per patient. Sixty-nine percent of patients required MV with the most common indication being refractory agitation (25.7%) or over-sedation (29.2%). Mean ICU and hospital LOS were 6.4 days and 12.9 days respectively. Complications assessed included development of delirium (76.1 %), hospital acquired pneumonia (38.7 %), and seizure during admission (14.7 %). Conclusions: This data describes the management of alcohol withdrawal patients at our institution prior to initiation of a standardized AWS treatment protocol. Our pre-protocol benzodiazepine utilization, need for MV, incidence of delirium, ICU and hospital LOS are significantly higher compared to previously published data. Future endeavors include comparison of pre- versus post-protocol data and creation of a predictive analytics model to predict ICU LOS based on patient specific variables.

CLINICAL OUTCOMES FOLLOWING INTRODUCTION OF A MULTIDISCIPLINARY PULMONARY EMBOLISM RESPONSE TEAM AT AN ACADEMIC TERTIARY CARE MEDICAL CENTER

CLINICAL OUTCOMES FOLLOWING INTRODUCTION OF A MULTIDISCIPLINARY PULMONARY EMBOLISM RESPONSE TEAM AT AN ACADEMIC TERTIARY CARE MEDICAL CENTER

Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic overwhelmed hospitals, forcing adjustments including discharging patients earlier and limiting intensive care unit (ICU) utilization. This study aimed to evaluate ICU admissions and length of stay (LOS) for blunt trauma patients (BTPs). MethodsA retrospective review of COVID (3/19/20-6/30/20) versus pre-COVID (3/19/19-6/30/19) BTPs at eleven trauma centers was performed. Multivariable analysis was used to identify risk factors for ICU admission. Results12,744 BTPs were included (6942 pre-COVID vs. 5802 COVID). The COVID cohort had decreased mean LOS (3.9 vs. 4.4 days, p = 0.029), ICU LOS (0.9 vs. 1.1 days, p < 0.001), and rate of ICU admission (22.3% vs. 24.9%, p = 0.001) with no increase in complications or mortality compared to the pre-COVID cohort (all p > 0.05). On multivariable analysis, the COVID period was associated with decreased risk of ICU admission (OR = 0.82, CI 0.75–0.90, p < 0.001). ConclusionsBTPs had decreased LOS and associated risk of ICU admission during COVID, with no corresponding increase in complications or mortality.

102. A Retrospective Case Series of West Nile Neuroinvasive Disease in Two Tertiary Health Centers in Miami

BackgroundAccording to the Centers for Disease Control and Prevention, Florida was the third leading state in reported West Nile Neuroinvasive Disease (WNND) infections in 2020. WNND accounts for less than 1% of all West Nile virus (WNV) infections but carries a 10% mortality rate. The clinical characteristics of WNND have not been well described in Florida, an area with high mosquito activity. We hereby describe the clinical characteristics of WNND at two large hospitals in Miami.MethodsA 10-year retrospective study was performed at the University of Miami Hospital and Mount Sinai Medical Center to identify adult patients with confirmed WNV infection and neuroinvasion. Patient demographics, symptoms, neurological exam findings, laboratory diagnostics, intensive care unit (ICU), and hospital length of stay (LOS), and outcomes were described.ResultsEleven patients (73% male, mean age 64.4 ± 16.3 years) were identified between January 2010 to December 2020. The most prevalent comorbidities were HTN (64%) and DM (27%). The most common positive findings on the review of symptoms were fever (100%), confusion (81.8%), and headache (63.6%). The mean hospital LOS was 15.5 ±11.3 days, while the mean ICU LOS was 7.2 ± 11.9 days. The majority of patients (75%) spent more than 2 weeks in the ICU. Subject age was correlated with hospital LOS with a Pearson correlation of 0.624 (p=0.04). The survival rate was 91%. At the time of discharge, 80% of patients continued to have neurological symptoms. Figure 1: The percentage of subjects with different types of WNND. The section titled others, includes atypical presentations such as amnesia, focal neurological deficits (ataxia, hemiparesis), and myelopathy. Figure 2: Month and year of presentation at the time of hospital admission. Figure 3: Clinical presentation (%).ConclusionThis is the largest case series of WNND in Florida. Most cases occurred during summer 2020, which corresponds to the peak of the COVID-19 pandemic. Despite pandemic restrictions, we may have seen an increase in WNV cases due to higher-than-normal temperatures promoting mosquito abundance, increased outdoor activities due to the COVID-19 pandemic, and/or the redistribution of public health resources towards the pandemic rather than mosquito control. Residual neurological symptoms and impaired functional outcomes are common. Within the limitation of our small sample size, subject age appeared to correlate with hospital LOS. This correlation should be further explored in a larger case series. A high index of suspicion for WNND is suggested for patients presenting with fever and neurologic symptoms in Florida. Disclosures Cynthia Rivera, MD, Gilead Sciences (Advisor or Review Panel member)Viiv Healthcare (Advisor or Review Panel member)

