Medical Intensive Care Unit Research Articles

Adaptive Pressure Control-Continuous Mandatory Ventilation Versus Volume Control-Continuous Mandatory Ventilation: Factors Associated With Initiation, Maintenance, and Adjustment.

Adaptive pressure control-continuous mandatory ventilation (APC-CMV) is a frequently utilized ventilator mode in ICU settings. This analysis compared APC-CMV and traditional volume control-continuous mandatory ventilation (VC-CMV) mode, describing factors associated with initiation, maintenance, and changes in settings of each mode. We analyzed ventilator data from a retrospective electronic health record data set collected as part of a quality improvement project in a single academic ICU. The majority ventilator mode was defined as the mode comprising the highest proportion of mechanical ventilation time. Multivariable logistic regression was used to identify variables associated with initial and majority APC-CMV or VC-CMV modes. Wilcoxon rank-sum tests were used to compare ventilator setting changes/d and sedation as a function of APC-CMV and VC-CMV majority modes. Among 1,213 subjects initiated on mechanical ventilation from January 2013-March 2017, 68% and 24% were initiated on APC-CMV and VC-CMV, respectively, which composed 62% and 21% of the majority ventilator modes. Age, sex, race, and ethnicity were not associated with the initial or majority APC-CMV or VC-CMV modes. Subjects initiated on APC-CMV spent 88% of the mechanical ventilation time on APC-CMV mode. Compared to VC-CMV, subjects with APC-CMV majority mode experienced more ventilator setting changes/d (1.1 vs 0.8, P < .001). There were no significant differences in sedative medications when comparing subjects receiving APC-CMV versus VC-CMV majority modes. APC-CMV was highly utilized in the medical ICU. Subjects on APC-CMV had more ventilator setting changes/d than those on VC-CMV. APC-CMV offered no advantage of reduced setting adjustments or less sedation compared to VC-CMV.

Study of Various Disseminated Intravascular Coagulation Scores and Sequential Organ Failure Assessment Score in Medical Intensive Care Unit.

Aim The aim of the present study was to assess the disseminated intravascular coagulation (DIC) and its correlation with DIC scores (International Society on Thrombosis and Haemostasis (ISTH), sepsis-induced coagulopathy (SIC)) and Sequential Organ Failure Assessment (SOFA) score in medical intensive care unit (MICU) patients. Methods The study was conducted at the medical intensive care unit at Dr. D.Y. Patil Medical College and Hospital, D.Y. Patil Vidyapeeth, Pimpri, Pune spanning from October 2020 to September 2022. A total of 100 patients admitted to the hospital ICU satisfying qSOFA score were included in the current study. Approval was obtained from the institutional ethics committee before commencing the study. All patients and their family members included in the study were provided with a detailed explanation of the study. Clinical history of illness and physical examination were done in detail. The laboratory values were obtained and were calculated with the International Society on Thrombosis and Haemostasis (ISTH), sepsis-induced coagulopathy (SIC) and Sequential Organ Failure Assessment (SOFA) scores. Results The average age of the study population was 52.08 ± 16.44 years. Within the study population, 65% were male and 35% were female. Within the group being studied, the average pulse rate was 66.64 ± 17.33 beats per minute, the average systolic blood pressure was 83.7 ± 11.38 mm Hg, the average diastolic blood pressure was 59.7 ± 10.49 mm Hg, and the average respiratory rate was 38.4 ± 4.8. The average Glasgow Coma Scale (GCS) among the participants was 9.51 ± 1.74. The average qSOFA score across the study participants was 2.58 ± 0.6. The study population consisted of 60% survivors and 40% non-survivors. Regarding the study population, 57.15% of individuals experienced mortality as a result of DIC. The statistical analysis revealed a significant difference in the mean ISTH score between the result groups at 48 hours. The disparity in the average SOFA score at admission, 24 hours, 48 hours, day 7 and day 14 between the outcomes (survivors and non-survivors) was statistically significant. Conclusion This research suggests that there is a positive link between higher scores on the estimated ISTH, SIC and SOFA scales. The prognosis of critically sick patients is negatively correlated with the progressive increase in DIC scores throughout follow-up, while a stable or declining DIC score is indicative of a more favorable prognosis. There was no significant link seen between non-overt disseminated intravascular coagulation (DIC) mortality and DIC scores.

Prescribing Trend of Antibiotics Among the Patients Admitted in Intensive Medical Care Unit: A Prospective Observational Study.