Healthcare Resource Utilization and Costs of Patients with AL Amyloidosis: An Analysis of Hospitalizations in the Premier Database

Healthcare Resource Utilization and Costs of Patients with AL Amyloidosis: An Analysis of Hospitalizations in the Premier Database

PREDICTING OUTCOMES IN COVID-19 PNEUMONIA WITH ACUTE RESPIRATORY FAILURE USING THE RESPIRATORY RATE-OXYGENATION INDEX

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Among the various indices of oxygenation, Respiratory Rate-Oxygenation Index (ROX), defined as the ratio of oxygen saturation and fractional percentage of inspired oxygen (SpO2/FiO2) to respiratory rate (RR), has been found to be a predictor of improvement with High-Flow Nasal Oxygen (HFNO) therapy. Limited information exists on utility of ROX in predicting outcome in coronavirus-19 (COVID-19) pneumonia. The objective of this study was to evaluate the ROX index at admission, ROX index at the patient’s lowest oxygen saturation (SaO2) levels and ROX index at Intensive Care Unit (ICU) admission as a marker of outcomes including need for invasive mechanical ventilation (InvMV), hospital length of stay (LOS), ICU LOS and mortality in patients with COVID-19 pneumonia with acute respiratory failure. METHODS: Records of one hundred and five (105) patients admitted to our hospital with COVID-19 pneumonia and acute respiratory failure were reviewed. The following data was obtained: Age, gender; ROX index at admission, at patient’s lowest SaO2 levels, and at ICU admission; need for InvMV, hospital LOS, ICU LOS and number of patients. Pearson’s correlation analysis was used to determine the impact of ROX Index at hospital admission, ICU admission and at lowest SaO2 respectively versus need for InvMV, hospital LOS, ICU LOS and mortality. p≤ 0.05 was considered statistically significant. RESULTS: Seventy-one (71) patients were male (67%)and mean age was 66.5 ± 16.75 years. Mean admission ROX index at admission was 13.46 ± 7.12; mean ROX index at patient’s lowest SaO2 was 6.92 ± 4.98; mean ICU admission ROX was 6.47 ± 6.43. Twenty-five patients (23.8%) required InvMV; the mean hospital LOS was 11 ± 8.91 days, the mean ICU LOS was 4.39 ± 8.26 days, and thirty-three patients (31.4%) expired. Pearson’s correlation analysis demonstrated the following: ROX index at Admission Need for invasive MV (p<0.001, r= -0.03) Hospital LOS (p=0.02, r= -0.222) ICU LOS (p<0.001, r= -0.383) Mortality (p=0.018, r= 0.234) ROX index at Lowest SaO2 Need for invasive MV (p<0.001, r= -0.347) Hospital LOS (p<0.001, r= -0.395) ICU LOS (p<0.001, r= -0.322) Mortality (p=0.014, r= 0.23) ROX index at ICU admission Need for invasive MV (p=0.022, r= -0.358) Hospital LOS (p=0.02, r= -0.36) ICU LOS p=0.08, r= -0.272) Mortality (p=0.17, r= 0.215) CONCLUSIONS: ROX index at admission and at patient’s lowest SaO2 is associated with increased need for InvMV, increased hospital LOS, ICU LOS and mortality. ROX index at ICU admission was also associated with increased need for InvMV and hospital LOS but did not show statistically significant correlation with ICU LOS and mortality. CLINICAL IMPLICATIONS: ROX index can be used to predict need for InvMV and mortality in patients with COVID-19. Further studies are required to delineate if there is a specific value that can predict need for InvMV and mortality. DISCLOSURES: No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Manasvi Gupta, source=Web Response No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Suong Nguyen, source=Web Response