Intensive medical care units (IMCUs) usually admit patients who are in critical medical need and require the utmost attention of healthcare professionals, along with the best treatment options available. These patients are prone to infections and require various antibiotics for the treatment. Varying costs of antibiotics, variable dosage forms, and antibiotic resistance cause an economic burden on patients Methodology: This study was designed and conducted prospectively to evaluate the prescribing pattern of antibiotics at the IMCU in a tertiary care hospital. A total of 102 patients were included in the study based on the exclusion and inclusion criteria, and the collected data was tabulated in an Excel sheetand analyzed using Prism GraphPad software. Data were presented as numbers and percentages. Most of the patients were in the age group of 41-50 years. The number of male patients was slightly more than that of female patients. The majority of the patients admitted to the IMCU had acute pulmonary edema and cerebrovascular accidents. Most antibiotics were prescribed empirically and administered parenterally, of which Amoxicillin + Potassium clavulanate was the most commonly used antibiotic. Tigecycline had the highest daily defined dose per 100 bed days value, and injection Sulbactam + Cefoperazone was the costliest of all antibiotic therapy. Antibiotic therapy used in the IMCU consisting of Sulbactam + Cefoperazone was found to be costlier, and Amoxicillin + Potassium clavulanate were the commonly prescribed antibiotics among the other prescribed antibiotics. The average cost of antibiotics was found to be higher, which increased the economic healthcare burden for patients and their families.

Enhancing Sleep Hygiene in the MICU: Developing &amp; Implementing an Interdisciplinary Protocol for Improved Patient Outcomes

Abstract Date Presented 03/21/24 A need for a sleep hygiene protocol in the intensive care unit (ICU) was identified to improve patient outcomes. An interdisciplinary survey was used to explore perspectives of sleep hygiene and current practices in the medical ICU (MICU) to guide further research. Primary Author and Speaker: Susan E. Whitworth Additional Authors and Speakers: Krista Garrison

Efficacy of Continuous Infusion Ketamine for Analgosedation in the Medical Intensive Care Unit: A Propensity-Weighted Analysis

Background: Few randomized controlled trials have evaluated the use of ketamine vs opiate-based analgosedation. Methods: A retrospective cohort analysis of 169 mechanically ventilated patients admitted to the medical intensive care unit (MICU) at an academic medical center was conducted to evaluate efficacy of ketamine vs opiate-based analgosedation by comparing the percentage of time within target sedation range. The primary outcome was percentage of time within target sedation range (RASS -1 to +1) within first 72 hours of primary sedation initiation. Secondary outcomes including percentage of time under-sedated, over-sedated, and in coma; use of concomitant analgesic, sedative, and antipsychotic agents; presence of delirium; percentage of CPOT scores at goal; and hemodynamic effects were also evaluated. Results: After weighting, the mean percentage of time at RASS goal for ketamine patients was 43.0% compared to 41.4% for opiate-based sedation patients. Ketamine was not significantly non-inferior to opiate-based sedation for the mean percentage of time at RASS goal (P = .11). The median percentage of CPOT scores at goal was 13.3% higher in the ketamine group (P = .042). Patients in the ketamine group received significantly less additional sedative agents than the patients in the opiate-based sedation group. Conclusion: A similar percent of time at RASS goal was found for the ketamine analgosedation group compared to the opiate-based sedation group, although this did not reach statistical signicance for non-inferiority due to lack of statistical power. This study found a higher percentage of CPOT scores within goal with less additional sedative agents required compared to an opiate-based sedation regimen.

Incidence and Severity of Adverse Drug Reactions in Medical Intensive Care Unit.

Adverse drug reactions (ADRs) curtail patients' quality of life by virtue of increasing therapeutic complexity and rising multimorbidity. In India, the frequency of ADRs for individual drugs and their economic burdens are rarely evaluated. This study aimed at identifying the incidence and severity of ADRs leading to hospitalization (ADRA) and occurring during a hospital stay (ADRH). The objective of this study is to evaluate the incidence the incidence and severity of ADRs in the ICU and their impact on the duration of hospitalization, along with the cost incurred to treat ADRs in the ICU. Demographic, clinical, and pharmacological data on patients admitted to the ICU were collected, analyzed and evaluated for ADRs. According to the setting analyzed, a descriptive analysis of the reactions, suspected medicines, and associated factors was undertaken. A total of 208 patients were admitted to the ICU during the study period, of which ADRA contributed 9.1% of the incidence rate and 8.1% of ADRH in 36 patients. Males had a higher incidence of ADRs than females. Patients who had ADRs had a substantially longer length of stay than those who did not. Electrolyte disturbance was the most commonly found ADR. According to the Hartwig scale and WHO-causality scale, 88.9% were moderate, and 97.2% were possible ADRs, respectively. In this study, a similar incidence rate of ADRA and ADRH was observed. The average cost for treating ADRA was higher than that for treating ADRH. As a result, identifying and preventing these reactions is critical, as they cause the patient greater suffering.