Nutrition Therapy in Patients Requiring Noninvasive Ventilation in the Intensive Care Unit: Feasibility, Tolerance, and Complications

Background: Patients requiring noninvasive ventilation (NIV) in the intensive care unit (ICU) are likely to have a high prevalence of malnutrition. Nutrition provision in these patients is of utmost importance; however, data on its feasibility, tolerance, and complications are largely unavailable. Objective: The objective of the study was to assess the prevalence of malnutrition in patients requiring NIV in the ICU and to analyze feasibility, tolerance, and complications of nutrition therapy in this population. Methods: This was a prospective, observational study of consecutive patients requiring NIV admitted to the multidisciplinary ICU of a tertiary care, teaching hospital between April 2017 and November 2017. Baseline nutrition status was assessed using subjective global assessment (SGA). Nutrition requirement calculation and prescription were standardized. All included patients were monitored for pattern of nutrition provision, adequacy of delivery tolerance, and complications. Relevant outcomes such as intubation rates, ICU length of stay (LOS), and mortality were also noted. Results: A total of 34 patients were included in the study. Seventy-six percent of patients (26 out of 34 patients) were malnourished as determined by SGA. The mean Acute Physiology, Age and Chronic Health Evaluation II score was 15.1 ± 6.9. The average time for feed initiation was 12.4 h, and the most common reason for the delay (in 43%) was an impending intubation. The mean percentages of calorie and protein requirement that was delivered by day 3 were 67.2% and 48.3%, respectively. Thirteen patients (38.2%) required continuous nasogastric (NG) feeding, while the others could be fed orally. In 14 patients (41.1%), we were able to achieve 80% or more of target calorie requirement by day 3, and among these patients, the mean percentage of target protein intake that could be achieved was 66.6% by day 3. Feed intolerance was observed only in three patients. One patient had an inadvertent dislodgement of NG tube. Six patients (17.6%) required intubation and three (8.8%) died. Mean ICU LOS was 5.6 ± 3.9 days. Conclusion: Patients requiring NIV in the ICU have a high prevalence of malnourishment. Protocol-driven nutrition delivery is feasible in this population and is well tolerated.

Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery.

Simple SummaryThis study aimed to investigate the effect of certain pre-operative parameters from the clinical routine directly on the post-operative intensive care unit (ICU)-length of stay (LOS) after major oral and maxillofacial cancer surgery. This study was performed to identify at-risk patients that are expected to need prolonged specialized care management post-operatively to these aforementioned operations. A homogenous cohort of 122 patients over a five year period was included in this study. At-risk patients are prone to need a significantly longer specialized care management than others. These patients are those with pre-operative severe renal dysfunction, peripheral vascular diseases and/or increasing heart failure stage categories. Confounding parameters that contribute to a prolonged specialized post-operative management in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.Objective: This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. Material and Methods: Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18–90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. Results: This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. Conclusions: At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.

Impact of Contrast Echocardiography on Outcomes in Critically Ill Patients

Limited data suggests ultrasound enhancing agent (UEA) use is associated with changes in clinical management and lower mortality in intensive care unit (ICU) patients. We conducted a retrospective observational study to determine if contrast echocardiography (vs non-contrast echocardiography) is associated with differences in length of stay (LOS) and subsequent resource utilization in the ICU setting. The Premier Healthcare Database (Charlotte, NC) was analyzed to identify patients receiving Definity vs. no use of contrast during the initial rest transthoracic echocardiogram (TTE) in an ICU setting. The primary outcomes of interest were subsequent TTE and transesophageal echocardiography (TEE) during the index hospitalization, and ICU LOS. Propensity scoring was used to statistically model treatment selection to minimize selection bias. A total of 1,538,864 patients from 773 hospitals were identified as undergoing resting TTE in the ICU with use of DEFINITY in 51,141 (3.3%) patients and no contrast agent use in 1,487,723 (96.7%) patients. After adjusting for patient, clinical, and hospital characteristics, patients in the Definity cohort were less likely to undergo a subsequent TTE or TEE as compared to those in the no contrast cohort (odds ratio = 0.704 for TTE, odds ratio = 0.841 for TEE; p < 0.0001 for both). Adjusted mean ICU LOS for the Definity cohort was shorter than that of the no contrast cohort (4.59 vs 4.15 days, p < 0.0001). In conclusion, Definity-enhanced echocardiography in the ICU setting (in comparison with non-contrast TTE) is associated with lower rates of subsequent TTE and TEE during the index hospitalization, and shorter ICU LOS.