Experience Curve With the Cone Procedure for Ebstein’s Anomaly: Effect on Cost and Resource Utilization

BackgroundThe volume-outcome relationship is well-known in health care. The Experience Curve, initially developed by the Boston Consulting Group for manufacturing, offers insight on this relationship and has never before been applied to health care. ObjectivesThe purpose of this study was to determine the effect of experience on cost and resource utilization for the Cone procedure. MethodsWe performed a retrospective review of patients who underwent Cone reconstruction for Ebstein’s anomaly at Boston Children’s Hospital between October 2010 and October 2021. Cardiopulmonary bypass time and aortic cross clamp time over time were evaluated using exponential regression to assess the surgeon-level learning curve. At the hospital level, length of stay and cost over time were assessed using exponential regression. ResultsThere were 115 patients included in the study. Median hospital length of stay was 7.9 days (IQR: 6.4-10.2 days) with a decline of 3.3% per year. Median intensive care unit [ICU] length of stay was 3.2 days (IQR: 2-5.7 days) with a decline of 10.5% per year. Adjusted direct costs indexed to 2020 prices fell by 4% per year. There was no statistically significant change in cardiopulmonary bypass or aortic cross clamp time. In mediation analysis, the reduction in cost was completely accounted for in the decline in ICU length of stay. ICU length of stay was correlated with duration of intubation. ConclusionsIncreasing familiarity with Ebstein’s anomaly and Cone reconstruction led to a reduction in resource utilization.

The Biomarker Potential of the Neutrophil-to-Lymphocyte Ratio in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Background Chronic obstructive pulmonary disease (COPD) is characterized by periods of exacerbations and seasonal variations due to the recruitment of inflammatory cells. Various cells, such as neutrophils, lymphocytes, and the inflammatory mediators released by them, play a role in its pathogenesis. The current study was conducted to determine the role of the neutrophil-to-lymphocyte ratio (NLR) as a marker in acute exacerbation of COPD (AECOPD). Materials and methods We conducted a cross-sectional observational study at a tertiary care center in Western Maharashtra over six months after receiving approval from the institutional ethics committee. The study included 50 patients with AECOPD and 30 age and gender-matched controls without COPD. The patients were examined with a detailed history, complete blood count, and spirometry. The NLRwas calculated and patients' disease severity was assessed using Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging. Results The mean age in the AECOPD group was 67.5 ± 12.5 years, whereas it was 46.2 ± 18.5 years in the control group. There was a male predominance in the AECOPD group (32/50). The majority of patients were in the GOLD stage 2 (42/50), followed by GOLD stage 3 (7/50). A total of 28 out of 50 AECOPD patients required admission to the medical intensive care unit. In the AECOPD group, 39 were smokers, and 11 were nonsmokers. Smoking was significantly associated with AECOPD when compared with controls. The mean NLR was 10.9 ± 10.2 in AECOPD patients and 4.3 ± 3.1 in the controls. Among cases with high NLR (≥5), seven required mechanical ventilation, 13 required noninvasive ventilation (NIV), and six succumbed to death. The mean duration of mechanical ventilation in this group was 12.5 ± 4.5 days, and for NIV, it was 7.5 ± 5.5 days. Conversely, patients with lower NLR (≤5) were more likely to avoid artificial ventilation and had a better in-hospital outcome. Conclusion COPD exacerbations can harm a patient's health, lead to disease progression, and increase mortality rates. Predicting exacerbations in advance can aid in early detection and treatment. NLR is an inexpensive, noninvasive, and easily available marker of inflammation and a predictor of outcome in AECOPD patients and hence should be calculated routinely in all patients with COPD.

Impact of Immunoglobulin M-enriched Immunoglobulins on the Outcomes of Severe Coronavirus Disease 2019.