Reducing ICU Length of Stay: The Impact of a Multidisciplinary Perioperative Pathway in Vestibular Schwannoma.

Objective This study was aimed to evaluate the impact of a multidisciplinary perioperative pathway on length of stay (LOS) and postoperative outcomes after vestibular schwannoma surgery. Setting This study was conducted in a tertiary skull base center. Main Outcome Measures The impact of the pathway on intensive care unit (ICU) LOS was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures. Methods Present study is a retrospective review. Results A universally adopted perioperative pathway was developed to include standardization of preoperative education and expectations, intraoperative anesthetic delivery, postoperative nursing education, postoperative rehabilitation, and utilization of stepdown and surgical floor units after ICU stay. Outcomes were measured for 95 consecutive adult patients who underwent surgical resection for vestibular schwannoma (40 cases before implementation of the perioperative pathway and 55 cases after implementation). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group ( p = 0.02). There were no significant differences in overall resource LOS postoperative complications or readmission rates between groups. Conclusion Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU LOS in patients undergoing vestibular schwannoma surgery without compromising quality of care. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population.

Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19.

Introduction: the COVID-19 pandemic put the world's population at risk. As the relationship between nutritional risk and clinical outcomes in critically ill patients with COVID-19 is still poorly understood, a multidisciplinary research team of the Argentine Society of Intensive Care (SATI) conducted a multicenter study aimed to define nutritional features, and to evaluate the relationship between nutritional risk and relevant clinical outcomes for COVID-19 patients in an intensive care unit (ICU). Methods: a multicenter, prospective, observational study including twelve Argentinian ICUs was conducted between March and October 2020. Inclusion criteria were: adult patients older than 18 years who were admitted to the ICU with a COVID-19 diagnosis were included. Clinical data included comorbidities scores, and nutritional screening tools such as the Subjective Global Assessment (SGA), the Nutritional Risk Screening (NRS) 2002, and the modified NUTRIC score (mNUTRIC SCORE) were used. In addition, clinical outcomes including overall mortality, mechanical ventilation (MV) days, and ICU and hospital length of stay (LOS) were recorded. Results: a total of 285 ICU patients met our inclusion criteria. Mean age was 61.24 (SD = 14.6) years; APACHE-II, 14.2 (SD = 6.6); Charlson Comorbidity Index (CCI), 2.3 (SD = 2.3). Most patients were admitted from the emergency room to the ICU. Hypertension, obesity, and diabetes were the most common comorbidities. Nutritional assessment showed that 36.9 % were SGA B+C, and 46 % were obese. Mean ICU LOS was 22.2 (SD = 19.5), and hospital LOS was 28.1 (SD = 21.9) days. Of all patients, 90.2 % underwent MV, and MV days were 20.6 (SD = 15.6). The univariate and multivariate analyses showed that risk factors for COVID-19 mortality were (odds ratio [95 % confidence interval]): SGA score of B or C: 2.13 [1.11-4.06], and NRS 2002 ≥ 3: 2.25 [1.01-5.01]. Conclusions: in the present study, nutritional status (SGA) and NRS 2002 were major mortality risk factors for CODIV-19 patients in the ICU.

Predictors of Length of Stay in Intensive Care Unit after Coronary Artery Bypass Grafting: Development a Risk Scoring System.

IntroductionTo determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study.MethodsIn this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS.ResultsThe mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS.ConclusionThe simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.