Coronavirus disease 2019 (COVID-19) led to a major global health crisis, leading to a worldwide pandemic. Several therapeutic interventions have been tried with varied results. The purpose of this academic work was to assess the efficacy of immunoglobulin M (IgM)-enriched Ig in the management of patients with severe COVID-19 pneumonia. In this retrospective cohort study, severe COVID-19 pneumonia patients who received IgM-enriched immunoglobulin, in addition to standard-of-care treatment, were retrospectively enrolled. Levels of inflammatory biomarkers, oxygenation status, and organ dysfunction were evaluated, and differences were noted after giving IgM-supplemented IgM. Data from 32 consecutive severe COVID-19 patients admitted to medical intensive care units (ICUs) were analyzed. After giving IgM-enriched Ig, there was an improvement in oxygenation indices as shown by saturation of oxygen/fraction of inspired oxygen (SpO2/FiO2) on days 3 and 7, but it was not statistically significant. Oxygen support could be de-escalated in 13 (40.6%) patients on day 3 and in 8 (25%) patients on day 7, after giving IgM-enriched Ig. After giving IgM-enriched Ig, there was a reduction in the levels of all the studied inflammatory markers [interleukin-6 (IL-6), D-dimer, and ferritin) on days 3 and 7, but it was statistically significant only for IL-6. The overall ICU mortality was 53.1%. Outcomes of patients with severe COVID-19 requiring ICU care remain dismal. IgM-enriched Ig may be helpful in improving oxygenation and combating cytokine storm in these patients. However, in the present study, the improvement in oxygenation indices (SpO2/FiO2) and reduction in inflammatory markers like D-dimer and ferritin were not statistically significant. Hence, larger randomized controlled trials are required to get more definitive evidence to support this therapy and show significant clinical and mortality benefits.

Nutritional gap after transfer from the intensive care unit to a general ward – A retrospective quality assurance study

BackgroundAdequate nutrition is important for recovery after critical illness. Even so, our knowledge of patients' nutritional intake after intensive care unit (ICU) discharge is scarce. ObjectivesWe aimed to explore nutritional planning and achieved nutritional intake in ICU patients who transfer from the ICU to general wards. MethodsA retrospective quality assurance study. Inclusion criteria: adult ICU patients transferring to a general ward at Copenhagen University Hospital-Herlev from May to August 2021. Primary outcomes were as follows: having a nutritional plan on the day of ICU transfer. A nutritional plan was defined as follows: (i) individual assessment of energy and protein requirement; (ii) intake, documented as achieved percentage of energy and protein requirements; (iii) prescribed type of nutrition. If using enteral or parenteral nutrition; (iv) the prescribed doses; and (v) the prescribed product. Secondary outcomes were as follows: achieved percentage of energy and protein requirements from day -1 before ICU transfer until day +1 and day +3 after ICU transfer. ResultsWe included 57 patients; the mean age was 64 years (±11.1); 43 (75%) patients were male; the median ICU stay was 6 days (interquartile range: 3–11). One (2%) patient had a full nutritional plan according to listed criteria. Patients' median percentage of requirements met declined significantly from the day before to the day after ICU discharge (energy: from 94% to 30.5%; p = 0.0051; protein: from 73% to 27.5%; p = 0.0117). The decline in percentage of requirements met remained unchanged from day 1 to 3 after ICU transfer. ConclusionsIn conclusion, few patients had a nutritional plan when transferring from the ICU to a general ward. After ICU discharge, percentage of energy and protein requirements met declined significantly and remained insufficient during the first 3 days at the general ward.

Clinical and Microbiological Profile of Gram-Negative Infections in Critically Ill Diabetic Patients.

Background and aim Type 2 diabetes mellitus (T2DM) is associated with several infections due to hyperglycemia and impaired immunity. This study aims to analyze the clinical and microbiological profile of critically ill T2DM patients with sepsis due to gram-negative bacteria (GNB). Materials and methods A prospective cross-sectional observational study was conducted at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, India, between December 2023 and May 2024, after ethics committee approval. A total of 100 patients (50 T2DM cases and 50 nondiabetic controls), diagnosed with sepsis due to GNB and admitted to the medical ICU, were included in the study. The clinical profile and laboratory investigations of these patients were studied. Cultures were obtained from peripheral/central venous samples, tracheal secretions, and urine samples. Cultures from other specimens, such as ascitic fluid, cerebrospinal fluid, and pus from skin and soft tissue infections, were also obtained. The statistical tests that were applied were two-tailed with a 95% CI, and a p-value of less than 0.05 was considered statistically significant. Results The mean age of critically ill T2DM cases was 60.52 ± 12.88 years. Of the 50 T2DM cases, 28 were males and 22 were females. The most common infection in critically ill T2DM patients was bloodstream infection (n = 21), followed by bronchopneumonia (n = 16) and urinary tract infections (n = 10). Escherichia coli (n = 15) and Klebsiella pneumoniae (n = 15) were the most common gram-negative pathogens isolated. The most common GNB isolated from the blood cultures of critically ill T2DM patients was Acinetobacter spp. (n = 6). The death rate was significantly higher in T2DM patients with GNB sepsis as compared to nondiabetic controls. Conclusion GNBs like E. coli, K. pneumoniae, and Acinetobacter spp. are commonly found in critically ill T2DM patients with sepsis. Bloodstream infection was the most common site of infection in critically ill T2DM cases. Acinetobacter spp. was the most common isolate found in the blood cultures of critically ill T2DM patients. It is important to identify the site of sepsis, isolate the organism, and treat it with appropriate antibiotics promptly in critically ill T2DM patients to improve the outcomes of these patients.

Screening of Intensive Care Unit Patients for the Presence of Carbapenem-resistant Enterobacterales (CRE) on Admission as a Measure of Infection Control

The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has been fostered by the lack of preemptive screening of patients in healthcare facilities that could prevent patient-to-patient transmission. To screen patients admitted to Medical Intensive Care Unit (MICU) for CRE carriage to take appropriate infection control measures. This prospective surveillance study was conducted in the MICU of a tertiary healthcare hospital between September to December 2022. Patients more than 18 years of age admitted to the MICU were included in the study. Patients transferred from different units within the hospital to MICU were excluded. Immediately after admission, two rectal swabs were collected after obtaining consent from the patients. These patients were selected based on the questionnaire framed from the Centers for Disease Control and Prevention (CDC) CRE tool kit. The samples were further analyzed and the antimicrobial susceptibility test was performed. The present study included 91 study subjects of which 53% were males. Of selected participants, 63.7% did not have any specified medical intervention or device placed and 78% had not used antibiotics previously. Of the tested isolates, Of the tested isolates, 12 (13.2%) were observed to be CRE colonized. These isolates were found to be resistant to both imipenem and meropenem. An association was reported between CRE and device placement (p = 0.000) as well as between CRE and previous use of antibiotics (p = 0.000). Current use of antibiotics (p = 0.6381) and gender (p = 0.6066) did not show any association with CRE colonisation. The study concludes that the presence of CRE is an existing danger for patients in ICUs and that there is a possible association between CRE and device placement as well as previous use of antibiotics which can be further studied.

The potential for drug incompatibility and its drivers − A hospital wide retrospective descriptive study

ObjectiveDrug incompatibility, a significant subset of medication errors, threaten patient safety during the medication administration phase. Despite the undeniably high prevalence of drug incompatibility, it is currently poorly understood because previous studies are focused predominantly on intensive care unit (ICU) settings. To enhance patient safety, it is crucial to expand our understanding of this issue from a comprehensive viewpoint. This study aims to investigate the prevalence and mechanism of drug incompatibility by analysing hospital-wide prescription and administration data. MethodsThis retrospective cross-sectional study, conducted at a tertiary academic hospital, included data extracted from the clinical data warehouse of the study institution on patients admitted between January 1, 2021, and May 31, 2021. Potential contacts in drug pairs (PCs) were identified using the study site clinical workflow. Drug incompatibility for each PC was determined by using a commercial drug incompatibility database, the Trissel’s™ 2 Clinical Pharmaceutics Database (Trissel’s 2 database). Drivers of drug incompatibility were identified, based on a descriptive analysis, after which, multivariate logistic regression was conducted to assess the risk factors for experiencing one or more drug incompatibilities during admission. ResultsAmong 30,359 patients (representing 40,061 hospitalisations), 24,270 patients (32,912 hospitalisations) with 764,501 drug prescriptions (1,001,685 IV administrations) were analysed, after checking for eligibility. Based on the rule for determining PCs, 5,813,794 cases of PCs were identified. Among these, 25,108 (0.4 %) cases were incompatible PCs: 391 (1.6 %) PCs occurred during the prescription process and 24,717 (98.4 %) PCs during the administration process. By classifying these results, we identified the following drivers contributing to drug incompatibility: incorrect order factor; incorrect administration factor; and lack of related research. In multivariate analysis, the risk of encountering incompatible PCs was higher for patients who were male, older, with longer lengths of stay, with higher comorbidity, and admitted to medical ICUs. ConclusionsWe comprehensively described the current state of drug incompatibility by analysing hospital-wide drug prescription and administration data. The results showed that drug incompatibility frequently occurs in clinical settings.

Identifying Prevalence and Potential Predictors of Do-Not-Attempt-Resuscitation Orders to Facilitate Preoperative Discussions on Code Status.

Do Not Attempt Resuscitation (DNAR) orders allow patients with life-threatening conditions to decline resuscitation efforts should the need arise. The American Society of Anesthesiologists (ASA) recommends discussions with patients on their code status to clarify and honor their goals of care perioperatively. This project sought to determine the prevalence of DNAR orders and to identify the demographics and potential clinical predictors of DNAR status at the beginning and end of admission, which would help anesthesiologists at our center facilitate these discussions. Factors associated with DNAR status at beginning and at end of hospital stay were determined through univariate logistic regressions. For DNAR status at beginning and end of hospital admission, variables assessed were age at arrival, race, sex, palliative consult, use of palliative care service, length of stay in days, presence of surgery, presence of emergent surgery, care level, and medical service. Approximately 2.4 percent of the sample had an active DNAR order at the beginning of their hospital admission compared to 7.4 percent at the end of hospital admission. Factors significantly associated with DNAR status at the beginning of the hospital stay were consistent with prior literature (age, palliative care consult or service). However, factors significantly associated with DNAR status at the end of hospital stay that were notable included length of stay, undergoing emergent surgery, higher level of care, and being on the oncology service and medical respiratory intensive care unit. This retrospective study allows anesthesiologists at our institution to identify patients who may benefit from a more comprehensive perioperative discussion about code status based on certain clinical characteristics, which may improve quality of care by preventing unwanted resuscitative measures that do not align with a patient's goals of care.

The impact of an animal assisted activity on healthcare worker well-being in the inpatient hospital setting

Chronic stress and burnout experienced by healthcare workers has been exacerbated by the COVID-19 pandemic. Animal-assisted activities, traditionally patient-focused, have the potential to benefit healthcare worker well-being. With limited evidence to support animal assisted activities for healthcare workers within inpatient hospital settings, the purpose of this study was to evaluate the acceptability and impact of an animal assisted activity using therapy dogs on healthcare worker stress, burnout, work engagement, and mood. Using a quasi-experimental, waitlist control design, healthcare workers from paired medical intensive care and medical-surgical units served as intervention and waitlist control groups and were offered the animal assisted activity three times a week for eight weeks. Visits ranged from 20 to 60 minutes. Measures of stress, burnout, and work engagement were measured pre- and post-intervention. Self-reported mood was collected before and after each intervention with participants reporting weekly participation. Intervention acceptability was measured post-intervention. Differences between pre- and post-intervention measures of stress, burnout, work engagement, and mood were assessed with paired and independent samples t-tests; participation and acceptability were measured descriptively. Acceptability of the animal-assisted activity, rated on a scale of 1 to 10, was similar for both intervention (M=8.92; SD=1.256) and waitlist control (M=9.57; SD=.787) groups. Weekly participation for both groups averaged one to two per week. There were no significant improvements in stress, burnout, or work engagement. Self-reported mood increased significantly for the intervention group (p=.05). Our findings suggest that an animal assisted activity, available for healthcare workers within busy inpatient settings, may offer immediate benefits through improved mood. Further research is needed to better understand short and and long-term effects of animal assisted activity on healthcare worker, patient, and organizational outcomes.

Evaluating the Diagnostic Performance of Nasal Methicillin-Resistant Staphylococcus aureus Polymerase Chain Reaction in Hospital-Acquired Pneumonia Within the Intensive Care Unit. A Retrospective Study.

Background: The methicillin-resistant Staphylococcus aureus (MRSA) accounts for 20% to 40% of all hospital-acquired pneumonia (HAP) cases with mortality rates up to 55%. Prompt and accurate diagnosis is essential, especially in intensive care unit (ICU) patients. Nasal MRSA polymerase chain reaction (PCR) diagnostic utility evidence is conflicting in the literature for HAP due to a low number of HAP patients included in prior studies or due to the lack of high-yield gold standard cultures defined for comparisons. Methods: This was a retrospective cohort study conducted in a 65-bed medical ICU, and encompassing all adult patients admitted from January 2015 to March 2023 for HAP. Respiratory cultures included were those obtained by bronchoalveolar lavage or endotracheal suction within 7 days of nasal MRSA PCR testing. Results: The study included 412 patients; 56.8% were males and 65% were Whites. The mean age was 60.5 years. Most patients (82.5%) underwent MRSA-PCR before intubation, and the average time between MRSA-PCR and lower respiratory cultures was 2.15 days. The diagnostic performance of nasal MRSA PCR in diagnosing HAP in the ICU yielded a sensitivity (Sen) of 47.83%, specificity (Sp) of 92.29%, positive predictive value (PPV) of 26.83%, and negative predictive value (NPV) of 96.77%. For nonventilator HAP (nv-HAP) cases sensitivity was at 50%, specificity 92.83%, PPV 28.57%, and NPV at 97.00%. In ventilator-acquired pneumonia (VAP-HAP), the corresponding values were 42.86%, 90.91%, 23.08%, and 96.15%, respectively. Conclusion: The nasal MRSA PCR shows a high NPV and low false negative rate, suggesting it is a reliable tool for ruling out MRSA HAP in ICU patients. Care should be taken into account for disease prevalence and clinical context, as these factors may influence test performance. Further validation through prospective large-sample studies utilizing high-yield lower respiratory tract cultures is necessary to confirm our findings.

Effect of Nutritional Support on Energy Balance and Its Clinical Outcome in ICU [Intensive Care Unit] Patients

Critical care is the specialized treatment provided to patients in intensive care units who are severely ill and need extensive care and close monitoring. Hence the present study was undertaken. A total of hundred samples were collected exclusively on those who stayed a minimum of five days in Intensive Care Unit from two reputed Multispecialty Tertiary Hospitals from Kerala, India. APACHE II scoring system, Day World Wide’s ICU Questionnaire and Glasgow Coma Scale were adopted to collect patient’s data such as personal details, demographic data, medical history, bio-physical parameters, bio- chemical parameters, feeding techniques, time of feeding and nutritional requirements. Admission to Medical ICU were about 43% with respiratory failure, sepsis and other infections, 22% were admitted with neurological diseases and 35% were nephrology patient. It is evident that about 79% were suffering from anorexia. Comparing the administration of exclusive commercial feed to commercial plus kitchen feed, it was observed that patients fed with the latter experienced increased abdominal pain (21%) and vomiting (17%). Diarrhea was more common in patients fed with commercial formula (12%), while constipation was higher in patients fed with kitchen feed (19%). There is no conclusive evidence favoring either exclusive commercial feed or kitchen plus commercial feed. A small percentage (7%) of patients had a mortality rate exceeding 80%. Positive outcomes were observed in critically ill patients through the enteral feeding system, with no significant difference between exclusive commercial feed and kitchen plus commercial feed.

A Review of Current Evidence for the Use of Steroids in the Medical Intensive Care Unit.

Systemic steroids are frequently used in critically ill patients for their anti-inflammatory properties. Potential benefits of these agents should be balanced against their known side effects. In this paper, we review trials assessing the use of systemic steroids in common conditions requiring admission to the intensive care unit. These include septic shock, the acute respiratory distress syndrome, severe pneumonia, COVID-19, and hypercapnic respiratory failure due to chronic obstructive pulmonary disease. We will mainly focus on well-conducted randomized controlled trials to determine whether steroids should be administered to critically ill patients presenting with these conditions.

Clinical outcomes of patients with in-hospital witnessed cardiac arrest: effect of co-morbidities

IntroductionCardiopulmonary resuscitation (CPR) is frequently performed in hospitalized patients after in-hospital cardiac arrest (IHCA), especially in the intensive care unit (ICU) (J Crit Care 24:408-414, 2009). Despite the fact that nearly half of the in-hospital cardiac arrests (IHCA) actually happen in intensive care units (ICUs) (N Engl J Med 367:1912-1920, 2012), intensive care unit cardiac arrest (ICU-CA) compared to IHCA or out-of-hospital cardiac arrests (OHCA) has received little attention, and data on ICU-CA remains scanty (Intensive Care Med 40:1853-1916, 2014).AimWe aimed to evaluate the clinical status and factors associated with the survival of patients subjected to cardiopulmonary resuscitation (CPR) after a witnessed cardiac arrest (CA) inside the medical intensive care unit (MICU).PatientsThe study included 110 patients, mean age of 60 ± 18 years, 69 (63%) males, and 41 (37%) females. Co-morbidities included diabetes mellitus was present in 46 (42%), hypertension 57 (52%), central nervous system (CNS) disease 31 (29%), cardiovascular (CVS) 76 (69%), respiratory 63 (57%), hepatic 16 (15%), shock 35 (32%), and renal 44 (40%). Mechanical ventilation was present in 97 (88%) of patients. SOFA score < 9 was present in 38%, MPM III score < 10 in 37%, and GCS > 7 in 66% of patients. Non-shockable rhythm occurred in 95 (86%) while shockable rhythm in 15 (14%) of patients.MethodsData were collected prospectively at the medical ICU of Cairo University from Jan. 2013 to Feb 2013. A resuscitation protocol was done according to the latest recommendation of the European Society of Cardiology at the time of patient inclusion. Clinical data were recorded and surviving patients were clinically followed daily until hospital discharge.ResultsOut of 110 witnessed cardiac arrests, CPR was initially successfully manifested by return of spontaneous circulation (ROSC) in 60 patients (55%), of whom 22 (20%) survived hospital discharge and only 9 patients (8%) were functionally independent. Compared to non-survivors, 60 patients (55%) with ROSC had a MPM III < 10 (p 0.015), EF ≥ 50% (p 0.001), and non-shocked patients (p 0.008). Other factors such as DC shocks < 3 (p 0.02), CPR cycles < 2 (p < 0.001), resuscitation duration < 10 min (p 0.03), time to start CPR < 1 min (p 0.001), maintained HCO3 (p 0.03), and PaCO2 (p 0.002) were found to improve ROSC. Mortality before discharge decreased with asystole (p < 0.01). Mortality before discharge increased with CNS (p < 0.02) and respiratory comorbidities (p 0.02), shock (p < 0.001) and mechanical ventilation (p < 0.0001), SOFA > 9 (p 0.001), MPM III > 10 (0.018), and time to start CPR > 1 min (p 0.001).ConclusionNot all ROSC reached long-term survival and hospital discharge. Several co-morbidities affect ROSC and short-term and long-term patient survival after witnessed MICU cardiac arrest.

Study on Clinical Profile and Treatment Outcome of Acute Paraquat Poisoning in an Intensive Care Unit in Bangladesh

Background: Paraquat, one of the most widely used herbicides, is a major cause of self-harm related death in Bangladesh resulting from multiple organ failure. The primary objective aimed to identify the demographic &amp; clinical characteristics of paraquat poisoning and the outcome of different treatment modalities. Materials and Methods: A prospective observational study was conducted over twenty-four months at the Intensive Care Unit of Dhaka Medical College Hospital, a tertiary care referral hospital.Between March 2022 and March 2024, patients presenting with acute paraquat toxicity who fulfilled inclusion and exclusion criteriawere selected by purposive sampling. A total of 42 patients were enrolled in the study.Demographic, clinical, and treatment particulars were collected. The study evaluated the outcomes, including length of stay in the intensive care unit (ICU), the need for mechanical ventilation&amp;hemodialysisandin-hospital mortality. SPSS version 25.0 was used for statistical analysis and reporting. Results: Among the patients, 54.8% were men with a median age of 23.31 years residing in rural areas (85.7%). All cases were suicidal, primarily due to family disputes (40.5%) and personal relationship issues (21.4%). Symptoms included shortness of breath (40.5%), disorientation (28.6%), difficulty in swallowing (14.3%), vomiting (9.5%), and low urine output (7.1%). Most ICU admissions occurred after 24 hours postingestion (59.5%). Organ involvement included acute kidney injury (57.14%), acute respiratory distress syndrome (50%), hepatic impairment (14.3%), pulmonary fibrosis (14.3%), and septic shock (2.4%). Methylprednisolone was administered to 21 patients (50%), with an equal number also receiving methylprednisolone plus cyclophosphamide (50%). Only 10 (23.80%) patients received gastric lavage.The median ICU stay was 6 days (IQR 4-9), while the Median hospital stay was 8 days (IQR 1-12). In-hospital mortality was high, and 41 out of 42 patients (97.8%) died. Conclusion: The rural population is mostly affected by paraquat poisoning for its easy availability,and clinical presentations, particularly pulmonary, renal and multi-systeminvolvement, are significantly associated with high mortality with the limited role of different treatment approaches. J MEDICINE 2024; 25: 129-135